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How should we think about value in health and care?

Discussion paper

‘Value’ is a contested notion both in the private and public sectors. Both sectors’ definitions are – and have been over recent decades – subject to significant tensions. Traditional ‘profit-oriented’ conceptions of value expressed through classical accounting models have been strongly critiqued, yet continue to have a significant impact on the behaviours of individuals and organisations.

In health care in England, perceptions of value have been dominated by a mix of clinical outcomes, system targets, competition mechanisms and encouragement for single units to act autonomously and be judged as single services. What people using health services value most has not been adequately considered or captured.

However, a number of recent changes are raising the question of whether the current ways of thinking about value in health and care – clinical outcomes and service utilisation – remain sufficient. For example:

•• Changing social attitudes have led to notions of wellbeing, quality of ife and happiness re-emerging in political conversation as values that society aspires to for its citizens. This has also been recognised within the academic community with wellbeing measures being validated and put into use.
•• The growing number of people living with long-term conditions is making it clear that patients are increasingly producers of their own health care. This challenges the assumption of the traditional medical model that the NHS produces value and patients consume it.
•• The prevailing understanding of health is re-orienting itself from the question ‘what’s the matter with you?’ to the broader question ‘what matters to you?’ This begs the question of how the value that health services create sits alongside other forms of value.

The long journey of adult social care towards personalisation has pointed the way to a values-based approach which prioritises improved wellbeing, independence, social connectedness, choice and control; one in which people feel supported to manage their own care. The changed and changing nature of the ‘caseload’ of the NHS (long-term conditions, co- and multi-morbidities) would seem to point in the same direction. The health and care systems are, in any case, increasingly aligning through integration programmes and will need aligned concepts and frameworks for achieving and measuring value.