Priority setting: strategic planning
For primary care trusts (PCTs) the most important priority setting is done at the strategic level. It is here that the major decisions shaping local healthcare services are taken. This is done through the development of strategic plans which are then translated incrementally through serial resource allocation decisions.
Strategic planning involves priority setting because it determines which healthcare needs will be met and which will not. Developing an implementation plan involves priority setting because it determines when needs will be met.
Priority setting is as old as the NHS itself. It is surprising, therefore, that priority setting at these levels is most in need of development. It could be argued that the focus on health technology assessment has been to the detriment of the development of other tools. As a result, many challenges remain. These include:
- how to best manage a large number of decisions
- how to construct all decision making to ensure that the primacy of prioritisation is maintained (see the previous report in this series, Priority setting: an overview)
- how to fairly and efficiently compare very different sorts of interventions
- how to ensure that investments reflect priorities
- how to fully engage the wider NHS and the public and in doing so secure the trust of the local community.
To meet these challenges PCTs will need to network with fellow PCTs and other partner organisations, including academic institutions, to develop understanding, tools and skills. Particularly important is the need to verbalise, capture and therefore give full account of the decisions PCTs currently make and how these are shaped by their unique perspective and responsibilities (for example: knowledge of opportunity costs, legal duties to provide comprehensive healthcare and being a budget holder).
While this report acknowledges the developmental nature of priority setting at the strategic level, it sets out some well recognised considerations for the planning cycle and presents some tools which may be useful for PCTs to adopt and adapt.
