Issuu on Google+

NHS KIRKLEES DEVELOPMENT OF A FRAMEWORK FOR PRIORITISING DISINVESTMENT ISSUES Proposal for Disinvestment

STEP 1 - Initial Screening Questions The screening is to ensure that the proposed change can proceed through the prioritisation process. A1. Is the proposed change ethical, eg discriminatory or involving untested treatments? (refer to ethical framework in the Individual Funding Review process for further details, if required) If the answer to this is ‘No’ then the proposed change cannot enter the prioritisation process. A2. Is the proposed methodology ethical? If the answer to this is ‘No’ then the sponsor should be advised that the proposed change cannot enter the prioritisation process unless an alternative, ethical, methodology is developed. A3. Does the proposed change impact negatively on a mandatory requirement? Maybe a local or national priority. If the answer to this is ‘yes’ then detail the impact of the proposed change and check with the SDC Chair (DQ:or other?) whether it is appropriate to continue. A4. Does the proposed change impact on the strategic objectives of the organisation (positively or negatively)? If so, which one(s), which way? If the answer is ‘no’ or ‘positively’, then proceed. If the answer is ‘negatively’ then detail the objective(s) affected and check with the SDC Chair (DQ:or other?) whether it is appropriate to continue.

1


STEP 2 – Assessment of the proposed disinvestment Rate as:

1 = Low

2 = Medium

3 = High

B. What Impact does the health issue related to the disinvestment have on local people? – Severity of the health issue B1. To what extent does the health issue detrimentally affect health functioning? Eg High (Hypertension), Medium (Pain), Low (Tooth decay) B2. To what extent does the issue cause other health issues? – Size of the health issue B3. How many cases of the disease/condition/unhealthy behaviour are there within the local population at any one time? (i.e. prevalence) Eg High (Obesity, Smokers), Low (Cystic Fibrosis sufferers, Illegal drug users) B4. How many premature deaths (ie under 75 years of age) occur locally on average each year as a result of this issue ? C. Local Changeability ie evidence of impact of proposed change on the health issue C1. How strong is the evidence that current interventions effect change? Eg High (NICE Guidance, randomised clinical trials etc exist), Medium (some documented evidence, lower in hierarchy), Low (very little exists, anecdote) Rate as: 1 = very little

2 = some

3 = a lot

C2. How much does the disinvestment increase the severity of the issue? Refer to B1 and B2. C3. How much would disinvestment increase the numbers of people with the issue? Refer to B3 and B4. C4. How much does the disinvestment impact on the gaps in the health of local people? Eg from the JSNA. Does it make it worse or not alter it? Ie people, issue and/or locality. C5. To what extent will the disinvestment have a negative impact on the intended long term health benefit?

2


C6. To what extent will the disinvestment increase deaths from the health issue(s) it affects? D. Acceptability of the proposed disinvestment Rate as

1 = Very willing/keen

2 = Neutral

3 = Resistant

D1. How willing are the recipients/target groups to the change the disinvestment will make? Ie how accepting of the intervention/reduction. D2. How willing are the relevant staff (groups or individuals), who will be implementing the proposed disinvestment, to do it? Rate as

1 = Positive

2 = Neutral

3 = Negative

D3. What are the political implications/ impact on reputation etc of the disinvestment? NB: If resistance to any of the above, may need to consider some pre work either before the proposed change is implemented or it needs to be part of the set up early in the proposed change implementation. E. Feasibility i.e. likelihood therefore risk Rate as

1 = High

2 = Medium

3 = Low

E1. What level of disinvestment is suggested ie capacity, people, equipment or premises? E2. What is the capability of the commissioner and / or provider to deliver the change/disinvestment? NB This may require some preparatory work, separately from the proposed change or as part of the set up. E3. What level of resources can be freed up relatively easily to support the proposed change? Eg intention may be 5%, of which 2% may be relatively ‘easy’, but 5% would be very problematic. Is it easier to stop it all? E4. How likely is it that the right people will be in the right place doing the right things within the timescale? Ie is the pace of change feasible and is it well managed and controlled. Eg if impact includes redundancies then mark low. Rate as

1 = Short

2 = Medium

3 = Long

E5. What timescale does the proposed change provide resources in and how does this relate to outcomes?

3


ie disinvestment vs outcomes vs timescale of change NB This may require more guidance to calculate Rate as

1 = No

2 = Neutral

3 = Yes

E6. Has this proposed disinvestment dependencies on other programmes that may have a negative impact on cost and/or outcome? Eg reducing investment in a weight management service will lead to an increase in referrals to bariatric surgery which is more costly with poorer patient outcomes. If ‘yes’, which programmes and what? Rate as

1 = Yes

2 = Neutral

3 = No

E7. Can this proposed disinvestment influence other programmes positively? If ‘yes’, which programmes and what? Grid of Questions for Prioritising Activity Aspect Severity of health issue being affected

Size of health issue being affected

Question B1. To what extent does the health issue detrimentally affect health functioning?

1

2

3

B2. To what extent does the issue cause other health issues? B3. How many cases of the disease/condition/ unhealthy behaviour are there within the local population at any one time? B4. How many premature deaths occur locally on average each year as a result of this issue?

Local C1. How strong is the evidence that the current Changeability interventions effect change? C2. How much would disinvestment increase the severity of the issue? C3. How much would disinvestment increase the numbers of people with the issue? C4. How much would disinvestment impact on the gaps in health of local people? Ie people, issue and/or locality.

4


C5. To what extent will the disinvestment have a negative impact on the intended long term health benefit? C6. To what extent will the disinvestment increase deaths from the health issue(s) it affects? Acceptability

D1. How willing are the recipients/target groups to the disinvestment? D2. How willing are the relevant staff (groups or individuals) who will be implementing the disinvestment to do it? D3. What are the political implications/ impact on reputation etc of the disinvestment?

Feasibility

E1. What level of disinvestment is suggested ie capacity, people, equipment or premises? E2. What is the capability of the commissioner and/or provider business to deliver the change/disinvestment? E3. What level of resources can be freed up relatively easily to support the proposed change? Is it easier to stop it all? E4. How likely is it that the right people will be in the right place doing the right things within the timescale? Ie is the pace of change feasible and is it well managed and controlled. E5. What timescale does the proposed change provide resources in and how does this relate to outcomes? E6. Has this proposed disinvestment dependencies on other programmes that may have a negative impact on cost and/or outcome? E7. Can this proposed disinvestment influence other programmes positively?

LOW SCORE = more likelihood of disinvestment opportunity

Totals

5


Further Comments

Version 1 2

Date 25/08/09

Author JH NJH

3

25/8/9

NJH

4 5

28/8/9 1/9/9

DJC DJC

6

1/9/9

DJC, JH, NJH

7

4/9/9

DJC

8

070909

JH

9

29/9/9

DJC

10

1/10/9

DJC

11

16/10/9

DJC

12

19/10/9

DJC (JH)

Comments From HNA workbook and discussion Initial development and discussion of elements of framework re Impact and Changeability based on discussion with DC 25/08/09 Revise elements to be questions with scale for Impact and Changeability and pull out screening type questions which need to be asked first. As above for acceptability and feasibility Following discussion JH, DJC order changed and consistency of terms incorporated. Following discussion, amend order of questions, remove duplication, scale for answers consolidated to HML wherever possible. Changes following SDC sub group discussion and development of easier to read questions Minor tidy up of initial section to make easier to read DN note added Split to 2 versions Disinvestment and Investment, following test with Weight Management programme Check and improve consistency of questions/answers (section E) Incorporate feedback from others trying it. Add more explanations and develop Guidance separately. Update with JH comments to A1, A4, C4, D2

6


http://www.kirklees.nhs.uk/fileadmin/documents/meetings/October_09/KPCT-09-181_Framework_for_Priorit