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In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process.

Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach.

A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool.

The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience.

All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges.

This study helps in increasing public involvement in complex health challenges.

No other groups have used this combination of approaches to address this issue.

The purpose of this paper is to explore factors affecting implementing the National Institute for Health and Care Excellence (NICE) quality standard on alcohol misuse (QS11) and barriers and facilitators to its implementation.

Qualitative interview study analysed using directed and conventional content analyses. Participants were 38 individuals with experience of commissioning, delivering or using alcohol healthcare services in Southwark, Lambeth and Lewisham.

QS11 implementation ranged from no implementation to full implementation across the 13 statements. Implementation quality was also reported to vary widely across different settings. The analyses also uncovered numerous barriers and facilitators to implementing each statement. Overarching barriers to implementation included: inherent differences between specialist vs generalist settings; poor communication between healthcare settings; generic barriers to implementation; and poor governance structures and leadership.

QS11 was created to summarise alcohol-related NICE guidance. The aim was to simplify guidance and enhance local implementation. However, in practice the standard requires complex actions by professionals. There was considerable variation in local alcohol commissioning models, which was associated with variation in implementation. These models warrant further evaluation to identify best practice.

Little evidence exists on the implementing quality standards, as distinct from clinical practice guidelines. The authors present direct evidence on quality standard implementation, identify implementation shortcomings and make recommendations for future research and practice.

The purpose of this paper is to provide an overview of the organisational and procedural arrangements for priority setting in England and Wales. It describes the role of social values in the decision‐making process.

The processes and content of decisions made by the National Institute for Health and Clinical Excellence are analysed using the framework developed by Clark and Weale for identifying social values in health priority‐setting.

While countries are seeking to achieve similar outcomes from their health prioritisation processes, each country has established different systems that reflect the social and legal framework underpinning their health systems. England is somewhat unique in being explicit about assessing “value for money” and using formal cost‐effectiveness in developing policy.

Many countries are now considering the use of formal health economic methodologies to assess the value and prioritise health care interventions. However there is increasing recognition of the importance of values other than efficiency (cost effectiveness) in making acceptable decisions. This is manifest in the range of potential new approaches being developed including multiple criteria decision analysis.

This editorial aims to outline the context of healthcare priority‐setting, and summarise each of the other ten papers in this special edition. It introduces a new multidisciplinary research programme drawing on ethics, philosophy, health economics, political science and health technology assessment, out of which the papers in this edition have arisen.

Key normative concepts are introduced and policy and research context provided to frame subsequent papers in the edition.

Common challenges of health priority‐setting are faced by many countries across the world, and a range of social value judgments is in play as resource allocation decisions are made. Although the challenges faced by different countries are in many ways similar, the way in which social values affect the processes and content of priority‐setting decisions means that those challenges are resolved very differently in a variety of social, political, cultural and institutional settings, as subsequent papers in this edition demonstrate. How social values affect decision making in this way is the subject of a new multi‐disciplinary research programme.

Technical analyses of health priority setting are commonplace, but approaching the issues from the perspective of social values and conducting comparative analyses across countries with very different cultural, social and institutional contexts provides the content for a new research agenda.

There is anecdotal evidence of a plethora of guidelines developed throughout the NHS. A national survey was carried out between March and June 1995 to identify the number of clinical guidelines produced in the UK in the clinical areas of coronary heart disease, asthma, breast cancer, lung cancer and depression. The response to the survey ranged from 95% (interest groups) to 10% (Ministry of Defence and prison hospitals). Four hundred and seventy two guidelines were identified in the survey. Most had been produced locally, only 21 guidelines were classified as national. Results confirm that there is a proliferation of guidelines in most parts of the UK. The survey illustrates the difficulties involved in conducting a UK survey of this kind, and highlights the need for national guideline coordination.

The NHS Executive expects purchasers and providers to base their agreed patterns of care on evidence of clinical effectiveness. If this approach is to be successful it is necessary to reconcile conflicting published information about effectiveness and local professional opinion. In this study we have identified the type of interactions that occur when purchasers and providers were brought together to discuss how this policy could be implemented locally. Three geographically‐based multidisciplinary workshops were structured around three case studies: coronary artery disease, diabetes, and the management of clinical depression in general practice. The proceedings were transcribed and analysed using content analysis methods. Structured observation techniques were used to examine the interaction between providers and purchasers in the three groups that discussed coronary artery disease. While the overall pattern of interactions between purchasers and providers was similar among the workshops, there were significant differences within them. In two of the workshops providers dominated the discussions on clinical effectiveness, which may affect the purchaser's ability to implement a policy of clinical effectiveness. If a local policy of clinical effectiveness is to be successful there is a need to strengthen purchasers' ability to match the provider's knowledge and enthusiasm.

The purpose of this paper is to introduce the new US health organizations called accountable care organizations (ACOs) which are expected to improve the quality and reduce the cost of healthcare for Medicare enrolees. It assesses the importance of ACOs, defining and articulating the values that will underpin their strategic and clinical decision making.

This paper uses a social values framework developed by Clark and Weale to consider the values relevant to ACOs.

It is likely that social values could be made more explicit in a US setting than they have ever been before, via the new ACOs. Social values could start to form part of a local health economy's marketing strategy.

ACOs are very new. This paper identifies that they will need to be very explicit about the values relevant to them. The development of ACOs and the articulation of social values therein may even form the basis of a meaningful dialogue on the importance of assessing value for money or cost‐effectiveness in the wider US health policy environment.

The purpose of this paper is to demonstrate that the social values framework developed by Clark and Weale could be applied to publicly available data and to explore the concordance between the framework values and those present in the statements of decision‐making protocols of Health Technology Assessment Agencies.

The web sites of the National Institute for Health and Clinical Excellence (NICE); the All Wales Strategy Medicines Group; and the Scottish Medicines Consortium were searched for references to social value statements and assessed according to the social values framework.

The framework was easy to apply and demonstrated that it is possible to find statements of operational expression of a range of social values in the description of the decision protocols used by the public agencies. Most of the framework's values find some expression in the statements of the decision protocols, but there are differences. For example, the All Wales Group, when discussing clinical effectiveness, explicitly refers to an assessment via “pathways of care” in a way that neither of the other two do. The value of autonomy is explicitly mentioned by NICE but not by the other two, whereas the value of solidarity (a value most typically associated with European social insurance systems) finds only indirect expression in the guidance notes of all.

The paper provides further information that will be useful in revising the framework in preparation for its role in future data collection.

This is the initial step in developing a social values instrument that will support health policy decisions. While there are other check lists of social values, this is the first time that an approach to creating a framework is being tested empirically.

Clinical guidelines are likely to be key components of any Health Service Trust's framework for improving clinical effectiveness. Initial results from the seven pilot sites of the NHS consensus strategy for major clinical guidelines have suggested a number of factors that can contribute to their successful implementation. They include a managed and structured process; adequate preparation; open and collaborative dialogue between appropriate stakeholders; clear identification of local clinical and managerial priorities; a receptive corporate environment; and health care professionals motivated to improve practice. Finally, in the turbulent setting of contemporary health care, the ‘luck’ of a successful implementation is often ‘preparation meeting opportunity’.

New hepatitis C medicines such as sofosbuvir underline the need to balance considerations of innovation, clinical evidence, budget impact and equity in health priority-setting. The purpose of this paper is to examine the role of public participation in addressing these considerations.

The paper employs a comparative case study approach. It explores the experience of four countries – Brazil, England, South Korea and the USA – in making coverage decisions about the antiviral sofosbuvir and involving the public and patients in these decision-making processes.

Issues emerging from public participation ac tivities include the role of the universal right to health in Brazil, the balance between innovation and budget impact in England, the effect of unethical medical practices on public perception in South Korea and the legitimacy of priority-setting processes in the USA. Providing policymakers are receptive to these issues, public participation activities may be re-conceptualized as processes that illuminate policy problems relevant to a particular context, thereby promoting an agenda-setting role for the public.

The paper offers an empirical analysis of public involvement in the case of sofosbuvir, where the relevant considerations that bear on priority-setting decisions have been particularly stark. The perspectives that emerge suggest that public participation contributes to raising attention to issues that need to be addressed by policymakers. Public participation activities can thus contribute to setting policy agendas, even if that is not their explicit purpose. However, the actualization of this contribution is contingent on the receptiveness of policymakers.