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Created in partnership with Warwick Business School

Tackling Tough Choices: Creating Public Value

The framework and tools contained in these pages will help you to seek out opportunities to make significant improvements to the lives of the public.  These tools and case studies are ground-breaking: these are the first time that Public Value has been translated in practical tools to support healthcare managers.

As public servants in the NHS, we are familiar with the need to make tough choices and crunch decisions resulting from finite resources and apparently infinite demand. It is widely recognised that these tough choices will become increasingly challenging in the context of the economic crisis and fiscal climate.

These challenges include investment decisions (service A OR service B? treatment A OR treatment B?). These are undeniably difficult challenges, often with no straightforward ‘correct’ answer, or even a clearly established method for tackling the problem. They involve dynamic tensions that need to be actively debated and managed by those designing, developing, delivering and receiving NHS services. Technical tools (such as modelling, generating scenarios, economic forecasting) are necessary but not sufficient for making such decisions. Almost any major health decision is heavily influenced by non-technical forces (such as local or national politics, organisational cultures, media involvement, and pressure from interest groups).


This toolkit introduces Public Value as an approach that may help you to identify, deliberate and manage these challenges. The tools and case studies are thoroughly grounded both in academic literature and in debate and testing within many parts of the public service

In these pages, you will find

  • Information on Public Value as a concept
  • Handy tools you can use locally
  • NHS case studies
  • Summaries of the potential Public Value offers to some specific NHS roles


The Department of Health has introduced QIPP as the means by which the NHS can both improve quality and deliver efficiencies by harnessing and implementing the themes of:

  • Quality
  • Innovation
  • Productivity
  • Prevention

The Public Value tools, approaches and case studies in this toolkit have the potential to impact on all four elements of QIPP.  Our primary case study (NHS County Durham) directly addresses the two Ps: productivity through investment decisions for prevention and treatment.

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NHS Institute for Innovation and Improvement