STAR: combining value for money with patient involvement

The difficult challenge of making cuts to budgets while also ensuring patient choice and satisfaction is something every new clinical commissioning group (CCG) will face in coming months. How can NHS organisations give patients and the local community a say in how money is spent on their healthcare?

The STAR programme aims to help. It is developing a commissioning support package that will offer CCGs and health boards a new way to involve stakeholders in setting health care priorities. The Heath Foundation is working on the programme in partnership with the London School of Economics (LSE), PricewaterhouseCoopers and representatives from commissioning groups and public health observatories, building on our research into Commissioning with the community.

What is STAR?

STAR stands for ‘Socio-technical Allocation of Resources’. It combines a rigorous, technical, value for money analysis with a social approach that involves commissioners, providers, the local public and patients. It was developed by an LSE team led by Professor Gwyn Bevan, as part of a programme of research funded by The Health Foundation from 2008 to 2010, and has been piloted successfully by both NHS Isle of Wight and NHS Sheffield.

The STAR programme aims to produce a toolkit that will be freely available to health services throughout the UK. The toolkit will have three parts:

• A decision support tool to engage stakeholders in comparing the value for money of different services. It will do this by estimating the costs of interventions, the number of patients affected, and their benefits. These assessments will draw from local data, clinical and epidemiological evidence, and expert judgments of involved stakeholders.
• A training module on facilitating decision conferencing. This technique empowers people without technical knowledge to take part effectively in multi-criteria decision analysis. It highlights conflicts, allows options to be properly assessed, and adds transparency and accountability to decision making.
• An evidence-based approach to priority setting, integrating patient experience into the decision-making process.

Why is STAR’s approach important?

Helen Knowles, Senior Public Health Manager at Bedfordshire CCG and a member of the STAR stakeholder group, says: ‘In the past, stakeholders have had variable involvement in decision making, depending on the area. The most exciting thing about this work is that we aim to involve stakeholders in a more meaningful way. If the toolkit is working well, it will make the information more readily accessible to stakeholders and lead to a better process for priority setting.’

Phil da Silva, Director of Commissioning Development at Derbyshire CCG, is another member of the stakeholder group. He says: ‘The ambition is to bring something together that uses a lot of the experience of commissioners, but in a simpler format. What’s exciting is the involvement of patients and population in planning and designing health services, along with clinicians.’

Where did the approach come from?

Between 2008 and 2010, The Health Foundation supported a programme of research into value for money in healthcare at LSE. The LSE team combined concepts of cost effectiveness from health economics with the socio-technical approach of decision conferencing to help health services to improve value through commissioning decisions. Decision conferencing has been developed over the past thirty years to support decision making that involves multiple stakeholders and conflicting values.

The LSE team tested the approach successfully with NHS Isle of Wight and NHS Sheffield. The Isle of Wight PCT used the outcomes of its decision conferencing to set priorities in its use of growth money, for which it was awarded a prize by South Central SHA. The LSE team developed the approach further in collaboration with NHS Sheffield, and this informed the local commissioners in deciding how to reallocate resources within current budget limits.

What does STAR hope to achieve?

The transparency of decision making offered by STAR may enable decisions to be made more quickly, as all stakeholders can see and understand the data. Ultimately, the programme aims to improve the health of patients and population, by enabling commissioning groups to involve the wider community in the decisions that affect them so greatly.