1. Priority setting in context
Author: Dr Benedict Rumbold
May 2011 © Nuffield Trust

2. Priority setting as allocation and arbitration
• Priority setting is about managing scarce
resources.
• Since it is not possible to provide all the health
care for everyone who could benefit from it, one
needs to balance the claims of different parties
to the same pot of money.
• Claims may be based on prospective users
capacity to benefit, the severity of their illness,
their proximity to death (as in the rule of rescue),
their age, brute bad luck (as opposed to
personal responsibility for their condition) etc.
• Criteria, and their relative weights are heavily
debated. © Getty Images
May 2011 © Nuffield Trust

3. Different levels of Priority Setting
A top-down system?
• Macro-level: NICE (e.g. HTAs); Government
performance management and policy
– ‘must-dos’ (e.g. National Service
Frameworks, Vital Signs); Ministerial
intervention (e.g. Hewitt and
Herceptin)
• Meso-level: PCTs - Core spend; allocation of new
monies/decommissioning at the
margin; exceptional treatment
requests
• Micro-level: Clinical judgments (e.g. GPs as gate
keepers, triage)
May 2011 © Nuffield Trust

4. The New Landscape
A bottom-up system?
• Macro-level: NICE?; the NHS Commissioning
Board?; Monitor? Government
performance management and
policy? Ministerial intervention?
• Meso-level: GP Consortia - Core spend;
allocation of new monies/
decommissioning at the margin;
exceptional treatment requests
• Micro-level: Clinical judgments (e.g. GPs as
gatekeepers, triage)
May 2011 © Nuffield Trust

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May 2011 © Nuffield Trust