Health economics resource list from PHE

Health economics resource list
Health Matters, PHE 23 August
Policy

• HM Treasury’s ‘The Green Book: appraisal and evaluation in central government’

Data

• PHE’s ‘Health Profile for England’

Guidance

• The PHE Prioritisation Framework: making the most of your budget 
• PHE ‘Health economics: a guide for public health teams’ 
• ‘Health Economics and Prioritisation in Public Health’

Tools

• Communities and Local Government’s ‘Multi-criteria analysis: a manual’
• PHE’s ‘Spend and outcome tool (SPOT)’
• PHE’s ‘Public Health Outcomes Framework’
• PHE’s ‘Health economics: evidence resource’
• PHE’s ‘Health economics: a guide for public health teams’

HSJ interview with Simon Stevens around 10 year NHS plan and changing funding rules

Stevens sets out 10 year plan priorities
HSJ 18 July 2018

• During an interview with HSJ Simon Stevens identified five major priorities for the 10 year NHS plan due to be unveiled this autumn.

1. mental health, especially services for children and young people, and potentially "core crisis care”. 
2. cancer, in particular screening services and addressing race and socioeconomic and gender and cultural barriers that exist to early diagnosis
3. cardiovascular disease – stroke and heart attacks
4. children’s services in particular prevention and inequality as they affect children.
5. reducing health inequalities 

• As part of the funding deal and long term plan, the prime minister announced a review of NHS waiting time targets.

Stevens promises ‘wholesale shift’ in funding rules
HSJ 18 July 2018

• During an interview with HSJ Simon Stevens discussed future changes to NHS funding rules and suggested that "Over the course of the next three years we’re going to see a wholesale shift.”
• A plan covering the financial years from 2019-20 to 2021-22 is being developed with NHS Improvement and in discussion with the NHS and will be set out at the end of September, then confirmed in November.
• Sustainability funding would be ended at the latest by the end of the three year period
• According to HSJ the funding plan in late September is likely to include three years of firm CCG  allocations and two years indicatively.

Priorities for health and social care from Kings Fund

What are the priorities for health and social care?
Kings Fund 8 August 2017

• The King's Fund has assessed the state of health and social care and set out the big issues facing the government under the headings of  NHS finance and performance, NHS reform and social care.

2016-17 Thames Valley SCN Commissioning Guidance

2016-17 Thames Valley SCN Commissioning Guidance
TV Strategic Clinical Network

• Annual Commissioning Guidance bringing national priorities and thought leadership to the local context, benchmarking systems and providing recommendations for action. Not only ‘what to do’ but also ‘how to do it’ with best practice examples and sources of help.
• Guidance across all clinical specialities, including cardiovascular, cancer, maternity, mental health LTCs, end of life care and prevention.
• http://commissioninguidance.tvscn.nhs.uk/

Making difficult decisions

Making difficult decisions: Commissioning healthcare in changing times
NHS Clinical Commissioners, University of Birmingham 28 September 2016

• This report sets out factors that can enable CCGs to successfully command the confidence of the public, patients, local politicians and other key stakeholders when making changes.
• It contains top tips drawn from academic research and additional insight from those interviewed during the report, including commissioners, patient groups and NHS England. These are:
• Identify opportunities for improvement and safe and cost-effective change in service provision.
• Plan the change management process in advance.
• Base decision-making on robust data where available.
• Manage stakeholder perceptions through active engagement, consultation and nurturing trustworthy relationships.
• Recognise that local community, clinician and political support is vital, and engage these interests early.
• Develop an integrated communication and engagement strategy from the start

Commissioning self management support - aspiration and reality

Commissioning of self-management support for people with long-term conditions: an exploration of commissioning aspirations and processes.
BMJ Open. 2016 Jul 15;6(7):e010853.

• Based on nine CCGs from the south of England, this research examines how self management support is delivered, from plans and aspirations to translation into commissioned services.
• The research was based on content analysis of CCG forward plans for mention of self management support, semistructured interviews with commissioners (n=10) and observations of governing body meetings.
• Despite the rhetoric of ensuring services are designed around patients' needs, the research found that patients and the public were not engaged in commissioning in meaningful ways and their voice was, almost entirely, absent.
• This study highlights where CCG aspirations and operationalisation do not align, and draws attention to where intentions are not being put into practice—effective self management support which is developed from the bottom-up.
• The research notes tensions between national NHS England guidance and local aspirations. While commissioners say that self management support is a priority, details of local initiatives were notably absent with austerity (cost-containment) and nationally measured biomedical outcomes taking precedence.

Using variation to identify opportunities for disinvestment

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study.
Health Serv Deliv Res 2015;3(13)

• There is large inter-PCT variability in procedure rates for common NHS procedures. Variation is highest where the diffusion or discontinuance is rapidly evolving and where substitute procedures were available, suggesting that variation may be a proxy for clinical uncertainty about appropriate use. 
• Using data from two PCTs the researches examined opportunities and barriers for disinvestment. 
• Evidence to support commissioning decisions was limited. 
• Commissioning meetings were dominated by new funding requests and benchmarking did not appear to be routinely carried out because of capacity issues and concerns about data reliability. 
• Perceived barriers to disinvestment included lack of collaboration, central support and tools for disinvestment. 
• Clinicians felt threshold criteria had little impact on their practice and that prior approval systems would not be cost-effective. 

NHS England Business Plan 2015/16

NHS England Business Plan 2015/16
NHS England 27 March 2015

• The plan sets out ten priorities to improve quality and access to services for patients, drive better value for money and to build the foundations for the future health and care system.
• The ten priorities are:
• Improving the quality of care and access to cancer treatment
• Upgrading the quality of care and access to mental health and dementia services
• Transforming care for people with learning disabilities
• Tackling obesity and preventing diabetes
• Redesigning urgent and emergency care services
• Strengthening primary care services
• Timely access to high quality elective care
• Ensuring high quality and affordable specialised care
• Whole system change for future clinical and financial sustainability
• Foundations for improvement

Implications of hypothetical decisions

Do respondents completing abstract, hypothetical priority-setting exercises agree with the policy implications of their choices?OHE, February 2015

• Results of a survey designed to elicit data on people’s preferences regarding health care priority setting found that people’s stated preferences regarding hypothetical scenarios are influenced by the way in which the information is presented to them. They also show that people do not always agree with the policy implications of their responses to the stated preference tasks.
• (Free registration required to download this report)

Commissioning for Value datapacks for CCGs and Area teams - Update

Commissioning for Value – datapacks for CCGs and Area teams
NHS England, with NHS Right Care and Public Health England, October 2013, Update November 2014

• These resources give CCGs practical support in gathering data, evidence and tools to help them transform the way care is delivered to their populations.
• The packs, based on  comparison with similar CCGs, contain a range of improvement opportunities to help CCGs identify where local health economies can focus their efforts – ‘where to look’ – and describes how to approach local prioritisation.
• October 2013  packs describe potential savings around lives saved per year, elective and non-elective and prescribing.
• Interactive tools are available to view maps, charts and tables for the indicators in the packs across CCGs and to explore the relationships between two indicators.
• Nov 2014 - A new set of Commissioning for Value resources for CCGs - ‘Pathways on a Page’ packs (interactive tools will follow) provide in depth data for 13 patient conditions - breast cancer, lower GI cancer, lung cancer, diabetes, psychosis, common mental health disorder, heart disease, stroke, COPD, asthma, MSK, trauma and injury, renal.

Interactive map of HWB priorities across England

Health and Wellbeing Boards priorities across England  - an interactive map
LGA, 4 June 2014

• This map of local authorities (LAs) across England includes links to the health and wellbeing strategy and reports highlighting measures of health and wellbeing and PHE Health profile. for that area.
• In addition by selecting a theme, the map will highlight all areas addressing related priorities.

Reading list around prioritisation and priority setting

Priority-setting/Prioritisation in healthcare - A Reading List
NHS Right Care, May 2014

• A reading list of 67 items resulting from a systematic search of the academic literature published January 2003 to February 2014.
• A key statement or conclusion is then extracted from the paper to help you assess the article’s value to your needs.
• Includes an introduction by Sir Muir Gray

STAR – Socio-technical allocation of Resources

STAR – Socio-technical allocation of Resources
Right Care Case Book, March 2014

• STAR (Socio-technical allocation of resources) is a priority setting process combining value for money analysis with stakeholder engagement. This approach allows those planning services to determine how resources can be most effectively invested, while the engagement of stakeholders means the decisions are understood and supported by those most affected.
• Right Care have published a description of the approach and case study of the its implementation in Sheffield in re-organising Eating Disorder services.
• See a presentation here.

Developing a more systematic approach to commissioning

Commissioning for Value: Developing a more systematic approach to commissioning

Right Care Case book, October 2013

• This Casebook shows how adopting the Right Care Commissioning for Value approach to commissioning decision making can help to develop a more systematic and focused method for prioritising improvement programmes.
• The case report describes work done in NHS South Sefton and NHS Southport and Formby CCGs 
• The full commissioning process was formally launched across the two CCGs at the end of September 2013, once the prioritisation framework had been agreed. As part of the development of the process, a number of projects were supported through to approval by Finance and Resource Committees during the summer. These included:
• A pilot GP care home service in Formby, providing weekly ward rounds to provide continuity of care, enhance patient experience and reduce attendances at hospital. 
• A pharmacy service to review and improve medicines use in care homes in South Sefton. 
• The two projects are projected to save more than £30,000 and £200,000 respectively.
• Once approved and live, every scheme is monitored monthly and quarterly by the PMO against three criteria – clinical improvement, patient satisfaction and finance.

• Read about  Commissioning for Value  on the Right Care website
• Commissioning for Value packs for all 211 CCGs are available for download here.

What does a great CCG look like? - CCG Development Framework 2013/14

CCG Development Framework 2013/14: Working together to achieve excellence in clinically led commissioning
Prepared by John Bewick, Director of CCG Development, NHS England, 28 August 2013

• The CCG Development Framework identifies the most important areas for future CCG development. The aim is to develop a clear understanding of what excellent practice looks like across the range of domains that underpin a CCG’s ability to deliver transformational change.
• It is intended to support CCGs and Area Teams in identifying where to prioritise development efforts. It will guide NHS England in its leverage of development resources with national partners; and it will signal to suppliers of development where they can most effectively add value. One of the outputs is a Directory of CCG Development Support Offers (draft Sept 2013)
• The most significant challenges identified as priorities by CCGs include:
• Service challenges
• addressing unwarranted variations in quality and safety of present services;
• reducing health inequalities, including variations in access to services and health outcomes;
• delivering whole care delivery system change, promoting health, wellbeing and independence and avoiding unnecessary use of urgent and emergency services; and
• redesigning services to bring them closer to home, wrapped around the complex needs of individuals, including the redesign of primary care.
• System challenges
• leading local communities in embracing new service offers;
• achieving collaborative agreement across several commissioners to shared priorities; and
• releasing resources trapped in familiar but outdated services for reinvestment.
• Development Challenges
• Striving to engage and exploit the talents of clinicians and managers within the CCG;
• Strengthening the new relationships between general practices as the membership of the CCG;
• Exploring the new potentials of commissioning support services provided from outside the CCG to complement their own strengths, improving their access to expertise, value for money and resilience in commissioning functions;
• Establishing new collaborative commissioning arrangements with other local commissioners including local government, NHS England and other CCGs; and 
• Establishing good and productive relationships with NHS England nationally and locally, including receiving useful support, commissioning together locally, and assurance and oversight.
• The CCG development framework will be reviewed annually

STAR - a new resource allocation tool from Health Foundation and LSE

STAR - Socio-Technical Allocation of Resources
Health Foundation, London School of Economics

• Star is a new approach to priority setting, to help commissioners and those planning services to allocate their health resources to benefit patients in their community, combining technical value for money analysis with extensive stakeholder engagement and discussion.
• Star combines value for money analysis with stakeholder engagement, where an Excel-based tool is used alongside a facilitated stakeholder workshop.
• The Excel-based Star tool enables users to compare the relative value for money of healthcare interventions through simple 'value triangles' graphics. These show the ratio of costs to benefit, taking account of individual patient benefit and population health gain. The use of simple 'value triangles' enables all stakeholders to take part in structured discussions about resource allocation

Top tips for priority setting

Top Tips for Priority Setting
Solutions for Public Health, July 2013

• Some top tips for Clinical Commissioning Groups on prioritising services.
• Remember you will be judged on the process, not the decision itself
• Start by developing a framework for the ‘three Ps' – principles, policies and processes
• Ensure all GPs know how decisions have been reached
• Consider sharing prioritisation processes with other CCGs
• Decide whether existing arrangements will meet the future needs of the CCG
• Remember, not only patients can challenge decisions

Priority-setting and rationing

Priority-setting and rationing in health care: evidence from the English experience
Suzanne Robinson et al, Social Science & Medicine, online 20 Sept 2012

•  Report of the Nuffield Trust research study (Setting priorities in health: The challenge of clinical commissioning)  which investigated local priority-setting activity across five English PCTs, March to November 2012. 
•  Highlights:
• There has been a shift towards more explicit priority-setting within healthcare, in England. 
• There is concern in relation to the instrumental effects and the wider legitimacy of priority-setting activities. 
• Decision analysis and evidence are used to pursue both of the above aims. 
• Rationing decisions require leadership skills around political astuteness, relationship management and coalition building. 
• Priority-setting should be fully embedded in resource allocation, not just a ‘bolt-on’ to the distribution of spare funds.

Value from limited resources thorough STAR

Looking for value in hard times
Health Foundation, August 2012

• A new approach to priority setting called Star (socio-technical allocation of resources) designed to help commissioners and others pinpoint where they may be able to get additional value from their resources by using them more effectively.
• An approach to comparing the value of different interventions with active input from staff, public and patients

A tool to support prioritisation and disinvestment decisions

How to prioritise disinvestment in support services
HSJ 7 Feb 2012

• NHS National Services Scotland has developed a tool to ensure decisions about prioritisation and disinvestment can be made systematically and objectively, relying on the best available information and evidence, applied in a practical and pragmatic way.