The National Institute for Health and Care Excellence (NICE) recently launched the work of a collaborative approach to Shared Decision Making. In this blog, Professor Alf Collins, reflects on the ethical, practical and legal imperatives of sharing decisions with informed patients.
I don’t know about you, but when I am faced with a decision, I like to think about the options I face and the risks, benefits and consequences of pursuing those options. And if I am making an important decision, I like to be supported/guided through that process by a professional.
This concept is of course usual practice in many walks of life. And it’s becoming usual practice in healthcare but not as quickly as many of us would like. Quite simply, shared decision making should be the norm in the NHS and we need to make sure it is.
The drive to embed shared decision making into everyday clinical practice gained significant momentum in 2015, when a pivotal ruling by the UK Supreme Court (Montgomery v Lanarkshire Health Board) pronounced that the process of gaining consent for any procedure which ‘interferes with bodily integrity’ should be informed by the principles and practice of shared decision making. Consent should only be gained when patients have shared a decision informed by what is known about the risks, benefits and consequences of all reasonable options.
Montgomery is a landmark ruling that should not go unheeded by trusts up and down the country but shared decision making is important for any clinical decision, not just a decision about whether to proceed to surgery or not.
Given this, over the last 18 months, NICE has led a coalition of national partners including NHS England, in building a Shared Decision Making Collaborative. Members include a number of arms length bodies, the Department of Health, regulators, academics and others who have come together to provide whole system leadership to embed the agenda into the everyday work of the NHS.
The Collaborative recently produced its first action plan, detailing the commitments of the various bodies to deliver this important agenda.
At NHS England, our commitment to the plan is to continue to build upon the impressive work that Right Care have already done to embed and spread shared decision making into the NHS. The NHS RightCare team have been working with clinical commissioning groups (CCGs) to ensure that they improve the value of NHS services and reduce unwarranted variation in service delivery through (in part) embedding shared decision making into patient pathways at scale.
RightCare is in the process of being rolled out across all CCGs in England and is being seen by many as one of the critical elements contributing to a sustainable NHS.
For too many years, we have organised and delivered patient care by developing pathways that do not take account of informed patient demand. It is only by sharing decisions with informed patients that we can really know how and where to spend limited NHS funds.
Shared decision making is not only an ethical and medico-legal imperative, it is an economic imperative and the recent announcement from NICE should be a clarion call for us all. Don’t just read about it. Make it happen.
Professor Alf Collins is a doctor, commissioner, researcher and national policy advisor in person-centred care.
He has researched and published widely on self-management support, shared decision making, care planning, co-production, patient activation and patient engagement.
Alf has worked with others to develop a number of measures of person-centred care, including the ‘clinician support for patient activation measure’.
He has a visiting professorship in person-centred care from Coventry University and Honorary Fellowships at the Royal College of Physicians and the Royal College of General Practitioners.