How do we define the value of public services?
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Version 0 of 1. Is it justifiable for someone who is housebound because of their medical conditions to use their personal health budget to buy a new television, mattress or computer? Media coverage of the NHS personal health budgets programme led to intense debate about how people living with long-term conditions or disability should be allowed to use public money. Opinions are polarised. At one end of the spectrum are clinicians who believe that public money should only be spent on evidence-based treatments. At the other end are people who have benefited from having their own budget and whose lives have been transformed as a result. Behind the debate are different perspectives on what constitutes value. Service users tend to think about the value of care, support or treatment options in terms of the impact that public services have on their lives – “what matters” to them as individuals. On the other hand, clinicians think about value in terms of clinically measureable improvement and managers and commissioners conceptualise value as system efficiency and cost. Public services should try to maximise value. But surprisingly, what service users value has not been prioritised. Only recently have we started to understand that measuring outcomes or impact is more relevant and useful than measuring outputs when we commission, design and deliver population health and care programmes. In other words, value should be concerned with outcomes, impact and cost. How should we think about value, the Realising the Value consortium’s new thought paper, raises debate about how we define value. It focuses on what matters to individuals in terms of their own health and wellbeing as being the critical component of how to add value to people’s lives, and calls for public services to recognise this. The paper states that we are co-producers of our own health and wellbeing and that those of us with medical conditions or disability live within a social network of carers, relatives, friends and community, all of whom add or could add value to our lives. But to really understand how all these resources work (or could work) together to add value, we need an ongoing debate about value and about other big issues: “What is health?”; “What is wellbeing?”; and “What is the legitimate contribution of public services to the health and wellbeing of individuals and communities?” We have taken these questions for granted for far too long. I’ve recently become an NHS commissioner in a forward-thinking CCG. What surprised me when I took up the job was how little we know about the value that public services add to people’s lives. We don’t know very much about the contribution that the local hospital makes to the overall health and wellbeing of our community. Clearly, people’s lives are being saved there everyday. Clearly running that hospital costs a lot of money, some of which might be best used elsewhere – on population-level prevention programmes for instance. If we want to make rational decisions about the best use of public money in the decades to come, we need to have better data on the impact of different sorts of public services on people’s overall sense of health and wellbeing. Is it better to spend money on a park, a community centre or a new orthopaedic surgeon for instance? Even in a future of very big data, there are unlikely ever to be definitive answers to these questions. But there need to be some measures of value in our system and to do that we need to debate the principles underlying those measures. Individuals and teams with experiences of approaches to value that may be of use to the Health Foundation’s research can share thoughts through the values paper. Join our network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views. |