Suzanne Robinson and Iestyn WilliamsHealth Services Management Centre

University of Birmingham

Aims of session Brief outline of priority setting research conducted

by Health Services Management Centre, University of Birmingham and The Nuffield Trust

Headline results inc: What is continuing in priority setting What is new in priority setting Making sense of findings going forward

Current research into PCT priority setting

University of Birmingham and Nuffield Trust study One of the first studies to have looked at PS activity

nationally The research questions that provide the basis for the research

are: What priority setting tools, processes and activities are

currently practiced as part of the commissioning processes of English PCTs?

What barriers are experienced by PCTs seeking to implement explicit priority setting and how are these being addressed?

What other strengths and weaknesses can be identified in current priority setting practice?

What lessons and learning can we derive that will be instructive for future priority setting within the NHS and elsewhere?

Research into PCT priority setting Aim to map and explore current priority setting

activities in English PCTs Survey- to all 152 PCTs (response rate 80/152 PCTS

in England (53%) ) 5 in-depth case studies Published report coming soon

Case studies

Table 1 Priority setting activity at the case study sites

Type of priority setting activities Wave one sites Wave Two sites

(Appendix 1 provides more detailed definitions of these different activities)

Morebeck Donative Nethersole Chetwynd Chatterton

Overall budget allocation (core budget spend) ✔ ✔ New resource allocation ✔ ✔ ✔ Reprioritising across budget areas ✔ ✔ Disease care pathway redesign ✔ ✔ Disinvestment /decommissioning of existing service provision ✔ ✔

Local priority setting continues to….

Be a difficult and challenging business Often happens at the margins (tinkering around the

edges) Be difficult in terms of decommissioning services- ‘easier

to invest than disinvest in services’ Focus on technical aspects and processes Be very political (P) (p) Be difficult in terms of implementation of decisions Require strong leadership and motivation

What’s new (developing) in local priority setting Attempts to take a more explicit approach – gov’t policy

through WCC has been one of the drivers for this Development of tools and techniques to aid PS Technical process can be an active part in PS – appeal to

stakeholders and help with engagement Understanding of evidence and what relevant evidence is

available locally Work around disinvestment is also becoming more

important and prominent in some areas Lots of good practice examples and work around PS and

investment

What works: drivers for success

Positive impact of a system wide approach – ‘PS is everyone's business!’

Shared decision making engagement with relevant stakeholders

Some commissioners are engaging with other stakeholders- taking health economy approach

Providing incentives to help with change and implementation of PS decisions

What works: drivers for success Strong leadership being able to negotiate the difficult

political and cultural aspects of health care Strong clinical engagement and leadership Motivation and engagement of middle managers and

front line staff Governance structures Once decision is made having a manager/s who lead

and implement the chance

Barriers to success Power of PCT – relative power in balance within health

economies – PCTs not having sufficient levers to instigate change National political arena does not specifically support

prioritisation and rationing of services Incentives of other polices - such as PBR, pressure of

‘must dos’ Lack of strong evidence base and capability and skill to

analyse and interpret evidence Lack of focus on non-technical aspects (governance,

engagement, organisational power , politics & culture Lack of strong and effective leadership

Making sense of and taking the learning forward

‘There are many ways of going forward, but only one way of

standing still.’Franklin D. Roosevelt

What needs to happen in the future… National support for priority setting-and in-particular

around disinvestment/decommissioning Priority setting needs to be engrained in the core

business and strategy of organisations – Develop structured explicit decision-making and

priority-setting processes which provide a forum for difficult decision-making

Draw on and develop existing economic and managerial tools to aid the priority-setting

Develop managerial and leadership skills that can develop and drive the process and implement the decision outcomes

Stakeholder engagement Need to happen early on in the priority-setting work. Close, joined-up working with stakeholders from across the health economy, This needs to be a top-down and bottom-up process, encouraged by the centre and managed and delivered locally

Local commissioning bodies: Have a responsibility and duty to work with other stakeholders in all aspects of priority setting, from development of strategy and processes through to implementing decisions NHS CB: support and encourage more joined-up working DH: Health and social care policies need to incentive stakeholder involvement in priority setting

Leadership and management Strong clinical and ‘lay’ leadership and management within and across organisations – a need to ensure sufficient and transformational leadership to drive the process and implement the outcomes with the engagement of those in middle management and front-line positions

Local commissioning bodies: Identify effective leaders across and within organisations who can ‘champion’ and influence priority setting. Gain specialist support in enhancing OD & leadership skills NHS CB/ DH: Support and encourage a strong focus on OD and leadership development, that will help to nurture and develop focus on the softer skills around leadership and management of individuals and organisations

Any Questions?