Priority-Setting In The UK NHS: Purchasing

The UK National Health Service has never provided services freely to everyone who could benefit from them, and explicit public recognition of rationing can be delayed or avoided no longer, executives of the Institute of Health Service Management told a House of Commons All-Party Health Select Committee evidence session on purchasing in the NHS, on October 27. The Committee's decision to focus on the role of purchasers is probably the most productive way into what is essentially a debate about rationing, they added.

Health care providers supply, day-to-day, most data available to purchasers. This limits purchasers' abilities to change patterns of provision. Providers are also best placed to monitor the effectiveness and clinical outcomes which are fundamental to any priority-setting process. The IHSM called for more comprehensive national priorities, informed by nationally-generated measures of outcome and effectiveness, and also for purchasers and providers to work together to develop long-term strategies to plan the pattern of services most suitable to the health needs of the population they serve.

Information is the key to effective purchasing. IHSM managers are concerned at the level and completeness of data collected from providers, especially quality measures. For their part, providers complain about the type of information requested and say that the same data is often requested by different purchasers in different formats. There is an urgent need for both sides to determine jointly what data is required, in what format, at what level of detail and how frequently it is updated; central guidance and involvement may be necessary here, at least in the short term.