Implementation and evaluation of local-level priority setting for stroke

We aimed to develop and evaluate a prioritisation process to combine the ev idence base with stakeholder involvement within a stroke programme for a He alth Improvement Programme (HImP). Implementation involved: formation of a district stroke group (DSG); review of the evidence; survey of DSG members; survey of other key professionals; consensus within the DSG; consultation with local users of the service. Evaluation was through semi-structured int erviews and documentary analysis. The process was accepted as appropriate a nd valuable by the majority of participants, and a district HImP implementa tion group allocated pound 100 000 for stroke development as a result of th is process. However, some felt that stroke itself had been an imposed, rath er than an agreed, local priority. The priority setting process was not cle ar to all participants and change of personnel, particularly in the NHS tru sts, led to some perceived lack of ownership. Professionals from secondary care participated, but later criticised the process when they felt that the priorities in the HImP could limit their ability to access money for other service developments. The user consultation days occurred too late to infl uence the 1999/2002 HImP. We have shown that it is possible to develop an a pproach that is broadly accepted by stakeholders and balance the evidence b ase with local ownership. The participation of stakeholders, clarity of pro cedures, local ownership and awareness of local politics are important in e ffective priority setting. The model developed will be of value in other se ttings.