The document summarizes a meeting between the Health Services Management Centre and Nuffield Trust on priority setting in health and social care. It includes an agenda with presentations on findings from a project on priority setting and implications for commissioning under new arrangements. There will also be a discussion on defining priority setting, rationing, and examples of priority setting decisions.

1. Health Services Management Centre and the
Nuffield Trust

2.  Chair: Dr Helen Dickinson
Morning sessions
 Setting priorities in health: findings from the HSMC /
Nuffield project Presenter: Dr Suzanne Robinson,
HSMC
 Priority setting under the new commissioning
arrangements – implications for health and social care
 Presenter: Dr Judith Smith, Head of Policy the
Nuffield Trust
 Priority setting under the new commissioning
arrangements – wider group discussion

3.  What would you like to get out of the day?
 What areas are you interested in exploring?
 What would you like to learn more about?

4.  Define priority setting  Define Rationing

5. Smokers who do not commit to
undergoing cessation treatment
should receive lower priority in the
allocation of expensive surgical
procedures (e.g. heart and cancer).

6. The National Institute for Clinical
Excellence has recommended that
trastuzumab be available for
women with HER2 positive
advanced breast cancer.

7.  The PCT priority setting
board recently scored a
number of business
proposals and made a
decision to fund the
following
treatments/services) over
the next 12 months:
 A new diabetes clinic at a
local hospital;
 A stop smoking cessation
programme;
 Cardiac rehabilitation clinic
 Expansion of EOL services.

8. A care home for older people is due to
be closed on the grounds that it is
providing poor quality care and is
potentially unsafe.

9. A primary care trust has agreed
to suspend funding IVF
treatment for most patients as
part of measures to save
millions of pounds by next
March.

10. Working definition of
Priority setting and
rationing
In combination, “Priority setting describes decisions
priority setting and about the allocation of resources
rationing can be
understood as the
between the competing claims of
processes by which different services, different patient
services that may be groups or different elements of
of benefit to users are care. Rationing, in turn, describes
withheld on grounds the effect of those decisions on
which include
cost.
individual patients, that is,
the extent to which patients
receive less than the best possible
treatment as a result” (Klein
2010:389).

11. NHS SOCIAL CARE
 Funding: relatively simple – general  Funding: means testing, co-payments
taxation, free at the point of use- set and devolvement of budgets to service
price activity based funding- users -set user charges at varying levels
 Accessing: committed to delivering  Accessing: NBA- can deny care to those
a comprehensive service, accessed with lower need and/or set different
without charge at the point of levels of user charges in different
deliver localities
 Resource allocation: EBA model  Resource allocation: less development
dominant one lots of tools and of prescriptive methodology- population
processes set up around population based models are less feasible
based PS  Political context: more local control,
 less development of prescriptive locally elected representatives and r
methodology- population based little routine interference from central
models are less feasible in social government
care  Rationing and variations in patterns of
 Political context: national service delivery are more socially
institution held in high regard and acceptable – and thus decisions to reduce
subject to government control and or deny care are politically more
reform acceptable – although still controversial