Background
Clinical commissioning involves ethically challenging decisions about health resource
allocation. However, commissioners come from a range of professional backgrounds
with varying levels of training and expertise in ethical decision-making. Hence, they
may lack the relevant training and resources to feel fully prepared for this
increasingly demanding role.
Aim
This study aims to provide insight into how prepared commissioners feel in making
ethical decisions, what ethics learning needs they might have, and how these might
be addressed.
Design and setting
This qualitative interview study explored the experiences of commissioners working
for Clinical Commissioning Groups (CCGs) in England.
Method
Eighteen participants were interviewed between December 2017 and July 2018 using
a purposive sampling approach to participant selection. Transcriptions were coded
and analysed using constant comparative method of thematic analysis.
Results
Most participants had not received ethics training in preparation for, or during, their
commissioning role, and reported difficulties identifying and analysing ethical issues.
Participants often felt uncomfortable about decisions they were involved in,
attributing this to a number of factors: a sense of moral unease, concerns that CCGs’
decision-making processes were not sufficiently transparent and CCGs were not fully
accountable to the population served.