The former Clinical and Public Health Director at the National Institute for Health and Care Excellence (NICE) has expressed dismay at the removal of explicit ethics and values in the proposed revision of the NICE Social Value Judgements document.
Professor Peter Littlejohns, together with a group of eminent political scientists, philosophers, health economists and ethicists, is the co-signatory of a commentary published today by the Journal of the Royal Society of Medicine. The commentary coincides with the NICE 20th anniversary and concludes that the proposed revision departs from many of the values that made NICE such an innovative and widely admired organisation throughout the world.
In 2005, as a way of publicly justifying its decision-making processes, NICE developed a statement of what it termed its ‘Social Value Judgements’. This was updated in 2008 when NICE acquired responsibilities for public health. In November 2018 NICE announced that it was updating its Social Value Judgements and has published a consultation document ‘The principles that guide the development of NICE guidance and standards.’
In their commentary, the group point to the remarkable absence of any specific commitments or reference to substantive social or ethical values in the revised NICE document. Substantive values present in the earlier versions – notably fairness, equality and respect for autonomy – have been dropped.
Professor Littlejohns said: “NICE’s rationale for this dramatic change is that all the values relevant to NICE are available in other documents. However, these total many hundreds of pages whose content is, for the most part, highly technical.”
He continued: “Patients who are being denied treatment on the basis of NICE’s decisions will particularly struggle to make sense of their situation, as will clinicians who need to explain such decisions to them. Equally, NICE’s decisions will be left open to a wide range of professional, financial, political and other interests without providing a basis for scrutinising them.”
The group suggest that it would be better to withdraw the revised document and start work on a thorough revision of NICE Social Value Judgements. Professor Littlejohns said: “NICE has a responsibility not only to ensure that its social and ethical values are explicit and aligned with the goals of the NHS, public health and social care, but how they are made a day-to-day reality. The new document does little to achieve this.”
National Institute for Health and Care Excellence, social values and healthcare priority setting (DOI: 10.1177/0141076819842846), by Peter Littlejohns et al, will be published by the Journal of the Royal Society of Medicine at 00:05 hrs (UK time) on Wednesday 3 April 2019.
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