Shifting the Gravity of Spending: Assessing the impact of PHE’s Prioritisation Framework

Abstract

Abstract Background Findings are presented from the evaluation of Public Health England’s (PHE) new Prioritisation Framework (PF) conducted between September 2017 and December 2018 aimed to help local authority commissioners with their public health investment and disinvestment decisions. The study explored the take up of the PF in three early adopter local authority settings. Methods Data collection was based on semi-structured interviews (n = 30) across three local authorities supplemented by participant observation of workshops and data concerning the implementation process as well as spend and outcomes both before and, where possible, after using the PF. Results Participants acknowledged that the PF provided a systematic way to guide prioritisation decisions and one that encouraged transparency over investment and disinvestment decisions. The role performed by PHE and its regional teams in facilitating the process was especially welcomed and considered to be critical to the adoption process. However, uptake of the PF required a significant investment of time and commitment from public health teams at a time when resources were stretched. The impact of the political environment in local government was a major factor determining the likely uptake of the PF. Ensuring committed leadership and engagement from senior politicians and officers was regarded as critical to success. Conclusions The study assessed the value of the PF and the processes surrounding its implementation and use. Further research could further explore the value of the tool in aiding investment and disinvestment decisions and its impact on spending. Key messages The PF provides a platform for engaged and informed deliberation about priorities and does so in an open, structured and transparent manner. Organisational and political context in which prioritisation occur shape the adoption of the PF tool.