Report on NICE Citizens Council meeting patient safety : 7-9 June
the possibility that failure to address the safety issue in question could have a severely damaging effect on public confidence in the NHS.
| Corporate Authors: | , |
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| Format: | eBook |
| Language: | English |
| Published: |
London
National Institute for Health and Clinical Excellence (NICE)
2007, 2007
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| Series: | Citizens Council reports
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| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | the possibility that failure to address the safety issue in question could have a severely damaging effect on public confidence in the NHS. We are aware that the methodology currently used by NICE - and which is also likely to be used in developing safety solutions - relies on the QALY. However, a substantial majority felt that the QALY methodology did not lend itself well to making decisions on cost effectiveness in the area of patient safety. This is because the QALY does not include certain costs including litigation, cost to carers and those left behind following a death. However, mindful that the QALY continues to be widely used in work of this kind and that currently there is no other adequate cost effectiveness tool, most of us also felt it would not be helpful to NICE simply to dismiss QALYs out of hand. So, with this absence of a suitable alternative, we would suggest that if NICE is to use QALYs in assessing safety solutions, it does so with a degree of flexibility greater than is normally the case when setting a threshold figure above which expenditure for a particular purpose is judged unacceptable. The Citizens Council provides NICE with a public perspective on overarching moral and ethical issues that NICE should take into account when producing guidance. Made up of members of the public, broadly representative of the adult UK population, the Council operates through a "citizens' jury" style meeting, to explore and respond to a question set by NICE. At its June 2007 meeting, the Citizens Council was asked: 1. Is it appropriate when developing "patient safety solutions" that NICE take the costs, as well as the benefits, into account? 2. If yes, what principles of cost-effectiveness should apply? 3. If no, what criteria should NICE apply in deciding whether or not it should recommend a particular safety solution to the NHS? In response to the first question put to us, a substantial majority of the Council agreed that it is appropriate for NICE to take account of costs as well as benefits when developing guidelines on the improvement of safety. While we recognise that departing from a single standard threshold creates problems of its own - not least in consistency - we are also aware that NICE does on occasion move outside its own self-imposed limits when particular circumstances seem to justify such action. What circumstances might be relevant when making decisions on the cost of equipment or practices intended to avoid error? We envisage a sliding threshold limit. Factors that might contribute to the case for moving a threshold include: 1. the severity to an individual of any likely injury or harm resulting from the error;2. the wider cost to society of coping with the aftermath of the error - cost to those left caring or bereaved, cost of litigation;3. the extent to which the error is unique to the medical environment (falls can happen anywhere; only in operating theatres do people have the wrong kidney removed); and4. |
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| Physical Description: | 1 PDF file (45 pages) illustrations, portrait |