Commissioners struggle to cut back on services, survey finds

BMJ 2011; 343 doi: (Published 19 September 2011) Cite this as: BMJ 2011;343:d5961
  1. Fiona Tasker
  1. 1London

Commissioners in England are more interested in new developments in the health service than setting priorities on how to spend their core funding, says a report. They also struggle to disinvest in services, to make evidence based decisions, and to involve the public.

The findings, from the Health Services Management Centre at the University of Birmingham and the health policy think tank the Nuffield Trust, are based on results from a survey completed by 80 (53%) of the 152 primary care trusts in England and in-depth case studies at a sample of trust sites.

“It is much easier for stakeholders to invest in new improvements than to stop providing services in the NHS,” said the report’s lead author, Suzanne Robinson, a lecturer in health economics and healthcare policy at the University of Birmingham. “People don’t like change, even if this could potentially be for the better. It will take a new set of leadership and management skills to drive disinvestment, which is a key priority for the NHS if efficiency savings and high quality service provision are to be provided.”

The report found variation in the amount of information available to support trusts’ decisions. Just over half of the respondents (23 trusts) have dedicated information resources to provide evidence for priority setting. These were mainly public health analysts and information teams. Only two trusts had access to a health economist.

“It is important to have people who can ask appropriate questions and analyse the answers,” said Ms Robinson.

The report claims that engagement of the public is currently limited to disseminating information rather than shared decision making.

“Public and patient engagement in priority setting is important, but it can be difficult to secure,” said Ms Robinson. “Attending forums to discuss decision making has been offered, which has often resulted in poor attendance. There is not much research into how and when patients and the public should be involved in decision making.”

The report suggests that lessons should be learnt from the weaknesses but also from the strengths of current practice.

Ms Robinson said, “There is a risk that knowledge around priority setting tools and processes will be lost as organisations disband and staff scatter into new posts.”


Cite this as: BMJ 2011;343:d5961