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Should social background, age, or lifestyle choices ever influence the healthcare provided by the NHS?  This is the controversial question that the National Institute for Health and Clinical Excellence (NICE) asked itself this year, to examine how these issues might affect how it develops guidance for the NHS.
 
The approaches that NICE will take are published today in its new report, Social Value Judgements – Principles for the development of NICE guidance.  The report sets out clearly if, and how, social value judgements should be considered in producing NICE healthcare guidance for the NHS.  The report takes account of how NICE has made these decisions to date, the views of its Advisory bodies, advice from its Citizens Council and comments from interested groups and the public.

Some key points include:

• No priority should be given based on individuals’ income, social class or social roles at different ages, when considering cost effectiveness in clinical guidance
• Clinical guidance should only recommend a treatment for a particular age group where there is clear evidence of a difference in that treatment’s effectiveness for that age group
• NICE guidance should not take into consideration whether or not a particular condition was self-induced; a patient’s individual circumstances may only be taken into account when there will be an impact on the clinical and cost effectiveness of the treatment
  

In the past, NICE has made judgements that take age into account. For example, NICE recommends that drug treatments for flu should be made available for people over-65 as they are a vulnerable group and likely to be more seriously affected by flu than younger people.  Also, our guideline on fertility treatment recommends that IVF should be made available to women aged between 23-39, as treatment is most likely to be effective in this age range. 

Professor Sir Michael Rawlins, Chairman of NICE, said: “On age we are very clear: our advisory groups should not make recommendations that depend on people’s ages when they are considering the use of a particular treatment, unless there is clear evidence of a difference in its effectiveness for particular age groups.  Even then, age should only be mentioned when it provides the only practical “marker” of risk or benefit.  NICE values people, equally, at all ages.”

The report acknowledges that it can be difficult to determine whether illnesses are self-inflicted or not.  For example, there is no way of knowing whether or not a smoker who had a heart attack would have had the heart attack even if they had not smoked.  As a result the report proposes that NICE should avoid discriminating against patients with conditions that are, or may be, self-inflicted. However, if the self-inflicted cause of the condition will influence the likely outcome of a particular treatment, then it may be appropriate to take this into account in some circumstances.

The Social Value Judgements report will not be issued as guidance for the wider NHS: it will simply be used to help those developing NICE guidance to make difficult decisions in the best way.  Decisions about individual patient care will be left in the hands of the dedicated doctors, nurses and healthcare professionals who are working across the NHS. 

Read the report, Social Value Judgements, on the NICE website at www.nice.org.uk/pdf/SocialValueJudgement-08_12_05.pdf