Deciding priorities

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Given a list of desirable actions, and using best evidence (including for cost effectiveness), commissioning organisations must agree their priorities for purchase, using a robust ethical framework.

Tips on searching the web:

When searching the internet, suggested terms include…

  • “priority setting” OR prioritising OR ((decide OR deciding OR decision) AND priorit*)
  • To limit to NHS papers, try combining your results with: (ccg OR nhs). To look for CCG publications add the following to your google search:  site: (note the space before the CCG.)
  • You can search for terms such as “board paper” / “strategy” to help to locate Trust papers

Also have a look at our summary of tips on searching the web.

List of contents

QIPP Right Care

Much of the recent work around prioritisation was part of the QIPP Right Care programme – a QIPP workstream focussed on increasing value for patients and commissioners. The programme had five workstreams including Programme Budgeting and Better Value Clinical Practice. From April 2013, Right Care transitioned four main modules to new host sponsors as summarised.

Commissioning for Value is a collaboration between NHS Right Care, NHS England and Public Health England about identifying priority programmes which offer the best opportunities to improve healthcare for CCG populations.

  • Commissioning for Value packs  were sent to all CCGs (Nov 2013) for use by the local health community and its partners, GP commissioners and leaders and CCG Senior Management Teams and Health and Wellbeing Boards. They provide localised information to support local discussion about prioritisation and utilisation of resources.
  • PHE have also published a Commissioning for Value Focus pack covering Cardiovascular Disease for each of the 211 CCGs in England.
  • Commissioning for Value: A Reading List produced by QIPP Right Care August 2012. Based on a literature search by Nicola Pearce-Smith, and includes tools and publications around how to commission for maximum value from the available resources.

Health Investment Network
Part of QIPP Right Care, established to help commissioners improve their ability to achieve the best health outcomes from every pound invested. A collection of e-guides, tools , resources and case studies. (Register for updates)

Prioritise investment

Priority setting – A set of briefings from the NHS Confederation (2007/8) on priority setting including an overview, strategic planning, legal considerations, managing individual funding requests and managing new treatments.

Commissioning with the Community
A Health Foundation report exploring how the Isle of Wight use value for money (VfM) approach to set local priorities.

Setting priorities in health: The challenge of clinical commissioning
A national study by the Nuffield Trust into how PCTs have prioritised NHS resources highlights the strengths and weaknesses of their processes and the lessons for the coming generation of clinical commissioners, mapping the activities taking place across the NHS and explores the effectiveness of these practices within specific local contexts. Also see report in Social Science & Medicine (September 2012).

Priority-setting and rationing in health care: evidence from the English experience
Social Science & Medicine, online 20 Sept 2012
Report of a qualitative research study which investigated local priority-setting activity across five English PCTs, March to November 2012. Respondents considered priority-setting processes to be compartmentalised and peripheral to resource planning and allocation. Further progress was required with regard to disinvestment and service redesign with respondents noting difficulty in implementing decisions. Includes an overview of processes and decision analysis tools in use at the case study sites.  Abstract:  (Not available through NHS Athens)

Prioritise Commissioning Opportunities
A simple but robust planning process from the NHS Institute to help PCTs make decisions quickly and effectively. It is supported by the NHS Better Care, Better Value Indicators incorporating Opportunity Locator.

N.B.The NHS Institute closed on 31 March 2013. The website is being maintained in the short term so that registered users can download documents. A number of key resources will transfer to the NHS Improving Quality’s website. Once the website is closed all publicly available content will available on The National Archives website.

Better Care Better Value indicators identify potential areas for improvement in efficiency which may include commissioners re-designing and shifting services away from the traditional setting of the hospital and out towards community based care.

The BCBV dashboard is based around high-level indicators that identify potential areas for improvement in efficiency.

  • Opportunity locator provides an insight into those areas with the greatest potential for services to be shifted into the community.
  • The Priority selector allows a wide range of views to be quickly collated to identify the key change projects and secure ownership of their delivery. (Registration required

A guide to Social Return on Investment, Cabinet Office 2009.
This guide aims to show organisations and institutions to make better decisions using Social Return on Investment (SROI) principles, helping them to recognise value beyond what can be easily captured by financial measurement.

Analysis of variation

CCG Spend and Outcome Tool (SPOT)– a quadrant analysis tool using Programme Budgeting methodology that graphically illustrates where CCGs stand, compared to similar CCG populations, on the health outcomes achieved for health spend.

NHS Atlas of Variation in Healthcare   (Right Care)
A series of interactive maps of variation across PCTs to stimulate a search for un-warranted variation in the utilization of health care services that cannot be explained by variation in patient or patient preferences. There is also a series of Right Care themed atlases  focusing on specific conditions or populations : Children and Young People; DiabetesKidney Disease;  Respiratory Disease, Liver disease, diagnostic services

Commissioning for Health Improvement: Using programme budgeting and marginal analysis to deliver quality, innovation productivity and prevention:  The Third Annual Population Review (Right Care 2011 )
An description of the use of  Programme budgeting, and marginal analysis to support priority setting.

Health Investment Packs (QIPP Right Care)
HIPs use the outputs from analysis tools already available to PCTs to analyse variation in spend, outcomes and activity growth by programme budget category for that PCT. The analysis tools include: the Programme Budgeting spreadsheet; SPOT (Spend and Outcome Tool), Programme Budgeting Atlases, NHS Comparators, and IVET (Inpatient Variation expenditure Tool). Most recent packs compiled July 2010

Cost effectiveness / value for money

Health economic resources to help decision making when investing in prevention and early intervention from PHE.

Value for money – Health Foundation Research Scan – Research selected by the Health Foundation.  Search the archive or sign up for monthly email updates.

Money well spent – assessing the cost effectiveness and return on investment of public health investments LGA,  November 2013
This briefing for councillors and officers explains the importance of assessing value for money in helping local authorities fulfil their public health responsibilities.

Star – socio-technical allocation of resources –  a new approach to priority setting from Health Foundation and LSE, to help commissioners and those planning services to allocate their health resources to benefit patients in their community. The Star approach combines value for money analysis with stakeholder engagement, where an Excel-based tool is used alongside a facilitated stakeholder workshop.

Value for Money Tools from the National Social Marketing Centre
A suite of online tools which to help practitioners and commissioners calculate the value for money of their social marketing and behaviour change programmes. The tools are downloadable and are developed in Excel, so they can be personalised by local teams to reflect local issues, audiences and costs (registration required). Tools available on Tobacco control, Breastfeeding, Obesity, Bowel cancer & Alcohol: Intervention.

Health England Leading Prioritisation (HELP)
Matrix Knowledge Group (Sept 2009)
H.E.L.P. provides information on the cost-effectiveness, impact on health inequalities, and reach of interventions to support the prioritisation of investments in preventative health care. It allows commissioners to access evidence on existing preventative health care interventions and to benchmark new interventions against existing care.  See the Final report 

Commissioning with the Community
A report from the Health Foundation (2010) exploring how the Isle of Wight used value for money analysis with stakeholder engagement to set local priorities.

Measuring value for money in healthcare; concepts and tools
Health Foundation, 2009
A description of various concepts of value for money in common use, how measures of value for money are constructed, and the challenges inherent in measuring value for money.

Over 150 potentially low-value health care practices: an Australian study. Med J Aust. 2012 Nov 19;197(10):556-60.

See the PubMed RSS feed on Unnecessary procedures

CASE STUDY – Librarians involvement in reducing the cost of compression stockings – that reduce the risk of DVT
The Clinical Librarian and Lead Research Nurse at the Whittington Hospital critically appraised the evidence for the relative effectiveness of compression stockings above and below the knee. The adoption of a policy to use knee-length stockings saved c£90,000.

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