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120:oral Developing and implementing a framework for priority setting in health and social care in Scotland
  1. Marissa Collins1,
  2. Rachel Baker1,
  3. Micaela Mazzei1,
  4. Cam Donaldson1,
  5. Alec Morton2,
  6. Lucy Frith3,
  7. Keith Syrett4,
  8. Paul Leak5
  1. 1Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK
  2. 2Department of Management Science, University of Strathclyde, UK
  3. 3Centre for Social Ethics and Policy, School of Law, University of Manchester, UK
  4. 4University of Bristol Law School, University of Bristol, UK
  5. 5Directorate of Health and Social Care, Scottish Government, UK


There is a move, internationally, towards greater integration of health and social care. In principle, integration reduces budgetary boundaries which can facilitate sharing of resources across health and social care. Part of the agenda is for local delivery organisations to alter the balance of care from acute to community environments. To facilitate this shift, against a background of increasing austerity, there is a need for robust processes for making difficult resource allocation decisions which meet the standards of disciplines such as economics, ethics, law and decision science. In 2014, the Scottish Government established 31 Health and Social Care Partnerships (HSCPs) acting as single commissioners to deliver this agenda.

The aim was to develop and implement an enhanced, multi-disciplinary framework for priority setting, for use by four HSCPs, and assess its impact on processes, decision-making and resource allocation.

Methods To develop the framework, a literature review was conducted. The findings form the review were combined with input from key stakeholders including, academics, local and national-level stakeholders. During implementation of the framework, Participatory Action Research was undertaken to explore how the framework functioned within HSCPs, to document how participants engaged with the framework and to consider how the framework could be adapted to an integrated institutional setting. Interviews were conducted before and after working with the framework.

Results The framework is underpinned by principles from economics (opportunity cost), decision-analysis (good decisions), ethics (justice) and law (fair procedures). Three sites worked through the process and made recommendations. Proposed recommendations include disinvestment and reallocations within budget areas. Despite challenges, stakeholders’ views were that such a framework is required to move from resource allocations being based on historical budgets and service provision and encourages transparent decision making involving wider stakeholders. Increased pressure on resources has made such frameworks even more critical for decision making.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: .

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