1. Suzanne Robinson and Iestyn Williams
Health Services Management Centre
University of Birmingham

2. 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

3. 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?

4. 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

5. 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 Morebeck Donative Nethersole Chetwynd Chatterton
definitions of these different activities)
Overall budget allocation (core budget
spend)
✔ ✔
New resource allocation ✔ ✔ ✔
Reprioritising across budget areas ✔ ✔
Disease care pathway redesign ✔ ✔
Disinvestment /decommissioning of existing
service provision ✔ ✔

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

15. Stakeholder engagement Local commissioning bodies: Have a responsibility and
Need to happen early on in the priority-setting duty to work with other stakeholders in all aspects of
work. Close, joined-up working with stakeholders priority setting, from development of strategy and
from across the health economy, This needs to be processes through to implementing decisions
a top-down and bottom-up process, encouraged by NHS CB: support and encourage more joined-up
the centre and managed and delivered locally working
DH: Health and social care policies need to incentive
stakeholder involvement in priority setting
Leadership and management Local commissioning bodies: Identify effective leaders
Strong clinical and ‘lay’ leadership and across and within organisations who can ‘champion’
management within and across organisations – a and influence priority setting. Gain specialist support in
need to ensure sufficient and transformational enhancing OD & leadership skills
leadership to drive the process and implement the NHS CB/ DH: Support and encourage a strong focus on
outcomes with the engagement of those in middle OD and leadership development, that will help to
management and front-line positions nurture and develop focus on the softer skills around
leadership and management of individuals and
organisations

16. Any Questions?