Shifting the gravity of spending?

Fuse researchers, based at Durham University, are researching priority-setting tools that local authority commissioners might find useful for public health investment and, conversely, disinvestment.

In a climate of austerity and ongoing spending cuts, there is increased urgency to demonstrate return on investment in relation to public health interventions and explore methods of decision-support for public health priority-setting. The return of the responsibility for public health commissioning to local authorities also means that priority-setting takes place within new organisational and cultural settings, which presents new challenges.

An initial two year study supported public health priority-setting in three local authority case study sites across England. The study brought together academic expertise from health economics and public health in a series of seminars and targeted decision-making support sessions for public health commissioners.

The relevance of prioritisation methods and their impact on spending patterns within and across programmes was evaluated through a series of initial and follow up interviews with decision-makers in each site.

The first stage of the study concluded that the relocation of public health to local authorities has raised questions about where and how investment should be prioritised.

The study found that there were four main influences on priorities for public health investment in the 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
• 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.

This research project, funded by the NIHR School for Public Health Research, ran from April 2012 to July 2015 in collaboration with colleagues from University of Sheffield and University of Kent.

A one-year follow on study is selecting a number of additional local authorities which have adopted priority-setting tools and approaches to identify what helps and hinders their uptake and impact.

• News: How are priority-setting tools used in local government?

Last modified: Fri, 15 Feb 2019 14:46:16 GMT