A safe space for engagement? Stories from the NICE front line
Andrew Dillon
Chief Executive
National Institute for Health and Clinical Excellence
NICE quiz!
Theme
• Some context about NICE, its role in the NHS and the approach we take to developing guidance
• Motivation and behaviours of the groups who act as stakeholders in our work
• Interaction between stakeholders and the influence of the media
• Nature of the space we create to enable stakeholders to engage with our advisory bodies
• Achievements and limitations of the approach
Contribution to health and social care
Independent advisory system
NICE process and methods
• Comprehensive evidence base• Expert input• Independent advisory committees• Consistent processes and methods• Genuine consultation and contestability• Regular review
Interpreting evidence
Who’s engaged?
Stakeholder ambition Stakeholder group Motivation Ambition
Users Improvements in quality , length of life; a sense of entitlement
Access to treatment, services
Manufacturers Shareholder value, return on investment
Buy decision
Professionals Duty of care, professional curiosity, esteem
Enabling recommendation
System Equity of resource allocation, good outcomes, cost control
Return on investment, financial control
Politicians Result for constituents, consistent decision-making
Defensible outcome
Media Story, editorial line, insight Story, editorial line, enlightenment, influence
Academia Methods development, influence
Research, opportunity to influence practice
More than one space for engagement
Stakeholder interaction
SystemSystem
StaffStaffUsersUsers
AcademiaAcademia
IndustryIndustry
MediaMedia
PoliticiansPoliticians
Judiciary
Stakeholder interaction
SystemSystem
StaffStaffUsersUsers
AcademiaAcademia
IndustryIndustry
MediaMedia
PoliticiansPoliticians
Judiciary
Dronedarone appraisal
Stakeholder interaction
SystemSystem
StaffStaffUsersUsers
AcademiaAcademia
IndustryIndustry
MediaMedia
PoliticiansPoliticians
Judiciary
Stakeholder interaction
SystemSystem
StaffStaffUsersUsers
AcademiaAcademia
IndustryIndustry
MediaMedia
PoliticiansPoliticians
Judiciary
Making the space work
• People can say what they want, but reasoned arguments carries the greatest weight
• Meetings structured to enable participation by members and people invited to give evidence
• Apply methods for interpreting evidence which helps ensure but don’t force a conclusion
• Encourage those involved to keep the debate inside the meeting
• Enable those involved to be conscious of but not to feel they should necessarily take account of media and political debate
• Continuously develop the approach
Support for those engaging
• Structure for involvement (evidence submissions, committee meetings, consultation, appeals)
• Resources to help engagement (briefings, guides, public involvement team)
• Standard approaches for assessing and interpreting evidence
• Policy for managing conflicts of interest• Opening the process to public scrutiny
Safe space: positives
• Genuine attempt to engage• Broad definition of involvement• Underpinned by structure and methods, applied
consistently• Transparent, with some limitations• Provides real opportunities to shape the scope and
influence the evidence base• Offers the chance to challenge and require review• Protects but doesn’t insulate the decision process from
external debate and comment
Safe space: limitations
• It’s clearly not, of itself, enough to contain the debate• It isn’t always an easy place to operate in, particularly
for users• Stakeholders not infrequently argue their voice hasn’t
(or hasn’t adequately) been heard• It’s hard for the media and the public to follow
sometimes technical and occasionally esoteric discussions
• It’s survived judicial challenge, but it hasn’t avoided it
Concluding thoughts
• These decisions are some of the hardest in British public life
• They touch on the some of the most sensitive and personal ways in which Government can affect our lives
• Bringing science, politics and service delivery together is messy, difficult to explain and frequently leaves someone unhappy
• But it is, as Frank Dobson said when he launched NICE in 1999, “worth a bloody good try”