Public considers what societal values should influence NICE’s decisions

The Citizens Council is made up of thirty members of the UK public that provides a public perspective on challenging social and moral issues that NICE has to take account of when producing guidance and quality standards.

The Citizens Council is broadly representative in key demographics such as age, gender, ethnicity and socio-economic status and meets for two days at a time to discuss a specific topic. During the meetings, members hear from topic experts and take part in exercises to examine the topic in detail and discuss their own views. A report writer captures the members’ views and conclusions and prepares a report of the meeting to present to NICE’s Board.

In May 2014, the Citizens Council met to explore the trade-offs between efficiency and equity in decisions about how resources are distributed. We wanted to know their overall thoughts on the issue and identify the range of societal values that underpin judgements about what appropriate balances of equity and efficiency look like.

NICE’s remit has grown over the years, from our initial focus on health care to the addition of public health and more recently social care, so we were especially keen to find out whether the Citizens Council felt the same societal values were important across all three areas of our work or where there might be differences.

We were also interested to know the Council’s views on any ‛special circumstances’ when we should place a particular emphasis on achieving either equity or efficiency.

To help explore these areas, the Council debated a series of case studies. These illustrated the difficulties involved in deciding how to get the best value from the money spent whilst ensuring those resources are shared fairly.  One example was a local council proposing to close a respite day centre used by a small number of severely disabled children, and instead use that money to improve and increase home-based care for children and their families.

The Citizens Council concluded that there are a number of values that apply across public health, health, and social care when making decisions on equity and efficiency, including:

  • collective responsibility
  • dignity
  • fairness
  • honesty
  • humanity

They also decided that there are some additional values that were particular priorities for each of the three areas of care, including:

  • public health: individual rights; maximising total benefit; safeguarding the vulnerable
  • social care: right to health and welfare for all; independence; individual choice
  • healthcare: justice; respect; being non-judgmental.

The Council also highlighted a special circumstance, where greater emphasis on equity is needed, is public health intervention in times of epidemic or natural disaster.  They felt that a special circumstance, where a greater emphasis on efficiency is needed, is non-essential cosmetic surgery.

Professor David Haslam, Chairman of NICE, said: “This thorny topic essentially looks at getting the most out of every pound spent against ensuring that there is fairness in the way resources are shared.

“The Council’s view was clear that there are core societal values which apply across NICE’s three main areas of care. The report conclusions will be helpful to our work integrating the development of our health, public health, and social care guidance and standards and will inform the update of the NICE social value judgements document.”

The final report was submitted to the Board of NICE and published in December 2014.