4 December 2014

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.