Abstract
Our commentary this month asks an important question: what happened to values at NICE, the National Institute for Health and Care Excellence? Peter Littlejohns et al. are worried that the UK’s world-renowned rationing organisation has downgraded the importance of social values in its judgements. 1 NICE is under scrutiny as it celebrates 20 years. At the outset, that seemed an optimistic longevity. Rationing had its critics as it still does, but the effectiveness of rationing policies was unproven. NICE won over critics with evidence-based guidance that was implemented nationally and spawned imitators in other countries. But consideration of social values helped contextualise evidence and make it more palatable. NICE is a healthcare organisation that the UK can be proud of and recommitting to social values is essential to its success and ongoing leadership.
Values help us guide practice and decision-making. As clinicians, we might aim to be patient-centred and evidence-based. It is common to hear senior management talk about living the values. But that’s only possible if the values resonate with staff and staff see senior management living those values too in the way an organisation is run. Perhaps values, then, are a factor in the disillusionment of many doctors in training? Why do doctors want time away from medicine in their early careers? Our research paper this month attempts to answer that question. 2
Indeed, values are essential and everywhere. They influence how we might operate on somebody with lung cancer. 3 They govern the politics of Winston Churchill and the practice of senior doctors who watched over his health. 4 They persuade us to involve patients and the public in clinical research. 5 They help us understand the importance of broaching difficult issues with young people to achieve tolerance and better health outcomes. 6 Above all, the right values, especially social values, help us better serve our patients.