This research will evaluate the new prioritisation framework tool informed by SPHR research and evaluate its impact on local authority decision-making when it comes to investment and disinvestment decisions.
October 2017 - September 2018
Shifting the gravity of spending? Exploring methods for supporting public health commissioners in priority setting to improve population health and address health inequalities
Research Team: Professor David J Hunter, Linda Marks, Dr Silvia Scalabrini, Professor Nick Payne, Dr Praveen Thokala, Professor Sarah Salway, Professor Stephen Peckham, Professor Luke Vale, Dr Sara McCafferty & Joanne Gray
Who's involved: Fuse, London School of Hygiene and Tropical Medicine & University of Sheffield
November 2012 - August 2015
Investing in health improvement and addressing health inequalities are key policy priorities. Whether they are reflected in practice will depend in on how commissioners prioritise investment and, particularly in times of economic limitations, how they make decisions about disinvestment.
Local authority priority-setting in England is now taking place within new organisational and cultural settings, since the responsibility for commissioning public health services transferred from Primary Care Trusts in April 2013, making this issue of particular importance.
There are many approaches for prioritisation, however their strengths and limitations are not well understood by commissioners and practitioners. The use of tools to assist priority-setting in public health investment has been limited and it is therefore important to understand the real-world benefits and challenges of using these tools in everyday practice.
This study aimed to provide tailored health economics support to three local authorities and evaluate its impact by using a range of methods. Researchers led workshops that increased knowledge of priority-setting tools and encouraged commissioners and practitioners to reflect on existing processes.
Positive impact was achieved at one site, where participants decided to use all of the three support sessions that were on offer. Political goals and strategies were found to be particularly important in setting public health priorities and in shaping decision-making processes.
Differing, and sometimes contrasting understandings of what public health involved in practice, as well as the understandings of evidence, were also found to be key factors in shaping commissioners and practitioners’ views of priority-setting tools, and how prioritisation should develop.
Austerity was also seen as a practical constraint within which commissioners and practitioners had to make choices about public health.The research findings provided important contextual knowledge to help understand how priority-setting tools might be embedded within real-world settings.
SPHR final report: Shifting the gravity of public health spending
Hunter, D.J., Marks, L., Brown, J., Scalabrini, S., Salway, S., Vale, L., Gray, J, Payne, N. The potential value of priority-setting methods in public health investment decisions: qualitative findings from three English local authorities. Critical Public Health 2016 26:5.
Brown, J., Hunter, D.J., Marks, L., Salway, S., Gray, J., McCafferty, S., Payne, N., Peckham, S., Thokala, P., Vale, L. Shifting the gravity of spending? Exploring methods for supporting public health commissioners in priority-setting to improve population health and address health inequalities: Second phase interviews: report of qualitative findings. October 2016.
Marks, L., Hunter, D.J., Scalabrini, S., Gray, J., McCafferty, S., Payne, N., Peckham, S., Salway, S, Thokala, P. The return of public health to local government in England: changing the parameters of the public health prioritisation debate? Public Health 2015 129:9.
South J, Hunter DJ, Gamsu M. What Local Government Needs to Know about Public Health. A Local Government Knowledge Navigator Evidence Review, Need to Know. Review Number 2, February 2014.
SPHR Public Health Evidence Briefing: Local authority decisions
SPHR project poster: Supporting public health commissioners