Abstract
In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process. Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach. A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool. The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience. All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges. This study helps in increasing public involvement in complex health challenges. No other groups have used this combination of approaches to address this issue.
Highlights
Emerald Publishing Limited purposes), subject to full attribution to the original publication and authors
One author’s experiences as the founding Clinical and Public Health Director of the National Institute for Health and Care Excellence (NICE) 1999–2012 in the UK has reinforced his view that there is a need to undertake more research in how to develop approaches to include social values into the prioritisation process that were conceptually clear and, most importantly, easy to apply on a routine basis in a consistent manner
In 2011, the inaugural workshop was convened at Gresham College London to initiate the process by exploring how social values were currently being incorporated into decision-making processes in different countries
Summary
All health care systems are facing ever greater demands due to aging populations and increasing opportunities to intervene within finite resources. One author’s experiences as the founding Clinical and Public Health Director of the National Institute for Health and Care Excellence (NICE) 1999–2012 in the UK (responsible for priority setting within a HTA framework) has reinforced his view that there is a need to undertake more research in how to develop approaches to include social values into the prioritisation process that were conceptually clear and, most importantly, easy to apply on a routine basis in a consistent manner. This is necessary to reassure patients and the public that institutions making tough prioritisations decisions on their behalf were doing so in an acceptable robust manner and reflected societal values. The user would grade how complete that value was reflected in the institution’s documentation and policies (Table I)
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