ABOUT THE RESEARCH PROGRAMME
In order to create effective and sustainable health systems many countries are introducing ways to prioritise health services which involves making difficult decisions concerning who gets (and who does not get) healthcare interventions. Priority setting requires technical judgements of clinical effectiveness (what works) and cost effectiveness (is it worth the money). But these judgements are embedded in a wider set of social (societal) value judgements that underlie justifiable reasoning about priorities, including fairness, responsiveness to need and nondiscrimination, and obligations of accountability and transparency. Even when these decisions are based on the best available evidence they face legal, political, methodological, philosophical, commercial and ethical challenges. Through international, multidisciplinary, collaborative working we are developing new ways of addressing these concerns. To generate public acceptance of the need for health prioritisation we have developed a novel way of encouraging key stakeholders, including patients and the public, to become involved in the prioritisation process. Through a multidisciplinary collaboration involving a series of international workshops (funded by the Nuffield Trust, the Wellcome Trust and the Brocher Foundation) we have applied ethical and political theory (including accountability for reasonableness) to develop a practical way forward . We have tested this approach in a range of Clinical Commissioning Groups (responsible for commissioning health services) in England using a mixed methods approach. Out of the first workshop emerged a social values framework that consists of content and process values that has been converted into a decision-making audit tool (the DMAT). Working with a design company we have now created an interactive digital online version that allows internal and external audit of how an institution is incorporating values into its decision making http://www.priorities4health.com/ . The conclusion of the second workshop exploring the international experience of public involvement in health prioritisation was that we need to bring alive the issues of health prioritisation in a way that makes sense to stakeholders, patients and the public . To achieve this we have collaborated with young film makers from the KCL Entrepreneurship Institute to produce a health prioritisation film relevant to the UK as the first step in producing a series of country specific films highlighting prioritisation issues “The lottery of Devolved Cancer Care” https://youtu.be/gHNYAc6njTA . This film depicts variation in access to expensive cancer drugs in the four home countries of the UK. Our approach has been applied in New Zealand and Chile and is being extended to Australia, Peru, Sierra Leone and Thailand
2012 workshop at Gresham College
2015 Workshop at Brocher Foundation
Policy Analysis by the Social Values Group London
This was the first international workshop where the social values framework was developed. There are papers from a range of countries where the framework has been applied and a conceptual paper and ethical critique are also here. The framework was also tested on two institutions
This was the second workshop where public involvement in a range of countries was explored . Papers describe the types of public participation in the representative countries and creates a research agenda to address the deficits in knowledge. The conference proposed a new way of looking at public participation. No longer should contestatory approaches be seen as illegitimate.
This section presents papers and activities of a multidisciplinary group of researchers and policy makers in London who assess current health policies linked to prioritisation issues in the UK. Many papers address the evolution of the National Institute for Health and Care Excellence (NICE). They should be considered as observations from a "critical friend" as NICE has become an important institution in the NHS ensuring that the care given to patients is of high quality and fairly distributed
A FILM ABOUT PRIORITISATION
IN THE UK
The film “The lottery of Devolved Cancer Care” was developed in 2017. It uses variation in access to expensive cancer drugs in the home countries as a relevant case study for a UK setting. It is based on the circumstances that led Ifron Williams moving from Wales to England to get his treatment.