Commissioners of NHS services have a fixed budget from which they must pay for services to meet health needs that are growing and changing (for example, as the population gets older). Sometimes new and better treatments that could replace what is currently being offered become available. This means commissioners must prioritise, making decisions about which services to continue to fund, start to fund, or stop funding (sometimes known as ‘disinvestment’).
DMAT is based on research about:
The processes that make decisions about priorities legitimate and acceptable to people.
The place of social values in health priority setting.
How commissioners or funders of services – such as NHS clinical commissioning groups (CCGs) in England – make these decisions in practice.
The contents and concept of DMAT have been tested with a number of CCGs and patient and public representatives in England. This prototype online version will be tested more widely. There are also plans to see whether such an online tool would be useful in other countries with different health systems, governance, and ways of involving people in decisions about health priorities.
We have created a film about the complexities of setting fair priorities for health care using the example of cancer treatment funding in the UK devolved nations, which you can watch below.
Priority-setting in health aims to determine what, in the context of limited resources, is most important.
Sarah Clark and Albert Weale, Social values in health priority setting: a conceptual framework (2012)
This current version of DMAT is a prototype for testing only. We welcome feedback on all aspects of the tool so that future versions are as helpful and easy to use as possible. Please send any comments you have to the research team via firstname.lastname@example.org
We already have plans to extend and improve DMAT in a number of ways. In addition to any comments of your own, we are very interested to hear from you about the following:
Did you find DMAT useful and how did you use it?
What could be improved to make it more useful for you or your organisation?
Content and language
Do the domains cover the right topics to help you make good decisions?
Are the main questions helpful and easy to understand?
Are the prompt questions helpful when it comes to answering the main questions?
How do you find using the tool? Is it intuitive and easy to use?
Peter is Professor of Public Health at the Department of Primary Care and Public Health Sciences at King’s College London and Honorary Consultant to Guy’s and St Thomas’ NHS Foundation Trust. He is Deputy Director of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, where he also leads the public health research theme. From 1999 to 2012 he was the founding Clinical and Public Health Director of the National Institute for Health and Care Excellence (NICE).
Katharina is a Research Fellow in Health Policy at the Department of Primary Care and Public Health Sciences at King’s College London. She is the deputy lead of the public health theme of the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, a research programme that aims to get evidence into policy and clinical practice. Katharina is a political scientist with a PhD from University College London (UCL). Her research expertise includes the politics of health priority-setting, public and patient involvement (PPI) in priority-setting, health technology assessment and comparative health policy.
Uscreates is a design and innovation agency creating better outcomes and experiences in health and wellbeing. Working with digital agency Kerve, Uscreates has supported the DMAT research team to develop the online prototype version of DMAT.
We would like to thank the following people for their contribution to the development and testing of DMAT:
Members of the public interested or involved in health care decision-making in Merton, who participated in one of our workshops in July 2014.
Patients, service users and clinical commissioners in south London who participated in the workshop ‘What is the best and fairest way to spend NHS money in the area in which you work or live?’ in April 2015.
Patients, service users, members of the public and clinical commissioners who participated in a design workshop in February 2017.
Members of the Patient and Public Voice Group of the NHS London Clinical Senate who provided us with valuable feedback on DMAT.
Professor Albert Weale, Emeritus Professor of Political Theory and Public Policy, School of Public Policy, University College London.
Dr Sarah Clark, formerly of the School of Public Policy, University College London.
Alexandra Melaugh, Pre-doctoral Fellow in Health Economics, King’s Improvement Science, King’s College London.