Public To Shape How NICE Balances Fairness With Efficiency
Dignity, collective responsibility, and safeguarding the vulnerable are among the values that should be considered when making decisions about how resources should be spent both fairly and efficiently.
The recommendation comes from the latest report by the NICE Citizens Council, which is a group of members of the public that provides input into NICE’s work.
Given the climate of increasing resource pressures in health and social care, it is often difficult to find ways of balancing an efficient use of resources – where the most is done with what’s available – with equity, where they are fairly distributed.
For example, a commissioner may decide to fund an expensive treatment because it is clinically and cost effective. However, this may not be an equitable use of resources if the treatment only benefits a small number of people.
Earlier this year, the Citizens Council met to discuss the societal values important for making decisions that balance efficiency and equity.
This led to the Council developing a list of key societal values that NICE should consider across its public health, social care and health care programmes.
The Council felt that these values should both influence decisions on the trade-offs between equity and efficiency, and be used as guiding principles for all of NICE’s work.
The list of key societal values to be considered across all three NICE programmes are:
- Accountability
- Collective responsibility
- Dignity
- Education
- Fairness
- Honesty
- Humanity
- Individual rights
- Justice
- Maximising total benefit/benefit for most/utilitarianism
- Quality of life
- Respect
- Right to health and welfare for all
- Safeguarding the vulnerable
- Value/quality of service
The Council identified additional values for particular aspects of NICE’s work. For example, consequentialism, and freedom/liberty for public health, independence and individual choice for social care, and respect and being non-judgemental for health care.
Special circumstances were also identified, which might require greater emphasis on either fairness or efficiency.
For example, a greater emphasis on efficiency might be needed for non-essential cosmetic surgery. And social care services for children might be a special circumstance which requires a greater emphasis on equity.
NICE will now use the Council’s findings to update its Social Value Judgements document, which outlines the principles for the development of NICE guidance.
Professor Sarah Garner, Associate Director Research and Development at NICE, said: “The particular strength in the report’s conclusions is that they are described in Council members’ own words, rather than the ‛official’ terminology of academics and others with expertise in societal values.
“This will be invaluable for ensuring that the updated Social Value Judgements document and NICE’s future discussions of societal values can be described in ways that feel relevant to the real world. It will also enable us to ensure that any development of our processes and methodology has those values at the core.”
Professor David Haslam, Chairman of NICE, said: “I very much welcome this final report from the Citizens Council on the societal values which inform its views on balancing equity with efficiency.
“The Council’s view that values based on fairness, including collective responsibility, a right to health and welfare for all, dignity, and humanity are some of the core societal values which apply across NICE’s three main areas of care, will help inform our work integrating the development of our health, public health, and social care guidance and standards.
“The Citizens Council provides a snapshot of the public’s views on a range of issues where people might have widely differing opinions – their conclusions are an important contribution to NICE’s work.”
He added: “Weighing up equity and efficiency is complex, so their final report identifying the range of societal values underpinning judgements on this issue is very helpful.”
