1. BALANCING EFFICIENCY AND EQUITY A NEW INTERNATIONAL RESEARCH PROGRAMME ADDRESSING THE ROLE OF VALUES IN HEALTH CARE Department of Primary Care and Public Health Sciences Professor Peter Littlejohns

2. Overview of Presentation The new environment Research examples Way forward

3. New Environment in South London Public Health Collaborative Collaboration for leadership in applied health research and care (CLAHRC) Academic Health Science Network

4. Improving health in South London

5. Project 1 – implementing cost-effective public health guidance Variation in the quality of health care is often due to a range of barriers that reduce the implementation of evidence based guidance. This project will explore which ones are considered most relevant for alcohol related disorders in South London. Provider professionals, health and social care commissioners, patients and the public will co-produce a prioritised list of interventions (and associated evaluations) to increase the uptake of best practice. Co-producers may have differing “values” and the project will explore the influence that these have on prioritising and designing local solutions.

6. Co-production* of solutions to increase compliance with NICE Alcohol Standards Patients, public, professionals, CCGs, HWBs Researchers Use interviews to identify range of gaps Use interviews to identify range of gaps Workshops to agree gaps and prioritise areas for intervention Workshops to agree gaps and prioritise areas for intervention Design intervention and its evaluation Design intervention and its evaluation Collect and create evidence Collect and create evidence integrate and communicate results integrate and communicate results Health practice Improvement Health practice Improvement Identification and response to gaps Exchanging and negotiating Design methods * Co-production means any group likely to be affected by the decision should be involved in making the decision

7. Project 2 - supporting commissioning Because of resource restraints Clinical Commissioning Groups and Health and Wellbeing Boards will inevitably find themselves having to make difficult decisions on the setting of priorities. Priority setting requires technical judgements of clinical and cost effectiveness, but these judgements are embedded in a wider set of social value judgements that underlie justifiable reasoning about priorities, including transparency, participation and justice. They will need to explain these decisions to patients, professionals and the public

8. Aims and objectives of CCG Project This project aims to support the Clinical Commissioning Groups (CCGs) and Health and Wellbeing Boards (HWBS) in South London in demonstrating that they are commissioning services in a way that balances issues of efficiency and equity in an open and transparent way based on the best available evidence of effectiveness and cost effectiveness by Testing a new draft prioritisation decision support tool (DST) with representatives of CCGs and HWBs, health professionals, managers, patients and the public in South London. Pilot the introduction of the DST into CCGS and HWBs in South London and then Roll out the instrument nationally within an evaluative framework.

9. Methods for CCG Project. The draft decision support tool (DST), designed as part of an international collaboration, will be introduced at an initial multi-stakeholder workshop in South London as a pilot educational intervention. In addition the “values” of the stakeholders will be explored using a validated Q methods approach and a mock NICE appraisal. This has been piloted on medical and MPH students. The DST will then be introduced into a random sample of national CCGs and its impact evaluated according to MRC complex methods. Outcome indicators will include the quality of commissioning, the credibility and acceptability of those decisions by patients and the public, and its effect on inequalities.

10. Prioritisation Decision Support Tool The processes of decision making Institutional setting Rules of decision making Accountability for decisions Participation in decision making The content of decision making Cost and clinical effectiveness Social value judgements

11. The Way Forward Tough decisions are going to have to be made. Openness and transparency is crucial Underpinned by a new type of evidence All aspects should be capable of being measured and assessed

12. NEW EVIDENCE…………….. The United Kingdom Freedom of Information Act (2000) in healthcare research: A systematic review Alexander J. Fowler a, Riaz A. Agha b, Christian F. Camm c, Peter Littlejohns d. Article Summary Investigate the use of the Freedom of Information Act (2000) in healthcare research since its implementation in 2005 and to discern the type of research that has been carried out using the Freedom of Information Act to date. Key Messages The Freedom of Information Act is an underused data collection method More requests led to greater data acquisition and an improved response rate, though there was no correlation between number of questions and acquisition of data. Data can be collected from many areas of the healthcare systems and could therefore play an important role in research

13. Need to constantly question our approach

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