Prioritisation Policy

Transcription

1 Prioritisation Policy April 2013 Author: Responsibility: Alison Lathwell Head of Strategy & Corporate Planning All Staff Effective Date: April 2013 Review Date: April 2014 Reviewing/Endorsing committees Clinical Investment Appraisal Group Governance and Risk Sub Group This policy should be reviewed in conjunction with the Individual Funding Request Policy Approved by Governance and Risk Sub Group 8 th July 2013 Date Ratified by CCG Board Version Number V0.4

2 POLICY DEVELOPMENT PROCESS Names of those involved in policy development Name Designation Alison Lathwell Head of Strategy & Corporate Planning Mary Low Strategy & Planning Knowledge Manager Names of those consulted regarding the policy approval Date Name Designation May 2013 Diane Gray Director of Strategy & System Redesign Equality Impact Assessment prepared and held by Date Name Designation July 2013 Alison Lathwell Head of Strategy & Corporate Planning Committee where policy was discussed/approved/ratified Committee/Group Date Status Clinical Investment Appraisal March 2013 Endorsed Group Risk and Governance Sub Group March 2013 Endorsed Equality Impact Assessment Bedfordshire Clinical Commissioning Group is committed to promoting equality in all its responsibilities as commissioner of services, as a provider of services, as a partner in the local economy and as an employer. This policy will contribute to ensuring that all users and potential users of services and employees are treated fairly and respectfully with regard to the protected characteristics of age, disability, gender, reassignment, marriage or civil partnership, pregnancy and maternity, race, religion, sex and sexual orientation.

3 Contents 1.0 Introduction Purpose BCCG s Ethical and Commissioning Principles Commissioning Policies BCCG s approach to Strategic Planning BCCG s approach to Annual Priority Setting Annual Priority Setting Programme Budgeting The Annual Prioritisation Process Annual Prioritisation Process Outcomes Responsibilities Related Documents Appendix A Appendix B Appendix D Prioritisation Policy Page 3

4 1.0 Introduction Bedfordshire Clinical Commissioning Group (BCCG) receives a fixed budget from central government with which to commission the entire healthcare required by its population. BCCG has insufficient resources to fund all types of healthcare that might potentially be available or requested for its population. It is therefore inevitable that BCCG has to make choices about which healthcare interventions to commission. BCCG has a responsibility to make rational decisions in determining the way in which it allocates resources, and to act fairly between patients. This document sets out BCCG s processes for prioritising the commissioning of services. It describes BCCG s approach to: Strategic Planning; Annual Priority Setting; Reviewing proposals for In-Year Service Developments; and Handling Individual Funding Requests (see also BCCG s Individual Funding Request Policy). 2.0 Purpose Prioritisation is the process whereby decisions are made about which services or interventions should take precedence in relation to each other for investment, within the total resources available. Underpinning all of BCCG s prioritisation processes and commissioning principles is the commitment to achieving value for money, i.e. obtaining maximum population benefit from the goods and services it acquires and/or provides, within the resources available to it. BCCG s Board will need to regularly review strategic priorities in light of any longer term financial changes to ensure investment in the most clinically effective and value for money services. BCCG will continue to develop the tools it uses to support strategic prioritisation, considering factors relating to both allocative and technical efficiency (efficiency achieved through the optimal distribution of goods and services versus efficiency achieved by improving outcomes with fewer resources). These tools will evolve as national and local expertise develops in this area. This policy will be regularly reviewed in light of the above. Prioritisation Policy Page 4

5 2.1 BCCG s Ethical and Commissioning Principles BCCG s approach to priority setting at all levels is underpinned by the organisation s Ethical and Commissioning Principles (see Appendix A). These principles have been included within the considerations of the prioritisation process assessment criteria (see Appendix D). In addition, in line with government policy, any changes to services must have support from GP commissioners, patients and the public, be based on sound clinical evidence and support patient choice. 2.2 Commissioning Policies Statements relating to BCCG s policies for the following areas are set out in detail in BCCG s Individual Funding Request Policy: NICE Guidance Treatments not covered by BCCG s Commissioning Guidance Requests to continue funding for patients entering into or coming off drugs trials or Expanded Access/Compassionate Use Programmes Drugs used outside their licensed indications Requests to continue funding of care commenced privately Requests for referrals to a specialist provider (tertiary, regional or supraregional centre or specialist private provider) Decisions inherited from other Clinical Commissioning Groups Requests for funding treatment abroad BCCG s approach to Strategic Planning For BCCG, as with all CCGs, the most important priority setting takes place at the strategic level. It is here that the major decisions shaping local health services are taken. The key principles underpinning BCCG s approach to strategic planning are as follows: Robust health needs assessment Consultation and engagement with patients, the public and other stakeholders Partnership working Robust prioritisation The current strategic plan, Strategic Commissioning Plan , has been developed according to these principles, and in line with; Health & Wellbeing Strategies provided by Bedford Borough Council and Central Bedfordshire Council Prioritisation Policy Page 5

6 Joint Strategic Needs Assessment Bedford Borough Council and Central Bedfordshire Council The NHS White Paper, Equity and excellence: Liberating the NHS 2.4. BCCG s approach to Annual Priority Setting It is during the annual prioritisation process that decisions are made about priorities and investments for the coming year. BCCG will undertake an annual priority setting process to prioritise commissioning plans for the coming year. This will involve a systematic review of BCCG s strategy and the development of plans to meets its objectives, with the aim of ensuring that annual investment/disinvestment decisions reflect BCCG s stated priorities. The outcome of the annual priority setting process will be captured in the Annual Commissioning Plan. BCCG will be performance managed against the delivery of its strategy and through the Commissioning Plan. Throughout the year, BCCG may need to review decisions about priorities and investments made at the beginning of the year to ensure that the organisation complies with its statutory duty to break even. 2.5 Annual Priority Setting The annual prioritisation process will involve consideration of the following questions 1 : 1) What are the total resources available for commissioning for the Bedfordshire population? 2) On which services/patient pathways are these resources currently spent? 3) Which services/patient pathways are candidates for receiving more or new resources (and what are the costs and potential benefits of putting resources into such growth areas)? 4) Can any existing services/patient pathways be provided as effectively but with fewer resources, so releasing resources to fund items on the growth list? 5) If some growth areas cannot be funded, are there any services/patient pathways that should receive fewer resources, or even be stopped, because greater benefits would be reached by funding the growth option as opposed to the existing service? The consideration of these questions will occur through a number of stages, including by Programme Boards, Locality Boards, Programme Budgeting, the Clinical Investment Appraisal Group and ultimately the BCCG Board Programme Budgeting BCCG will continue to embed and expand the use of Programme Budgeting to support strategic prioritisation. Programme Budgets are a different (but nationally established) way of looking at money spent by Clinical Commissioning Groups. The money is split into disease categories (known as Programmes). Programme Budgeting is a process whereby key stakeholders (e.g. commissioners, healthcare providers, GPs, councils, public health) perform marginal analysis within each Programme. This means that the stakeholders discuss the effect of removing money from and adding money to particular services within a Prioritisation Policy Page 6

7 Programme Budget in order to identify the best use of money to achieve optimal patient outcomes within available resources. Programme Budgeting should result in the development of both commissioning and decommissioning plans for each programme of care. Like all Clinical Commissioning Groups, BCCG is unlikely to receive substantial increases in funding over the next few years. This places three major new requirements in terms of a prioritisation process: In order to allocate resources to new services, BCCG may have to reduce the amount of resources allocated to existing services. There are likely to be more cost-effective interventions than can be afforded. An increased focus on commissioning to improve outcomes, not commissioning health services per se. Allocating resources through Programme Budgeting will support BCCG in addressing these requirements. 2.7 The Annual Prioritisation Process The development of the Annual Commissioning Plan will involve the prioritisation of potential service developments/commissioning plans against a transparent set of criteria (see Appendix B) reflecting BCCG s stated strategic priorities Potential service developments/commissioning plans will be identified from a wide range of sources, including the following: Local Joint Strategic Needs Assessments Health and Wellbeing Strategies of Bedford Borough and Central Bedfordshire Local Authorities Strategic Commissioning Plan and Annual Commissioning Plan (Bedfordshire Plan for Patients) Quality, safety and patient experience reports National and local targets/operational standards Locality Delivery and Programme Board Plans BCCG s patient and public involvement activities, including focus groups, patient surveys, project reference groups, complaints and PALS (Patient Advice and Liaison Service) enquiries, yellow- card scheme and reports from the Patient Engagement and Experience Group Programme Budgeting Horizon scanning activities undertaken by Public Health, BCCG s Commissioning and Medicines Management Teams, including interventions due to be reviewed under NICE s (National Institute for Clinical Excellence) Technology Appraisal programme Service developments previously considered by the Prioritisation Advisory Panel and not funded in-year (this may include service gaps identified via the Individual Funding Request process) Clinical and Strategic Networks Service development proposals from service providers. Specialist Commissioning Groups. Prioritisation Policy Page 7

8 Whilst BCCG strives to embed a culture of planning throughout the calendar year an innovation window between April and June within the annual business planning cycle (Planning and Delivery Framework) will be utilised to identify potential commissioning pathway opportunities across the health economy. The annual prioritisation process will be led by the BCCG Clinical Investment Appraisal Group (CIAG) and will occur in September to support the development of Commissioning Intentions; a higher level view of BCCGs Annual Commissioning Plan. Recommendations from the Group will be will be incorporated into the Annual Commissioning Plan for agreement and sign off by the BCCG Board, usually by April. All potential service/patient pathway developments to be considered within the annual prioritisation process must be submitted to the CIAG using the Prioritisation Process Template (see Appendix B). As far as possible, schemes relating to the same Programme Budget area should be coordinated and submitted within one template, or accompanied by an over-arching commissioning plan explaining how the schemes will inter-relate, and the expected outcomes from the combination of initiatives. Where insufficient information is available to produce robust commissioning plans in time for the annual prioritisation process, commissioners should submit as much information as is available. This will include, for example, the horizon scanning activities undertaken by Public Health and BCCG s Medicines Management Teams, identifying new technologies/treatments which are likely to have a high impact on the health economy in the coming financial year (e.g. expected NICE Technology Appraisals). A judgment will be made about which of these potential service developments may need to be implemented during the coming year and the likely financial impact, and their relative priority against all other submitted commissioning plans. This will enable BCCG s to plan for, and potentially set aside funding for, highpriority/must-do service developments where information is limited at the time of the prioritisation process. The annual prioritisation process is adapted from the evidence-based NHS Institute of Innovation and Improvement (now NHS Improving Quality) Priority Selector tool. The intention behind the utilisation of this tool is to aid decision making and enable a deliberative, transparent decision making process. It provides a structure to focus collective discussion and decisions that prioritise and agree the services/patient pathways that will maximise health improvement. The CIAG will hold an extraordinary prioritisation meeting in September. Prior to this meeting individual CIAG members will initially score proposals using the evaluation matrix (see Appendix D) that has been developed from the Priority Selector assessment criteria (see Appendix B). This individual scoring is to enable review of proposals, identification of any outstanding information gaps and preparation of relevant questions for the commissioner submitting the proposal. Commissioners submitting proposals will attend the prioritisation meeting to answer questions/provide further information as required. The CIAG members will then hold a collective discussion to share individual positions and reasoning of scores against assessment criteria. A group decision will then be reached about the scoring of the proposal which will enable identification of proposals that are recommended to proceed to develop a business case to be assessed within the Business Case Development and Approval Process Prioritisation Policy Page 8

9 (Planning and Delivery Framework) and the ranking of those proposals in accordance of importance and do-ability (see Table 1). A 50% pass mark is required for the CIAG to recommend that the proposal proceeds to business case stage. Table 1. Example of Priority Selector outcome 2.8 Annual Prioritisation Process Outcomes The risks associated with the initiatives which do not get prioritised will be detailed as part of the prioritisation process, and will be managed according to BCCG s Risk Management Assurance Framework. In line with the Framework, each risk will have a named owner and clear mitigating actions. All risks will be reviewed on a monthly basis, including consideration of the probability of the risk occurring and its likely impact. As well as prioritisation of new services/patient pathways as part of the annual prioritisation process, BCCG will keep existing services under constant review to ensure that they continue to deliver clinically effective and cost-effective services at affordable cost. Where possible, BCCG will seek to divert resources from less effective services to more effective ones. The Annual Commissioning Plan will be shared with Overview and Scrutiny Committee s for information. The financial position will be subject to change throughout the financial year. The list ranking potential proposals in order of priority will be used to identify which other schemes should be funded in-year should additional funds become available, and to make recommendations about which schemes should no longer be funded if unexpected cost pressures emerge during the year. Prioritisation Policy Page 9

10 For schemes approved in principle during the annual prioritisation process, funding is not guaranteed. All prioritised service developments will need to be worked up into detailed business cases and approved prior to implementation, in line with BCCG s Business Case Development and Approval Process. All business cases must be submitted to the Business Case Process by a commissioner, although the initial preparation for business cases, e.g. relating to high cost drugs, may be completed by providers. All drug-related business cases must be reviewed by the BCCG Joint Prescribing Committee (JPC) prior to submission to the Business Case. It should be noted that business cases can be submitted via the Business Case Approval Process at any point in the year. Definitions Phrases/Words and Documents Commissioning Intentions Strategic Commissioning Plan Annual Commissioning Plan (Bedfordshire Plan for Patients) Equality impact assessment/analysis Health and Wellbeing Strategies Explanation A document that explains initial outline plans for the following year(s) with regards to changing/purchasing services. Intended to allow health care organisations to respond effectively in a timely manner. The plan in which BCCG set out its overall approach to commissioning NHS funded healthcare for the people of Bedfordshire. The plan sets out our vision, values and strategic objectives and gives an overview of how these will be delivered. A detailed technical document that provides an in depth breakdown of the Strategic Commissioning Plan and focuses upon the following financial year (April April) A tool to help establish whether plans/service changes have the potential to affect people differently. A document that sets out the priorities, objectives and vision of the local Health and Well-being Boards for the local population health and wellbeing needs Prioritisation Policy Page 10

11 3. Responsibilities The Head of Strategy and Corporate Planning will lead the prioritisation process on behalf of BCCG. The Clinical Investment Appraisal Group (CIAG) will be accountable for Prioritisation in accordance with this policy. The Governing Body will receive recommendations of CIAG in relation to Prioritisation outcomes. 4. Related Documents This policy should be read in conjunction with the Individual Funding Request Policy and the Planning and Delivery Framework. Document Replaces Prioritisation Policy November 2012 References 1 Taken from: Ruta, D, Mitton, C, Bate, A, Donaldson, C. 2005: Programme budgeting and marginal analysis: bridging the divide between doctors and managers, BMJ, 330: Prioritisation Policy Page 11

12 Appendix A ETHICAL and COMMISSIONING PRINCIPLES BCCG receives a fixed budget from central government with which to commission all the health care required by their populations. BCCG has insufficient resources to fund all types of health care that might be requested for its population. It is inevitable that BCCG has to make choices about which types of healthcare to commission. This document sets out the principles BCCG uses to make these decisions in order to make the process consistent, transparent and fair. These principles have been developed from the original Ethical Framework of the Bedfordshire and Hertfordshire Priorities Forum. BCCGs commissioning decisions will be based on the following principles: 1) Health Outcome The aim of commissioning is to achieve the greatest possible improvement in health outcome for our population, within the resources that we have available. In deciding which interventions to commission, BCCG will prioritise those which produce the greatest benefits for patients in terms of both clinical improvement and improvement in quality of life. 2) Clinical Effectiveness We will ensure that the care we commission is based on sound evidence of effectiveness. We will usually expect this to come from sources such as the National Institute for Public Health and Clinical Effectiveness, well designed systematic reviews and meta-analyses or randomised controlled trials. The key success factors in evaluating clinical effectiveness are the need to search effectively and systematically for relevant evidence, and then to extract, analyse, and present this in a consistent way to support the work of prioritisation and commissioning. Choice of appropriate clinically and patient-defined outcome needs to be given careful consideration, and where possible quality of life measures and cost utility analysis should be considered. We will promote treatments for which there is good evidence of clinical effectiveness in improving the health status of patients and will not normally recommend treatment that is shown to be ineffective. Issues such as safety and drug licensing will also be carefully considered. When assessing evidence of clinical effectiveness the outcome measures that will be given greatest importance are those considered important to patients health status. Patient satisfaction will not necessarily be taken as evidence of clinical effectiveness. Trials of longer duration and clinically relevant outcomes data may be considered more reliable than those of short duration with surrogate outcomes. Reliable evidence will often be available from good quality, rigorously appraised studies. Evidence may be available from other sources and this will also be considered. Patients evidence of significant clinical benefit is relevant. 3) Cost Effectiveness We will take into account cost-effectiveness analyses of healthcare interventions (where available) to assess which yield the greatest benefits relative to the cost of providing them. We will compare the cost of a new treatment to the existing care provided and will also compare the cost of the treatment to its overall benefit, both to the individual and the community. We will consider technical cost-benefit calculations (e.g. quality adjusted life years), but these will not by themselves be decisive. Prioritisation Policy Page 12

13 4) Equity We consider each individual within our populations to be of equal value. We will commission and provide health care services based solely on clinical need, within the resources available to us. We will not discriminate between individuals or groups on the basis of age, gender, gender identity, sexual orientation, race, religion, lifestyle, occupation, social position, financial status, family status (including responsibility for dependants), intelligence, disability, physical or cognitive functioning. However, where treatments have a differential impact as a result of age, sex or other characteristics of the patient, it is legitimate to take such factors into account. BCCG has a responsibility to address health inequalities across our population. We acknowledge the proven links between social inequalities and inequalities in health, access to health care and health needs. Higher priority may be allocated to interventions addressing health needs in subgroups of our population who currently have poorer than average health experience (e.g. higher morbidity or poorer rates of access to healthcare). 5) Access BCCG will ensure that the care we commission is delivered as close to where patients live as possible. Some services cannot be provided in local settings and we may need to commission some services from distant providers in order to ensure quality, safety and value for money. BCCG will also ensure that it commissions safe services for its population. 6) Patient Choice BCCG respect the right of individuals to determine the course of their own lives, including the right to be fully involved in decisions concerning their health care. However, this has to be balanced against BCCG s responsibility to ensure equitable and consistent access to appropriate quality healthcare for all the population. In commissioning healthcare, BCCG will: i) ensure that in assessing the effectiveness of health care, we take account of outcomes that are important to patients and the patient s experience of the care. ii) ensure, wherever possible, that within the care commissioned or provided there are a range of alternative options available, and that patients are given the necessary support to make an informed choice. iii) recognise that evidence of effectiveness usually relates to groups rather than individuals. We have set up an individual case mechanism to allow individuals to be considered as an exception to commissioning policy where evidence is available to suggest that an intervention not routinely funded may be of particular benefit to them in relation to other patients who might not be funded. iv) as a general rule, decline to provide individual funding for care that is not routinely commissioned or provided solely on the basis that an individual, or a clinician involved in their care, desires it. This is in line with our responsibility to ensure consistent and equitable access to care for all our population. It reflects our concern not to fund for one individual care which could not be openly offered to everyone in our population with equal clinical need. v) decline to provide a treatment of little benefit simply because it is the only treatment available vi) consider treatments which effectively treat life time or long-term chronic conditions equally to urgent and life-prolonging treatments 7) Affordability BCCG may not be able to afford all interventions supported by evidence of clinical and costeffectiveness within their available budgets. Where this is the case further prioritisation will be undertaken based on criteria including national and local policies and strategies, local Prioritisation Policy Page 13

14 assessment of the health needs of the population, to ensure that we do not exceed our available resources. BCCG is duty-bound not to exceed its budget, and the cost of treatment must be considered. The cost of treatment is significant because investing in one area of health care inevitably diverts resources from other uses. This is known as opportunity costs and is defined as benefit foregone, or value of opportunities lost, that would accrue by investing the same resources in the best alternative way. The concept derives from the notion of scarcity of resources. A single episode of treatment may be very expensive, or the cost of treating a whole community may be high. 8) Needs of the Community Public health is an important concern of BCCG, and BCCG will seek to make decisions which promote the health of the entire community. Some of these decisions are promoted by the Department of Health (such as the guidance from NICE and National Service Frameworks). Others are produced locally. BCCG also supports effective policies to promote preventive medicine which help stop people becoming ill in the first place. Sometimes the needs of the community may conflict with the needs of individuals. Decisions are difficult when expensive treatment produces very little clinical benefit. For example, it may do little to improve the patient s condition, or to stop, or slow the progression of disease. Where it has been decided that a treatment has a low priority and cannot generally be supported, a patient s doctor may still seek to persuade BCCG that there are exceptional circumstances which mean that the patient should receive the treatment. 9) Quality BCCG will aim to commission high quality services as evidenced against national and international best practice. The quality of services will be measured where possible not only in terms of quality of outcomes and clinical effectiveness but also in terms of process and organisational efficiency; reducing dependency on health care; the quality of patient care; and the quality of the patient experience. 10) Policy Drivers The Department of Health issues guidance and directions to NHS organisations which may give priority to some categories of patient, or require treatment to be made available within a given period. These may affect the way in which health service resources are allocated by individual CCG s.bccg operates with these factors in mind and recognise that their discretion may be affected by National Service Frameworks, NICE technology appraisal guidance, Secretary of State Directions to the NHS and performance and planning guidance. 11) Exceptional Need There will be no blanket bans on treatment since there may be cases in which a patient has special circumstances which present an exceptional need for treatment. Each case of this sort will be considered on its own merits in light of the clinical evidence. BCCG has procedures in place to consider such exceptional cases on their merits and this will be done through the Individual Case Policy of BCCG. 12) Disinvestment As well as commissioning new services on the basis of the criteria above, BCCG will keep existing services under review to ensure that they continue to deliver clinical- and costeffective services at affordable cost. Where possible we will seek to divert resources from less effective services to more effective ones. Prioritisation Policy Page 14

15 Appendix B Prioritisation Process Template: Guidance for completion The italic text (grey) is intended to provide guidance and point to sources of support to complete relevant sections. Some assessment criteria may be more relevant than others; this is therefore only intended as a guide and is neither prescriptive nor exhaustive of the type of information that can be included. It can be deleted from the completed submitted document if required. The assessment criteria is derived from the NHS Institute of Innovation and Improvement (now NHS Improving Quality) Priority Selector tool The scoring for each section will be based upon the following scores (Table 1. Criteria Scoring; the example of patient benefit is given, this will be replaced by the relevant assessment criteria under evaluation e.g. stakeholder, clinical benefit etc.) Table 1. Criteria Scoring No information Provided Unable to determine from information provided whether any [Patient Outcomes etc)] can be realised Response provides satisfactory reassurance that [Patient Outcomes etc] can be realised Response provides evaluator with a high level of confidence that the proposal will deliver [Patient Outcomes etc)] Response provides evaluator with a high level of confidence that the proposal will deliver [Patient Outcomes etc] delivered through innovative practice The assessment criteria are weighted (Table 2. Weighted Scores) Section 1. Project Brief is included to provide the evaluator an overview of the initiative and support overall understanding, it will not be scored Individual Clinical Investment Appraisal Group (CIAG) Members will undertake initial review and scoring individually in order to identify any gaps in information and prepare questions for the commissioner submitting the Prioritisation Proposal. Commissioners submitting proposals will attend the prioritisation meeting to answer questions/provide further information as required. CIAG members will then hold a collective discussion to share individual positions and reasoning of scores against assessment criteria. A group decision will then be reached about the scoring of the proposal which will enable identification of proposals that are recommended to proceed to develop a business case. A 50% overall pass mark is required for the CIAG to recommend that the proposal proceeds to business case stage. Prioritisation Policy Page 15

16 Table 2. Weighted Scoring Weighting Pass/Fail Threshold Quality % Finance % Overall 100 Scoring and Weighting Summary A.Quality 80 Question Question Question Overall Max Score Weighting Weighted Score Weighted Score % Contribution 1 PATIENT OUTCOMES % 2 CLINICAL BENEFIT % 3 NATIONAL PRIORITY % 4 LOCAL PRIORITY % 5 STAKEHOLDERS % 6 BUILDINGS & EQUIPMENT % 7 WORKFORCE % 8 SERVICE DELIVERY % Total % B. Finance 20 9 FINANCIAL BENEFIT % 10 INVESTMENT REQUIRED % Total % Grand Total % This column details evaluation The weightings areas (Quality and Finance) reflects the and lists each of the questions relative asked in each area importance of each of the questions and always add up to 100 The score shown is the maximum score for each question. The max score should be the same for each question This translates the max score into a weighted score by multiplying the score by the weighting This translates the area weighted score into an overall score by multiplying the area section score by the evaluation area % This column presents the % contribution that each question makes to the overall score (100%) Prioritisation Policy Page 16

17 1. Project Brief: Please provide an overview of the service/patient pathway proposal: Include details of background, scope, rationale for proposal Please indicate which Locality/Programme Board this project will be accountable to: e.g. Ivel Valley Locality Board, Planned Care Board etc. Please provide details of any assumptions/constraints that have been identified: Please describe project milestones: As described in the Planning & Delivery Framework; please provide indicative dates for each of these gateways, PMO will be able to support you with planning advice 0 Project Scoping 1 Health Needs Assessment/Evidence Gathering 2 Patient Engagement and Stakeholder Assessment (Potentially including statutory consultation) 3 Business Case and Investment Appraisal 4 Service Specification 5 Procurement and Contracting 6 Service implementation Planning 7 Service review and project closure Please describe project risks and mitigating actions: You may find it useful to reflect on your mandatory risk management training, Risk Management Assurance Framework or PMO can help you identify and articulate risk Prioritisation Policy Page 17

18 DO-ABILTY ASSESSMENT CRITERIA 2. Stakeholders: To what extent are stakeholders within the local health community supportive of this initiative (e.g. local acute trusts, social care, local mental health providers, local authorities, voluntary & charitable organisations etc)? What is the likely reaction of local patient groups and politicians to the initiative (e.g. Overview & Scrutiny Committee, Local Involvement Network / Patient & Public Involvement Forum, local politicians)? 3. Buildings and Equipment: To what extent would this initiative require change to buildings and equipment? Has this impact been considered in the financial investment/benefit criteria? 4. Workforce To what extent would this initiative require current workforce to be redeployed? To what extent are any new or additional skills that are required for the initiative scare or reliant on long-term training once staff have been appointed? To what extent will new ways of working/skill mix utilised differently e.g. Nurse Led follow up, multi-disciplinary team working etc. 5. Service Delivery To what extent does this initiative represent a complex service change (e.g. extent and number of changes, interdependencies with other projects, system wide changes)? Does this initiative include cross-organisational working e.g. health and social care Would this initiative affect the viability of other services? Is there a provider capable of delivering the service required through this initiative? Has this initiative been undertaken successfully elsewhere? 6. Investment Required Would this initiative require additional financial investment? If so, what investment is required? Prioritisation Policy Page 18

19 IMPORTANCE ASSESSMENT CRITERIA 7. Patient Benefit To what extent would the initiative improve convenience and ease of access for users of the affected service(s)? How many patients would benefit from improved convenience and ease of access as a result of the initiative? To what extent would the initiative contribute to reducing health inequalities? see Ethical & Commissioning Principle for Equity To what extent would the initiative contribute to adopting a preventative and early intervention approach that promotes people s independence and wellbeing? To what extent would the initiative contribute to patient choice? 8. Clinical Benefit To what extent would the initiative enhance the implementation of clinical practices designed to improve quality of life (e.g. admission avoidance or case management)? To what extent would the initiative enable the achievement of evidence-based health outcomes (e.g. through implementation of NSFs, NICE)? see Ethical & Commissioning Principle for Health Outcomes To what extent is the initiative supported by sound evidence of clinical effectiveness? see Ethical & Commissioning Principle for clinical effectiveness 9. National Priority To what extent would the initiative address the key national priorities set out in the Outcome Framework s and in the Department of Health s reform agenda? 10. Local Priority To what extent would the initiative address key local priorities and objectives? E.g. Health & Wellbeing Strategies, Joint Strategies with Local Authority commissioners, Joint Strategic Needs Assessment, other local health needs assessments To what extent is there pressure for change in the area of the initiative from people or organisations outside the local health community (e.g. patient groups or local politicians)? To what extent is there pressure for change in the area of the initiative from internal factors (e.g. workforce, equipment, changes in regulations, alternative providers)? 11. Financial Benefit To what extent would the initiative result in financial savings? see Ethical & Commissioning Principle for cost effectiveness How long would it be before the initiative produced financial savings? Prioritisation Policy Page 19

20 Appendix C Equality Impact Assessment Title of Policy Guidance/ Procedure Name of Author Prioritisation Policy 2013 Alison Lathwell Date of creation/review 01/04/ 2013 Version No. 0.2 B1 PLEASE OUTLINE THE RESULTS OF YOUR IMPACT ASSESSMENT BELOW What are the aims and proposed outcomes of your policy guidance/procedure? Prioritisation is the process whereby decisions are made about which services or interventions should take precedence in relation to each other for investment, within the total resources available. The policy sets out the process BCCG will undertake to make those decisions in a fair and transparent manner. B2 What research has been undertaken? A review of the historic PCT policy and of the national literature has been undertaken; including attendance to a national conference. Interviews/discussions were held with individuals previously involved in undertaking Prioritisation within the PCT to explore views and experiences in more depth. B3 (a) What consultation has taken place? (who has been consulted, and by what method?) Internally within BCCG Presentations on outcomes of the research undertaken were provided to the Risk Group and the Clinical Advisory Group (the group responsible for undertaking the prioritisation process), including recommendations for the future policy. A draft policy has been circulated to the Risk Group (represented by all directorates), Clinical Advisory Group and strategy and system redesign teams and feedback requested. A questionnaire was circulated with the draft policy to capture this feedback (attached). Prioritisation Policy Page 20

21 (b) Externally The draft policy has been reviewed with the Local Authority Public Health Strategy Team and with the Commissioning Support Service (procurement lead as an expert of methods of evaluation and Equality and Diversity lead). Plans are in place to review the policy with a local Equality & Diversity Leads Group once this group has been established. Any comments made by the group will be considered and may be used to further the policy. 38 Degrees, the community campaigning group, provided comments on the draft prioritisation policy B4 What feedback was received? Interviews: The previous 2 stage process (long list and Short list) within the historic PCT process was deemed overtly complex and bureaucratic, which in turn was perceived to constrain the quality of discussion held to inform decisions as opposed to provide a helpful framework for discussion. Literature Review: National surveys demonstrate that there is no one approach to undertaking Prioritisation, a range of methods and tools are utilised with differing contexts, with differing levels of evidence to support their use. Tools will often use a scoring system to rate and prioritisation services or interventions. The literature suggests the most valuable tools will use any scoring system to aid decision making & allow for a more deliberative, transparent decision making process- rather than come up with a final score. The NHS Institute for Innovation and Improvement (now NHS Improving Quality) have developed a scoring tool that enables a prioritisation score to be identified and also ranks priorities. The Priority Selector tool puts emphasis on the framework for discussion, recognising that the value of a score is in relation to transparent decision-making. Presentations: The review of research and recommendations was discussed and approach endorsed Questionnaires: feedback re clarifying wording to some areas, but generally well understood and clear. Public Health: Within the brief template it was suggested that patient outcomes; should be changed to benefit for clarification and a 0-2 scoring criteria was suggested as opposed to 0-4. CSU: Built the evaluation matrix to support the policy 38 Degrees: This Policy seems to be comprehensive. The test will be to see how it works in practice, particularly with regard to opportunities for patient input and how that is organised. Pleased to see the sections relating to the importance of equality of treatment, and the recognition that that can sometimes mean treating deprived patients unequally, to make up for their extra needs. Perhaps there could be clarification at 2.6 on who the key stakeholders are. Prioritisation Policy Page 21

22 What amendments, if any, have been incorporated into the policy/function to reflect that B5 feedback? Wording and definitions have been clarified/adjusted as suggested. B6 If changes were recommended but not incorporated, what justification is there for this? The recommendation to move to a 0-4 to a 0-2 scoring criteria was evaluated and a concern was raised that this may constrain discussion/responses in a restrictive manner. It was agreed to keep the criteria at 0-4 and evaluate how effectively this scoring criteria supports decision making during the process. B7 What monitoring arrangements are to be put in place (or already exist) to monitor the actual impact of this policy guidance/procedure? A report will be provided to Governing Body following each annual prioritisation process. Prioritisation Policy Page 22

23 Appendix D DO-ABILTY ASSESSMENT CRITERIA Considerations STAKEHOLDERS BUILDINGS & EQUIPMENT To what extent are stakeholders within the local health community supportive of this initiative (e.g. local acute trust, clusters, social care, local mental health trust)? What is the likely reaction of local patient groups and politicians to the initiative (e.g. Overview & Scrutiny Committee, Healthwatch / Patient & Public Involvement Forum, local politicians)? To what extent would this initiative require change to buildings and equipment? To what extent would this initiative require current workforce to be redeployed? WORKFORCE To what extent are any new or additional skills that are required for the initiative scare or reliant on long-term training once staff have been appointed? SERVICE DELIVERY INVESTMENT REQUIRED To what extent does this initiative represent a complex service change (e.g. extent and number of changes, interdependencies with other projects)? Would this initiative affect the viability of other services? Is there a provider capable of delivering the service required through this initiative? Has this initiative been undertaken successfully elsewhere? Would this initiative require additional financial investment? Prioritisation Policy Page 23

24 IMPORTANCE ASSESSMENT CRITERIA Considerations To what extent would the initiative improve convenience and ease of access for users of the affected service(s)? PATIENT BENEFIT CLINICAL BENEFIT NATIONAL PRIORITY LOCAL PRIORITY FINANCIAL BENEFIT How many patients would benefit from improved convenience and ease of access as a result of the initiative? To what extent would the initiative contribute to reducing health inequalities? To what extent would the initiative enhance the implementation of clinical practices designed to improve quality of life (e.g. admission avoidance or case management)? To what extent would the initiative enable the achievement of evidence-based health outcomes (e.g. through implementation of NSFs, NICE)? To what extent would the initiative address the key national priorities set out in the Operating Framework and in the Department of Health s reform agenda? To what extent would the initiative address key local priorities and objectives? To what extent is there pressure for change in the area of the initiative from people or organisations outside the local health community (e.g. patient groups or local politicians)? To what extent is there pressure for change in the area of the initiative from internal factors (e.g. workforce, equipment, changes in regulations, alternative providers)? To what extent would the initiative result in financial savings? How long would it be before the initiative produced financial savings? Prioritisation Policy Page 24