The importance of shared decision making

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.

Alf Collins

Professor Alf Collins is NHS England’s Clinical Director, Personalised Care Group.

He was a community consultant in pain management and in parallel worked for a decade with the Health Foundation. He has researched and published widely on self-management support, shared decision making, care planning, co-production, patient activation and patient engagement.

He has honorary fellowships from the Royal College of Physicians and the Royal College of General Practitioners and is a Visiting Professor at Coventry University.


  1. A Cev says:

    There are limits to shared decision-making. It cannot be used as an excuse for passing the risk arising from medical decisions onto patients, which is how some appear to be interpreting it.
    Risk management and life-changing risk decisions are complex. They can be poorly understood/expressed to patients. How are such actions which, you mention in your article, are linked to financial decisio-making, accurately rcorded and assured?

  2. Kassander says:

    Three cheers for 3 heroes: Montgomery; NICE; the 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”
    This is supposed to be about involving us, the patients
    Lord Nelson? “I see no Patients”
    Ah, the CCGs are involved and they have Lay NEDs
    But the CCG Boards choose and pay them. So they’re not really representatives OF patients in any democratic way
    False alarm
    ​Until we patients, actual and potential, have seats​ at the tables of power, for our elected delegates, this faux consultation will continue unchecked with self declared Patient Leaders cum Trainers, a growth industry.
    Now patient K, which colour bandage would you like today? We’ve got white, white or white
    And NO you can’t see the report from Anu Singh’s 12th Sept W’shops about PPPI What’s it got to do with you even if you were a participant?

    • Anonymous says:

      seems about right ie. the comment

    • madcyclistuk says:

      Kassander, believe me even Patient Leaders appointed on merit that have worked closely, and courageously with NHSE are being side-lined for organisations and representatives that have minimal knowledge, and experience.
      NHSE kids itself their new advisers are representative of communities, but those of us that truly are know they are not!
      If one wants to see further evidence of how disastrous such a policy is one need look no further than the new CRGs.
      Such highly destructive and myopic policy achieves only one thing in the long term – unfit and failing services.
      And NHSE needs to wake up to this asap before it loses total touch with reality, and those that CAN truly save it from itself…

      • Kassander says:

        @ madcyclistuk 25 September, 2016 at 3:05 pm
        You are correct.
        Tho’ perhaps “they” wish to shed their “touch with reality”?
        How else can this cabal of privateers sleep at night as they drive Our=NHS over the cliff into the gaping maws of Big Business, and their own just (?) rewards as Fifth Columnists?