Books

Published: 09/05/2002, Volume II2, No. 5804 Page 31

Hidden Assets Values and decision making in the NHS Edited by Bill New and Julia Neuberger

Publisher: King's Fund.

ISBN: 1857174585. 230 pages.£17.

Available from:www. kingsfundbookshop. org. uk

Almost no pronouncement by politicians, managers or clinicians omits a reference to values, and this book represents a 'rough guide' to almost every point of interest along the values coastline.

Julia Neuberger's introduction is an interesting and balanced insight, but there are also 15 impressive essays.

Julian Le Grand challenges the notion of 'public good, private bad'.He argues that a public service ethos is not the same as altruism, in which there is a great deal of self-interest.He adds that a public service ethos and altruism can exist in the public and the private sectors.We would argue that values belong to individuals, not organisations.This contribution informs an important debate on the relationship between individual values and an organisation's decision-making.

Three other themes emerge.The first is major semantic problems with how the idea of 'value' is used. Bill New argues that despite the comforting familiarity of the term, there is a cacophony of meanings.

The second is that having a clear set of values may guide decision-making, but does not necessarily make it any easier.

The values people invoke around health - such as efficiency and patient choice - do not integrate well, and any decision will score better for some values than for others.

The third theme is that the pluralistic nature of a health system almost inevitably means a conflict between different sets of values as different stakeholders bring their influence to bear.

Pam Charlwood warns against the 'lowest common denominator'effect of a vox pop approach to decision making and calls for more deliberative approaches to patient and public involvement.But almost every chapter ends with powerful arguments for greater transparency about the rationale for decisions and greater public involvement in the decisionmaking process.

Though Rudolf Klein believes language about values is so confused that any debate is unlikely to reach a useful conclusion, we are sure the debate can illuminate policy thinking and inform practice.This book is an excellent contribution to that debate.