Health Services Management Centre and the Nuffield Trust

Chair: Dr Helen Dickinson Morning sessions Setting priorities in health: findings from the HSMC /

Nuffield project Presenter: Dr Suzanne Robinson, HSMC

Priority setting under the new commissioning arrangements – implications for health and social care

Presenter: Dr Judith Smith, Head of Policy the Nuffield Trust

Priority setting under the new commissioning arrangements – wider group discussion

What would you like to get out of the day?

What areas are you interested in exploring?

What would you like to learn more about?

Define priority setting

Define Rationing

Smokers who do not commit to undergoing cessation treatment should receive lower priority in the allocation of expensive surgical procedures (e.g. heart and cancer).

The National Institute for Clinical Excellence has recommended that trastuzumab be available for women with HER2 positive advanced breast cancer.

The PCT priority setting board recently scored a number of business proposals and made a decision to fund the following treatments/services) over the next 12 months:

A new diabetes clinic at a local hospital;

A stop smoking cessation programme;

Cardiac rehabilitation clinic Expansion of EOL services.

A care home for older people is due to be closed on the grounds that it is providing poor quality care and is potentially unsafe.

A primary care trust has agreed to suspend funding IVF treatment for most patients as part of measures to save millions of pounds by next March.

Working definition of Priority setting and rationing

“Priority setting describes decisions about the allocation of resources between the competing claims of different services, different patient groups or different elements of care. Rationing, in turn, describes the effect of those decisions on individual patients, that is,

the extent to which patients receive less than the best possible treatment as a result” (Klein 2010:389).

In combination, priority setting and rationing can be understood as the processes by which services that may be of benefit to users are withheld on grounds which include cost.

NHS

Funding: relatively simple – general taxation, free at the point of use- set price activity based funding-

Accessing: committed to delivering a comprehensive service, accessed without charge at the point of deliver

Resource allocation: EBA model dominant one lots of tools and processes set up around population based PS

less development of prescriptive methodology- population based models are less feasible in social care

Political context: national institution held in high regard and subject to government control and reform

SOCIAL CARE

Funding: means testing, co-payments and devolvement of budgets to service users -set user charges at varying levels

Accessing: NBA- can deny care to those with lower need and/or set different levels of user charges in different localities

Resource allocation: less development of prescriptive methodology- population based models are less feasible

Political context: more local control, locally elected representatives and r little routine interference from central government Rationing and variations in patterns of

service delivery are more socially acceptable – and thus decisions to reduce or deny care are politically more acceptable – although still controversial