The organising principle of this research programme is that as it is so difficult to change the delivery of health care, any option appraisal must consider, for any proposed change, the scale of its impact, and not just marginal analysis (as in cost/quality-adjusted life year). From 2005 to 2007 the Health Foundation funded research at the School focused on developing methods to model diseases, to give estimates of the scale of impacts of interventions at the level of populations: in terms of health gains, reduction in the Burden of Disease (BoD) and costs. This research was designed to develop a generalisable approach by examining acute and chronic conditions and different kinds of interventions. The researchers have developed a method of accounting for costs and benefits over time, for different kinds of interventions to give consistent results so that these can be compared; and a sound way of measuring the impacts of interventions on reductions in BoD. The key lesson from this and later research is that when the objective is to guide strategic decisions to identify where changes will have a material impact, requisite models are required, which can be developed relatively quickly by making explicit assumptions, and establishing the models' robustness by sensitivity analysis.
In 2008, the team collaborated with the Isle of Wight (IoW) Primary Care Trust (PCT) in developing a socio-technical process for prioritisation of 'growth money'. This combined the social process of decision conferencing, which involves key stakeholders, and technical processes that produce evidence using requisite models. Estimated value for money for different interventions for the population was based on four criteria:
Gains in health
Reduction in health inequalities
Likelihood of successful implementation
The IoW collaboration was successful: the outcomes of decision conferencing were used by the PCT to set priorities in its use of growth money, that exercise was awarded a prize by South Central SHA, and the IoW has extended this approach in 2010 (with the Decision Institute, a consultancy linked to the School).
In 2009, the team collaborated with NHS Sheffield in developing a socio-technical process to prioritisation without 'growth money'. This developed the approach used in IoW to examine options along care pathways. This is because experience from Programme Budgeting and Marginal Analysis (PBMA) shows that when stakeholders consider re-allocation of resources that entail reductions in expenditure on one (or more) stage(s) of care pathways, they need to understand the impacts of these reductions on the other stages. Information on the impacts of interventions on inequalities in health was also generated, so that stakeholders could better understand how to make tradeoffs. Three areas were examined: eating disorders (as a small discrete care pathway within mental health), three cancers (breast, colorectal and lung), and dentistry. This research showed how this approach could inform the PCT: both in deciding how to reallocate resources within an area; and which areas are, and are not, likely to be fruitful for such re-allocation.