External  ▪ To address political priorities  ▪ To meet legislative, regulatory or accreditation requirements and professional standards  ▪ To meet national recommendations  ▪ To address legal and ethical issues  ▪ To be sensitive to the environment |
Financial  ▪ To save money to meet budget cuts  ▪ To find money to spend on something else  ▪ To prioritise where money is spent  ▪ To redistribute within or between budgets  ▪ To support investment in new technologies  ▪ To support continued investment  ▪ To get value for money |
Economic  ▪ To maximise benefits from resource use  ▪ To improve efficiency  ▪ To maintain quality without extra expenditure  ▪ To remove TCPs with unacceptable cost per QALY |
Organisational  ▪ To meet strategic goals and priorities  ▪ To ensure sustainability  ▪ To increase productivity  ▪ To work within organisational capacity  ▪ To work within staff capability  ▪ To rationalise services eg only provide orthopaedics at hospital A and oncology at hospital B  ▪ To enable system redesign  ▪ To reduce health service utilisation  ▪ To reduce risk to staff, finances or reputation  ▪ To reduce waste  ▪ To address specific problems |
Patient care  ▪ To improve patient health outcomes  ▪ To reduce patient harm  ▪ To target populations or indications for best results  ▪ To improve patient flow and reduce waiting times  ▪ To improve patient satisfaction or reduce inconvenience  ▪ To improve patient access and equity of service provision  ▪ To reduce unnecessary tests or treatment |
Health technology, clinical practice or service  ▪ To keep equipment up-to-date  ▪ To remove obsolete or superseded technology  ▪ To remove or restrict TCPs that are harmful  ▪ To remove or restrict TCPs that have little or no value  ▪ To replace TCPs with alternatives of greater benefit  ▪ To remove services that are not performing as intended  ▪ To remove services that are not meeting the needs of the target population |
Evidence Based Practice  ▪ To ensure practice is consistent with current evidence  ▪ To actively identify evidence of harm or lack of effect and remove relevant TCPs  ▪ To update evidence-based guidelines and protocols |
Social judgement  ▪ To ensure public funds are spent wisely  ▪ To reduce public funding on discretionary services eg some cosmetic procedures |