Shifting the Gravity of Spending? Priority-setting for local authority public health commissioners

Transcription

1 Shifting the Gravity of Spending? Priority-setting for local authority public health commissioners Presented by David Hunter Professor of Health Policy and Management 8 th September 2016 NIHR School for Public Health Research This is an outline of independent research funded by the NIHR. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

2 The NIHR School for Public Health Research (NIHR SPHR) is a partnership between: The University of Sheffield The University of Bristol The University of Cambridge University College London The London School for Hygiene and Tropical Medicine The University of Exeter Medical School The LiLaC collaboration between the Universities of Liverpool and Lancaster Fuse; The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities

3 The Team David Hunter (PI), Linda Marks, Jean Brown, Durham University Luke Vale, Sara McCafferty, Newcastle University Jo Gray, Northumbria University Sarah Salway, Nick Payne, Praveen Thokala, Sheffield University Stephen Peckham, University of Kent

4 The Study Funding: NIHR School for Public Health Research Main study: November 2012-August 2015 Follow on study: September 2015-August 2016 Methods: 3 local authority case studies (main study) 3 days of prioritisation support per case study site 3 local authority case studies (follow on study)

5 Research Questions Which prioritisation tools do LA commissioners find useful for prioritising public health investment and why? What are the enablers and barriers for decision-making related to prioritising investment in public health? What difference does the use of specific decision-making support exert on spending within and across programmes with reference to improving health and addressing health inequalities?

6 Influences on Priorities for Investment Organisational context where a broader conception of health exists not just about health care and where accountability is to a local electorate Commissioning and priority-setting context located within broader local authority decision-making processes Differing views over what counts as evidence and role of knowledge Debates over what constitutes a public health intervention

7 Organisational Context There aren t many services within a local authority that don t have an impact on public health, either positively or in some cases negatively. Public Health

8 Commissioning and Priority- setting Context Well I would be very pleased if we could use some of these [prioritisation] tools, but the reality is that in practice it s just not possible to, because at the end of the day it s elected members who make decisions about where money is spent. Public Health

9 This very exercise, this sanitised academic process of prioritisation...this pseudo-scientific rigorous prioritisation process is completely inappropriate for a local authority. We have to embed ourselves into the culture of the council which is all about politics. It s all about aligning politicians, of selling them what you need to sell them. Public Health

10 I think this kind of prioritisation approach is really, really useful when your decisions are likely to come under significant challenge. Local Authority

11 So long as you don t apply them too mechanistically I think these sorts of tools give you some really good questions to ask about priorities and it allows you to start to rank them in order. CCG

12 What Counts as Evidence I guess there ll be lots of evidence about various things out there that would help support decisionmaking. A lot of the time the decision-making mechanism is between the officer and cabinet member. It s about the priorities that the cabinet member might see that we need to deal with that would shape where we spend the money. Elected Member

13 There s different ways of collecting evidence and seeing evidence and evidence appearing. So members see a lot of what they would call evidence on the ground in their communities about what might be a public health issue. And they would see that as a priority. Elected Member

14 What Constitutes a Public Health Intervention Previously we had a lot of influence over a relatively narrow set of uses of the budgets and approaches to public health, and now we have less influence but over a wider range of things. Local Authority

15 One of the great joys of public health coming to the local authority is we can have a bigger focus on the preventative agenda, and that s what this has really been all about. Cabinet Member

16 Highlights from the Main and Follow on Studies Variable approaches to priority-setting approaches and tools from methodical to discussion and reaching agreement Tension between encouragement of uptake of prioritisation tools and their perceived value Preference for fast and frugal keep it simple Different views of evidence between public health and elected members Desire for system-wide approaches with more sharing of priorities and budgets

17 For further information please visit our website: thegravity