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Section 4: Prioritising needs and resources

Priorities at different levels

Although locally identified health needs, inequalities and risks are the foundation of agreeing the priorities for public health and wellbeing, there are a range of other factors which influence this decision making process:

  • The first set of priorities are driven by policies developed by national Government, which in turn may be influenced by international bodies such as the World Health Organisation (WHO). It is important that these national priorities are considered in the local context and prioritised accordingly.  A summary of the current national priorities is provided in the following pages
  • The second set of priorities are identified from the differences in health outcomes in South Gloucestershire in comparison with other local authority areas, nationally, regionally and within demographically similar areas. Of particular interest are indicators which show South Gloucestershire as a statistically significant outlier for a given measure of health. These comparative needs drive local targets aimed at reducing inequalities between areas and within England. These needs are illustrated in the local health profiles, public health outcomes framework and other sets of published indicators. They are summarised in the updated JSNA
  • A third set of priorities relates to inequalities in health outcomes and determinants of health identified through analysis of the available data at populations and geographies smaller than the local authority area. An example of such analyses is provided in Section 3, but more detailed analyses are included in the JSNA as well as health equity audits undertaken locally for specific services
  • A fourth and final set of priorities are those which are emerge from engagement with the public, patients, service users, elected representatives, and health and care professionals. These so-called ‘felt needs’ form an important part of the overall picture and provide valuable context to the prioritisation process

In this section of the report, we consider these sometimes competing pressures and propose an approach to agreeing local priorities for public health and wellbeing.

National priorities

Department of Health

The Department of Health for England has published a five year strategy which outlines its priorities. There are objectives covering a wide range of issues, however Objective 5 directly relates to public health and wellbeing and summarises six areas for action.

Department of Health public health priorities

Objective 5: Preventing ill health and supporting people to live healthier lives

  • Review how best to support those suffering from long-term, but treatable, conditions (such as drug and alcohol addiction or obesity) back into work
  • Reduce childhood obesity
  • Continue to promote clear food information
  • Implement a national, evidence-based diabetes prevention programme
  • Deliver the prime minister’s 2020 Dementia Challenge
  • Continue to combat antibiotic resistance, taking forward the findings of the independent review

Source: Department of Health Shared Delivery Plan 2015-2020

NHS England

The Five Year Forward View provides the strategic plan for the NHS in England. (19)  It describes a range of priorities for improving healthcare and public health, including:

  • helping people live healthier lives to prevent disease and ill-health
  • breaking down barriers in how care is provided and taking a holistic approach to healthcare which is appropriate for the local population
  • improving the use of technology in healthcare
  • investing in research and development to support service improvement
  • reducing the demand for health services, improving service efficiency and better allocation of funding

Public Health England

Public Health England set out its main public health priorities in parallel with the NHS England Five Year Forward View.

Public Health England priorities

  • Addressing obesity, smoking and alcohol
  • Ensuring a better start in life
  • Reducing dementia risk
  • Robustly tackling tuberculosis and antimicrobial resistance

Source: Strategic plan for the next four years: Better outcomes by 2020

Nationally mandated functions for local authority public health

There are a number of nationally defined mandatory public health functions which local authority public health teams must deliver by law, including:

  • protecting the health of the local population (for example from disease outbreaks and environmental hazards)
  • ensuring commissioners of NHS services receive the public health advice they need
  • ensuring appropriate access to sexual health services
  • the National Child Measurement Programme (weighing and measuring children in reception and year 6 classes)
  • the NHS Health Check programme
  • delivering the mandated checks for 0-5 year olds (health visitors)

Local priorities

In addition to mandatory work, the South Gloucestershire Director of Public Health Report 2014-2015 identified a number of priorities for the 2015/16 – 2017/18  These priorities are based on the 2013 JSNA.

South Gloucestershire Council Public Health and Wellbeing Priorities

  • Mental health and wellbeing
  • Reducing childhood poverty
  • Alcohol harm reduction
  • Health in schools
  • Childhood obesity
  • Domestic abuse
  • Preventing young people starting to smoke

Source: South Gloucestershire Director of Public Health Report 2014-2015 (9)

Approaches to prioritising needs and resources

In this section of the report we have shown that the local prioritisation of health needs, activity and resources requires us to use a range of sources of information. However, the process of prioritisation is as important as the information itself – perhaps more so.

A range of approaches and tools have been developed to support the prioritisation of health resources within administrative areas. Multi-criteria decision analysis (MCDA) has emerged as one of the dominant approaches and is now used extensively by health and wellbeing boards to prioritise health issues for policy making, strategy development and resource allocation.

There are different ways of undertaking MCDA analysis (20), but the following steps are central to the process:

  1. Identifying the needs or interventions to evaluate
  2. Identifying the criteria relevant to the organisation or partnership
  3. Determining relative weighting to score the criteria based on locally agreed values
  4. Measuring how well the needs or interventions meet the criteria
  5. Combining the scores for all the criteria
  6. Comparing the summary scoring for each need or intervention and ranking them by relative priority

Agreeing scoring criteria from locally held values

It is important that the scoring process for prioritisation is agreed locally and in advance of the scoring. The criteria and relative weighting applied to each issue should relate to locally agreed values and principles. The box below lists the strategic values included in the South Gloucestershire Joint Health and Wellbeing Strategy.

  • Prevention: Our actions should facilitate healthy lifestyles to keep people in good health and prevent illness
  • Early intervention: Appropriate treatment or other support should be initiated as soon as possible through early diagnosis and assessment of people’s circumstances. This minimises the risk and severity of illness and maximises the effectiveness and efficiency of treatment
  • Equity: Provision of services should be proportional to need and specific services targeted to the areas, groups and individuals that need them most.
  • Accessibility: Services should be accessible to all in terms of opening hours, location, transport links and physical access
  • Integration: The integration of services should be considered where it would improve ease of use and outcomes for people. All relevant organisations should work together to maximise benefits and efficiency
  • Effectiveness: Activities and services should be evidence based and provide value for money
  • Safety and safeguarding: Services should be delivered safely and patients treated with dignity. Processes should protect children and adults from abuse and neglect

Source: South Gloucestershire Joint Health and Wellbeing Strategy 2013-2016 (21)

Examples of criteria used by other health and wellbeing boards in England have been collated in and are appended to this report (see Appendix A).

The use of MCDA as a prioritisation process is strongly supported by the public health and wellbeing division. Prioritisation of the health needs identified in the JSNA and other documents referred to in this report will be an important part of the review of the Joint Health and Wellbeing Strategy (JHWS) which is due to be published in April 2017 (see Section 5: Looking forward).

Someone walking in training shoes