Research

DMAT grew out of a collaborative project that was carried out in 2011 with the National Institute for Health and Clinical Excellence (now National Institute for Health and Care Excellence), known as NICE. This project investigated the role of social values in choosing where to allocate resources, particularly in times of financial constraint. Researchers from around the world were involved in the original project and many are now acting as advisors for the current CLAHRC South London project.

The DMAT prototype draws on two main frameworks for its domains: Norman Daniels and James Sabin’s Accountability for Reasonableness (A4R) and Sarah Clark and Albert Weale’s Social values in health priority setting.

The A4R framework for fair and legitimate priority setting in healthcare is based on the idea that it is easier to agree on fair processes than on principles of fair decision-making in priority setting. It suggests that transparent, consistent decision procedures – those which provide public access to the reasons behind decision outcomes – will be legitimate and acceptable to those affected by them.

Clark and Weale’s social values framework is concerned with social values (that is, values that are held by society at large), in relation to both the content and processes of priority setting. They argue that justifying social value judgements is an important element in any public justification of how priorities are set. They also highlight that values are linked and interconnected. For example transparency may depend on increasing participation or accountability.

You can read more about the background to DMAT and the ongoing research in the BMJ Open article ‘Does accountability for reasonableness work?’

Legal duties

In England, the NHS is required by law to involve patients and the public in decision-making about the planning and providing of health services. These statutory duties are contained within the Health and Social Care Act 2012. They are summarised in Appendix A (p.50) of ‘Patient and public participation in commissioning health and care: Statutory guidance for clinical commissioning groups and NHS England’. This guidance also contains resources and good practice examples to help local decision-makers involve people effectively and fairly.

As part of the Health and Social Care Act 2012, NHS England and CCGs have a separate statutory duty to reduce health inequalities between patients in terms of, both, access to health services and the outcomes (health benefit) that can be achieved.

The Equality Act 2010 prohibits unlawful discrimination in the provision of services on the ground of ‘protected characteristics’. These are:

  • Age
  • Disability
  • Gender reassignment
  • Marriage and civil partnership
  • Pregnancy and maternity
  • Race
  • Religion or belief
  • Sex and sexual orientation.

Glossary

Accountability

Accountability is the obligation of an individual or organisation to accept responsibility for their actions; and to be able to provide satisfactory reasons for acting as they did; and to disclose or actively share their decisions and the thinking behind them.

Clinical effectiveness

Clinical effectiveness means that a treatment, ‘treatment pathway’ or service works well and does what it intends to do, based on good evidence.

Clinical commissioning group

Clinical commissioning groups (CCGs) are responsible for the planning and commissioning of NHS services for their local area.

Commissioning

Commissioning is the process that public sector organisations use to plan, pay for, and monitor services for local residents.

Cost effectiveness

Cost effectiveness examines the costs of a service or treatment in relation to its benefits in order to assess whether the costs of funding a service can be justified in light of the expected benefits.

Disinvestment

Disinvestment is a technical term for ceasing to fund – or invest in – something (a service or treatment) that was previously funded.

Equality Impact Assessment

Equality Impact Assessment (EIA) is a process designed to ensure that a policy, project or scheme does not discriminate against any disadvantaged or vulnerable people. Public organisations may be obliged by law to carry out an EIA if they are making certain kinds of funding decisions or changes to the way they deliver services.

Fairness

Fairness is about treating people equally or in a way that is considered right or reasonable. Fairness may mean different things to different people in different situations. Organisations that commission services need to consider the impact of their decisions on different groups and do their best to ensure that no-one is unfairly disadvantaged.

Joint Strategic Needs Assessment

A Joint Strategic Needs Assessment (JSNA) looks at the current and future health and care needs of local populations to inform and guide the planning and commissioning (buying) of health, well-being and social care services within a local authority area.

Legitimate

A decision or action may be legitimate if it is based on correct or acceptable principles of reasoning; if it is considered reasonable, sensible, or valid; or if is in accordance with law. DMAT is particularly concerned with how best to make a decision that is considered reasonable and valid by those affected.

Outcome

An outcome is a consequence or result. In health, it is often used to describe the health benefit or improvement achieved as a result of treatment.

Prioritisation

In healthcare funding, prioritisation is the process of deciding which services or treatments are most important to fund from within a fixed budget that cannot fund everything.

Public health

Sometimes known as ‘population health’, public health is about the health of groups of people and not individuals. It is concerned with preventing ill health (mental as well as physical) rather than curing disease. Public health also aims to reduce so-called ‘health inequalities’ or the differences in health between different groups.

Social care

Social care refers to services and organisations providing practical or emotional support to help people lead an active and independent life (for example, older or disabled people). Social care is different from healthcare which aims to help people who are ill, although there are people who need both kinds of care.

Social values

Social (sometimes ‘societal’) values are the moral or ethical values of a particular society (in other words, what society thinks is important as a matter of principle). Examples of concepts that are impacted by such values are: the place of personal and collective or shared responsibility; the role of the family in caring; the importance of preventing or treating specific diseases. Social values reflect factors such as culture; religion; how wealthy or poor the society is; and what groups make up the population (for example, whether it is a younger or older population overall). Social values may also change over time.

Stakeholder

Stakeholder is a term often used in policy and public sector organisations, and is used to reference a person or organisation with an interest in an organisation or activity, particularly if they will be affected by any decision (such as about funding).

Strategy

A strategy is a plan for achieving goals over a relatively long period of time, including both what will be done and how.

Transparency

Transparency is about being open, and also showing a willingness to demonstrate and explain what has been done and why. It is closely connected to accountability.

Treatment pathways

Also known as clinical or care pathways, treatment pathways are standard or agreed ways of managing a patient’s care over time.