DEMAND Project


Investigating deliberative methods for setting a monetary capability threshold in the context of social care and public health – the DEMAND Project

About the Project

This work is funded by the Medical Research Council.

Institutions such as the National Institute for Health and Care Excellence (NICE) set guidelines which influence resource allocation decisions in the NHS and social care. Decisions by NICE are informed by clinical evidence and economic evaluation. Economic evaluation is the systematic comparison of different interventions/options in terms of both their costs and their impact on the service user. Currently, in the NHS, impact is defined in terms of increased life expectancy and improved health functioning. However, the focus on health is problematic in the case of social care, which is broader in its scope and impact. Social care aims to help people to retain their dignity and independence (hence being able to live an active life).

Some economists have begun to explore a different framework for the economic evaluation of social care, one that is based upon the capability approach. The term capability reflects a person's ability to be and achieve the broad things that they value. Questionnaires have been developed to measure wellbeing in terms of capability. One such questionnaire is the ICECAP-A. By asking service users to complete the questionnaire we can assess what impact a service has had on their wellbeing (wellbeing in a broader sense than just health functioning). The ICECAP-A is one of a small number of questionnaires recommended for use by NICE for the evaluation of social care.

Research into the capability approach is still at a relatively early stage. When evaluating healthcare using health functioning (quality adjusted life years) there is a clear way of presenting information to decision-makers and clear rules that decision-makers follow when deciding whether to fund a new treatment. The aim of this project is to develop a way of presenting capability information to decision makers and to provide evidence on the public's preferences, to help guide decisions in the social care/public health contexts.

The first phase of the project will answer the question "What level of wellbeing should be deemed by society as 'sufficient', if those experiencing levels of wellbeing below this are prioritised for state funded support?" The question will be addressed by members of the public in a series of citizens' workshops.

We will then conduct a further series of citizens' workshops with a new sample of the public. The question to be addressed by participants in phase II will be: "How much (in monetary terms) is our standard unit of benefit worth to society?" I.e. how much is society willing to pay to improve a person's wellbeing from no capability to sufficient capability?

Deliberation means participants can be informed about the context and share and challenge each other's views in a supportive environment. Experiences of participating in the workshops will be understood through individual follow-up interviews; this will be published to inform the design of future studies.

We will contrast results from the public workshops with separate results from three policy-maker workshops and from individual responses to an online survey. In such a survey, respondents have less scope to consider and form their views.