Friday, September 30, 2011

[EQ] Setting priorities in health

Setting priorities in health

A study of English primary care trusts

Research report: Suzanne Robinson, Helen Dickinson, Iestyn Williams, Tim Freeman, Benedict Rumbold and Katie Spence

Health Services Management Centre, University of Birmingham and the Nuffield Trust

September 2011

Available online PDF [84p] at:

The research reported in this document was designed to map the priority-setting activities taking place across the National Health Service (NHS) in England, and to explore and assess the effectiveness of these practices within specific local contexts.

The questions that provided the basis for the research were as follows:

• What priority-setting tools, processes and activities are practised currently as part of the commissioning processes of English primary care trusts (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 learning can be derived that will be instructive for future priority setting within the NHS and elsewhere?


Key messages from the research

1. Background and context

Understanding priority setting

Priority setting and commissioning

The challenges facing priority-setters

Research on local priority setting in England

Research scope and aims

2. Methodology

Stage 1: National survey

Stage 2: In-depth case studies

Data collection

Data analysis and reporting

Setting priorities in health: a study of English primary care trusts

3. Priority setting: the national picture

Developments in local priority-setting processes

Remit and scope of priority-setting arrangements

Stakeholder involvement in decision making

Use of evidence and decision tools

Use of decision tools in priority setting

Strengths and weaknesses of priority-setting processes

Disinvestment decisions

4. In-depth exploration of priority setting

Rationale for forming priority-setting processes

Key features of the case study priority-setting processes

Formal decision criteria

Decision processes

Role of discussion and deliberation

Technocratic approaches to aid priority setting: the evidence-based approach

Stakeholder involvement in priority setting

Engagement and involvement of health and social care organisations

Engagement and involvement of the public and patients



Overall coherence and ‘success’ of priority-setting processes

Response to the White Paper: the impact of government reforms on priority setting

5. Discussion

Decision tools

Outcomes of priority-setting work

Non-technical dimensions of priority setting

Engaging stakeholders and the public

Political dimensions of priority setting


Information resources and expertise

Impact of government reforms on priority setting

6. Conclusions and recommendations

Key policy drivers


Technical challenges

System-wide approach to priority-setting

Political realities





Appendix: Different types of priority-setting activity to be considered



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