Criticism of market-based approach to service delivery and structure
If criticism grows of the application of health economics and cost-benefit approaches, pressures may grow to develop alternative approaches.
Efforts to rationalise decision making through the application of health economics and cost-benefit approaches have gained footholds in many areas of health management. However, these efforts are often contested in terms of specific applications (as in campaigning against specific NICE decisions). In another example it is also unclear how commissioning through Any Qualified Provider (AQP) will affect service delivery including health promotion and awareness in the public health domain. There are implications in the current financial climate that overall in health care AQP may lead to driving down costs at the expense of quality. This may have implications for long term workforce planning and training as higher degrees of uncertainty will emerge in a more competitive environment.
Several factors could lead to more challenges to these methods, including:
- multiculturalism, where different communities have differing values attached to various aspects of life
- recognition that public health involves informal care with burdens very unevenly distributed (e.g. across gender and income levels)
- extreme cases where application of these methods results in highly publicised anomalies.
Efforts to develop alternative methods and/or to shore up these techniques may take different forms. Therefore, different communities may in practice develop their own approaches, leading to public health and commissioning professionals requiring training in different approaches, and managers having to confront departures from universalism and difficult questions where individual responsibility is seen to play a role in ill health (e.g. smoking, obesity).
This might be seen as part of a shift away from modern assumptions of universal rationality to postmodern experimentation with multiple approaches. On the other hand, a new ethics-of-care approach might be consolidated; it is highly likely that much more attention will be given to ethics in public health in coming years. Note: These public health ideas are liable to be pervasive but may become especially difficult where emergencies create needs for triage or very uneven distribution of resources.
Analysis
This section outlines the projected workforce impacts of the idea.
Impact on sector
workforce demandThe vertical axis represents an increase or decrease in supply or demand from the baseline which is the year 2012.
Level of confidence in this analysisThe confidence level is based on the confidence of the stakeholder who added this idea in their information.
Low
Low
Comment
Impact on financial outcomesThe scale used to assess the impact on financial outcomes is:
significant cost savings (25%+),
moderate cost savings (5%-25%),
minor costs savings (1%-5%),
minor increase in cost (1%-5%),
moderately increases cost (5%-25%),
significantly increases costs (25%+).
| Health and social care practitioners |
 |
moderate cost savings (5%-25%) |
| Employers |
|
moderate cost savings (5%-25%) |
| Training and education providers |
 |
moderately increases cost (5%-25%) |
| Private sector organisations |
|
moderately increases cost (5%-25%) |
| Commissioners |
 |
minor costs savings (1%-5%) |
| Government (England) |
 |
minor increase in cost (1%-5%) |
Geographical variance of impacts
| Increase imbalances |
 |
|
Level of certainty about impactsThe scale used in this question is:
Very likely (90–100% probability),
Likely (66–90% probability),
About as likely as not (33–66% probability),
Unlikely (10–33% probability),
Very unlikely (0–10% probability).
| About as likely as not (33 to 66% probability) |
 |
|
Early signals
This section highlights any warning signals indicating that this idea is unfolding.
The AQP programme results in large profit seeking companies, with capacity to drive down costs, entering public health sector Increasing concerns that price competition will threaten patient care and quality assessed service delivery Private sector providers unable to provide appropriate staff training as too costly Discontinuities emerge in delivery as some private sector providers go out of business as they find they lack capacity (e.g., in another domain, private security contracting for London 2012) Increasing confusion as to financial impacts on all the relevant stakeholders
Forward looking advice
Who should care about the idea?
This analysis provides stakeholders with guidance about what they need to consider when planning the workforce based on this idea unfolding.
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General public and service users
Recommendations: Strengthen understanding of importance of public health to elicit support for changes in service delivery related to speicifc community needs
-
Employers
Recommendations: May involve devolution of decision making responsibilties to local community interest groups:
-
Training and education providers
Recommendations: Flexibility in response to demands for changes in training platforms and curricula which seemingly do not fit traditional approaches
-
Commissioners
Recommendations: Unclear as may be confronted by increases in unregulated and controversial approaches to public health arising from grass roots levels
-
Private service providers of health and social care
Recommendations: Unclear as such providers might emerge from grass roots activity to compensate for deficits perceived in traditional institutional structures of public health provision
-
Policymakers (national level)
Recommendations: May have to facilitate scoping to ascertain whether or how the growth of alternative approaches will affect current and projected changes in public health structures
Link to big picture challenges
This idea potentially impacts on the following big picture challenges:
"Unable to assess impact as dependent on many scenarios"
"Unable to assess impact as dependent on many scenarios"