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Appendix 3: Practical guidance on completion of the Service Priority Assessment Tool

a. Service intervention or treatment

List key elements of the service or service programme/workstream

It is important to systematically identify key elements of a service or service programme for prioritisation. In doing this, it may be helpful to first identify the broad generic components that comprise the service or service programme. Within each of these broad generic components specific elements of the service can then be identified and prioritised.

For a hospital, primary care trust or primary care organisation the key clinical activities/specialties provided need to be identified. For a hospital based specialty, eg respiratory medicine, this would include identifying specific activities/treatments provided (emergency and routine) across a range of settings including emergency room, inpatient, outpatient and day care. Any hospital outreach services, interventional activities, diagnostic or public health services provided should also be listed.

Conditions or treatments that make up the majority of the workload, as well as highly specialised services or services to medically vulnerable sectors of the population, should be identified.

The survey should be completed for each of the service treatments/interventions identified

The aim is to prioritise the service, workstream or treatment offered and not the individual - so it may be helpful to focus on a specific treatment for an average patient with no co-morbidity. This is indicated by the phrase 'single morbidity assessment' on the survey sheet.

b. Categories

Select the category that best captures the nature of the identified service, intervention or treatment.

Select one of the following:

• immediately life threatening
• emergency
• semi-elective (semi-urgent)
• elective.

c. Rate of deterioration

Without intervention, what would be the rate of deterioration for the 'average' patient using the service?

Select one of the following:

• rapid - over days
• moderate - over weeks
• slow - over months
• not predicted - when at the time of assessment the rate of deterioration cannot be usefully estimated.

d. Impact of doing nothing

Without intervention, what would be the anticipated impact on the health state of the average patient (or on the population)?

Select one of the following:

• death
• severe
• moderate
• mild
• none.

e. Maximum deferral period

Using clinical judgement and any available evidence, what would be the maximum clinically acceptable deferral period for this service, intervention or treatment?

Select one of the following:

• None - <6 hours
• 6 hours - <24 hours
• 24 hours - <3 days
• 3 days - <1 week
• 1 week - <2 weeks
• 2 weeks - <1 month
• 1 month - <2 months
• 2 months - <3 months
• 3 months - <6 months
• 6 months - <1 year
• 1 year and over.

f. Current delivery setting

Identify the range of settings where the service or treatment is currently delivered.

g. Current delivery personnel

Identify the personnel who currently deliver the service or treatment.

h. Current impact on other health and social services upstream and downstream

Identify other key staff, services or supplies that are required to enable the service to be provided, or are impacted upon by the service. For example, these may be in community, primary or secondary care, the NHS, social care or voluntary sector.

i. Alternative delivery setting

In a pandemic, working practice will alter. What would be the alternative setting/s in which this service or treatment could be delivered?

j. Alternative delivery personnel

Who might be an alternative deliverer of the service or treatment in a pandemic?

k. Impact on other health and social services upstream and downstream

What might be the impact on other services or supplies of the altered setting and delivery personnel?

Practical check on the completed Service Priority Assessment Tool

Now consider the scenario where it is the peak of the pandemic and 50% of staff are off work. High levels of clinical activity relating to pandemic flu and its complications are occurring. Which services or treatments would you choose to maintain? Are they those with the shortest deferral period?

Service and patient prioritisation for pandemic influenza survey

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