Priority Setting

15399Shifting the gravity of spending? Exploring methods for supporting public health commissioners in priority-setting to improve population health and address health inequalities.

What are the aims of this project?

The main aim is to investigate which prioritisation tools do Local Authorities find useful for prioritising public health investment and why. In addition, it addresses the following questions:

  • What are the enablers and barriers for decision-making related to prioritising investment in public health?
  • What difference does the use of specific decision-making support exert on spending within and across programmes with reference to improving health and addressing health inequalities?

 Why is this important?

Investing in health improvement and addressing health inequalities are key policy priorities. Whether they are reflected in practice will depend in large measure on how commissioners prioritise investment and, particularly in times of economic stringency, how they make decisions about disinvestment.

While there are many approaches and methods for prioritisation, their respective strengths and limitations are not well understood by Local Authority commissioners and practitioners. However, there is increased urgency to demonstrate ‘return on investment’ in relation to public health interventions and in exploring methods of decision support for public health priority-setting.

 How will the research be carried out?

The proposal will adopt a mixed methods approach. Three local authorities across England will be selected as case study sites. In each site:

  • We will support decision-making through bringing together specialist input from health economics and public health, combined with knowledge exchange support.
  • We will conduct interviews with stakeholders to inform the development of priority-setting and also provide a baseline assessment of methods and approaches in use.

The impact of prioritisation methods will be evaluated through:

(1) follow up semi-structured interviews to identify views on (a) the degree to which prioritisation methods adopted in their case study site influenced service change or the balance of services; and (b) the relevance of prioritisation methods adopted in their site for improving health and addressing health inequalities;

(2) documentary analysis in order to (a) analyse the discourse related to prioritisation within and across departmental budgets; (b) identify the size of the public health ring-fenced budget within the case study sites at the start of the project and monitor changes over an 18 month period; (c) examine actual or planned shifts in spending patterns within and across specific topics related to health improvement.

There will also be direct observation of key meetings where priorities and budgets are being discussed subject to negotiation and prior agreement with the Chief Executive of the local authority.


Early 2013 until Autumn 2015; (with an extension until 2016 for the follow-on project).

Who is undertaking the research?

Led by Professor David Hunter (Durham)

In ScHARR: Sarah Salway, Nick Payne, Praveen Thokala, Liddy Goyder.

How are stakeholders being engaged?

An external advisory group, reflecting expertise from public health, academia, the NHS and local government, will provide advice and support throughout the project.

 What will be the outputs from the study?

  • Presentations at Public Health and Local Government Conferences;
  • Articles in peer reviewed journals;
  • Articles in the practitioner press.
  • A project website will be established and serve as a vehicle for communicating between the research team and study sites.
  • A copy of the final report will be sent to all participants.

Presentations and papers from the project will be listed here.

Marks L1, Hunter DJ2, Scalabrini S3, Gray J4, McCafferty S5, Payne N6, Peckham S7, Salway S8, Thokala P9.  The return of public health to local government in England: changing the parameters of the public health prioritisation debate? Public Health. 2015 Sep;129(9):1194-203. doi: 10.1016/j.puhe.2015.07.028. Epub 2015 Aug 19.

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