Prioritisation of specialist health care services: going beyond the evidence

Materials and methods A Prioritisation Panel representing a wide range of stakeholders was convened. A master list of services was achieved through matching against criteria (including high cost individual care, growth or implementation that exceeded an incremental cost of £50,000, uncertainty about evidence or ability to benefit) for evidence and prioritisation. Condition-Treatment pairs were created for the services falling under the remit of WHSSC, evidence reviews undertaken and evidence of effectiveness and cost effectiveness were collated to inform the decision making process. Discreet choice methods were used to rank order and apply a cut off point for commissioning or not. Score cards were developed to score for scientific rigour, inclusiveness, transparency, independence, challenge, review, support for implementation and timeliness. These features relate to the procedural justice requirement for ‘accountability for reasonableness’ described in the published literature. Results The common finding for the condition treatment pairs was lack of evidence to guide confident decision making. Through the process, the Panel was required to make judgements: scientific value judgements about interpreting the quality and significance of the evidence available and social value judgements. These latter were guided by four principles: respect for autonomy, non-maleficence, beneficence and distributive justice. A prioritisation and commissioning list was created and specific services identified for commissioning and decommissioning.