Introduction

After a discussion of behaviour changes associated with the establishment of Clinical Commissioning Groups (although not directly the domain of this book), possibly the most important aspect of any systemic change is the way that priority-setting and resource allocation is undertaken. An ethically based resource allocation procedure for decision-making at times of financial pressure is an essential toolkit for any commissioning management. Although there is a lot to be done to set up CCGs and the other aspects of the government’s proposed changes to the health and social care system, the need for a robust and ethical resource allocation system is unarguable. Unfortunately, with so many changes to the overall system, and with the harsh austerity measures beginning to bite, it is likely that commissioners will make quick and sometimes erroneous judgements about resources that may be, at best, less than optimal, and at worst leave some patients with poorer care than previously.

Under the previous regime the 11 World Class Commissioning (WCC) competencies contained two competencies that were especially relevant to priority setting and resource allocation.

• Competency 6: prioritise investment according to local needs, service requirements and the values of the NHS. ‘By having a clear understanding of the needs of different sections of the local population, PCTs, with their partners, will set strategic priorities and make investment decisions, focused on the achievement of key clinical and health and community outcomes. This will include investment plans that address the areas of greatest health inequality’.

• Competency 11: make sound financial investments to ensure sustainable developments and value for money. PCTs will ensure that their commissioning decisions are sustainable and provide a sound investment to secure improved health outcomes for both now and the future. Excellent financial skills and clinical resource management will enable PCTs to manage the financial risks involved in commissioning, and to take a proactive rather than reactive approach to financial management. The financial strategy will ensure that the commissioning strategy is affordable and set within the organisation’s overall risk and assurance framework. (Department of Health, 2007.)