The main study from NIHR SPHR’s Shifting the Gravity of Spending project, which explores public health decision making and priority setting in the context of local government, has been completed and funding has been secured for a one-year follow-on study.
The research team is led by Professor David Hunter of Fuse (a collaboration between Durham, Newcastle, Northumbria, Teesside and Sunderland Universities). Other researchers include staff from the University of Kent, and the University of Sheffield.
There were four main influences on priorities for public health investment in our case study sites:
- an organisational context where health was less likely to be associated with health care and where accountability was to a local electorate;
- a commissioning and priority-setting context located within broader local authority priority-setting and decision making processes;
- different views of what counts as evidence and, in particular, the importance of local knowledge; and
- debates over what constitutes a public health intervention, triggered by the transfer of the public health budget from the NHS to local authorities in England.
The study concludes that the relocation of public health to local authorities raises questions over prioritising public health investment, including the balance across lifestyle interventions and broader action on social determinants of health and the extent to which the public health evidence base influences local democratic decision-making. Action on wider social determinants reinforces not only the art and science but also the values and politics of public health.
The wider Shifting the Gravity of Spending project looks at decision-making for investment in prevention at a time when local authorities in England have, since April 2013, become commissioners for public health services. The project took a developmental and evaluative approach based on the premise that if decision-support methods are to be used they should be developed in conjunction with local commissioners, reflecting local priorities. It has involved close engagement with commissioners, practitioners and other stakeholders through targeted activities. Working closely with them to identify the tools and techniques they might find most useful, the research team has adopted a co-production model of knowledge generation and exchange.
The 12 month follow on study is selecting a number of local authorities which have adopted priority-setting tools and approaches to identify the barriers and enablers governing their uptake and impact.