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Published online by Cambridge University Press: 05 July 2012
Introduction
After a discussion of behaviour changes associated with the establishment ofClinical Commissioning Groups (although not directly the domain of this book),possibly the most important aspect of any systemic change is the way thatpriority-setting and resource allocation is undertaken. An ethically basedresource allocation procedure for decision-making at times of financial pressureis an essential toolkit for any commissioning management. Although there is alot to be done to set up CCGs and the other aspects of the government’sproposed changes to the health and social care system, the need for a robust andethical resource allocation system is unarguable. Unfortunately, with so manychanges to the overall system, and with the harsh austerity measures beginningto bite, it is likely that commissioners will make quick and sometimes erroneousjudgements about resources that may be, at best, less than optimal, and at worstleave some patients with poorer care than previously.
Under the previous regime the 11 World Class Commissioning (WCC) competenciescontained two competencies that were especially relevant to priority setting andresource allocation.
Competency 6: prioritise investment according to local needs, servicerequirements and the values of the NHS. ‘By having a clearunderstanding of the needs of different sections of the local population,PCTs, with their partners, will set strategic priorities and make investmentdecisions, focused on the achievement of key clinical and health andcommunity outcomes. This will include investment plans that address theareas of greatest health inequality’.
Competency 11: make sound financial investments to ensure sustainabledevelopments and value for money. PCTs will ensure that their commissioningdecisions are sustainable and provide a sound investment to secure improvedhealth outcomes for both now and the future. Excellent financial skills andclinical resource management will enable PCTs to manage the financial risksinvolved in commissioning, and to take a proactive rather than reactiveapproach to financial management. The financial strategy will ensure thatthe commissioning strategy is affordable and set within theorganisation’s overall risk and assurance framework. (Department ofHealth, 2007.)
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