For decades to come need and demand will increase faster than the resources available. Society will need to maximise value from the resources it allocates for public services including healthcare and to do this ten questions need to be addressed
Question 1: How much money should we spend on healthcare?
Question 2: Is the money allocated for the infrastructure that supports clinical care at a level which will maximise value?
Question 3: Have we distributed the money for clinical care to different parts of the country by a method that recognises both variation in need and maximises value for the whole population?
These questions are primarily the responsibility of the Cabinet and the Secretary of State for Health. Then comes the role of the Commissioners. They will want they resources they allocate to be used in ways that have a positive answer to questions 5-10 but they hold those to whom they have allocated resources to do this. The answer to Question 4 is, however the primary responsibility of commissioners. It is important to note that specialist commissioners produce some of the answers to question 5 but do so with regard to the effect their decision this has on the distribution of resources to the different and the thirty sub groups of the population outlined in Appendix 1
Question 4: Has money been allocated to different patient groups in a way that is not only equitable but also maximises value for the whole population?
Question 5: Are all the interventions being offered likely to confer a good balance of benefit and harm, at affordable cost, for this group of patients?
Question 6: Are the patients most likely to benefit, and least likely to be harmed from the interventions, clearly defined?
Question 7: Is effectiveness being maximised?
Question 8: Are clinical risks being minimised?
Question 9: Can costs be cut without increasing harm or reducing effectiveness
Question 10: Could each patient’s experience be improved?
This game focuses on Question 4 which is not only a responsibility of commissioners. They have to make decisions about the allocation of resources between programmes, for example between respiratory disease and cancer. Clinicians will be responsible for the allocation of resources within programmes, for example between asthma, COPD and sleep apnoea within the respiratory programme budget and, with patient involvement making decisions within each system , and the STAR tool is a related game designed specifically for this purpose (2)