Prioritizing care in a resource-limited health service

Abstract 

Despite the promise of more resources for the NHS the need to ration and prioritize the activities of the NHS will not disappear. The NHS Plan has set a national agenda, to be implemented by National Service Frameworks. Decisions by NICE are expected to be implemented to avoid post-code prescribing. At the same time, patients are given more choice and local primary care organizations encouraged to plan to meet the specific needs of their local populations.

Oxfordshire Health Authority developed a methodology for priority setting based on regular meetings of its Priorities Forum and the use of an ethical framework. The decisions made were best judgements informed by consideration of effectiveness, equity and patient preference taking into account views of all stakeholders. The new structures in England mean new ways of making decisions—perhaps based on the lessons from the past—but the biggest challenge will be to shape local decision-making to reflect local priorities and not just respond to the national political imperatives.

Keywords: prioritization, policy implementation, ethics

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• f1 Correspondence to: SG. Tel.: +41 1865 227175; Fax: +41 1865 311278; E-mail: sian.griffiths@dphpc.ox.ac.uk