The NHS needs to think more about who is being harmed by decisions as it battles to reduce costs, a leading researcher has said.

Jim Baxter, lead researcher on the National Inquiry into Organisation Ethical Decision-Making in the NHS, said people making decisions in the NHS needed to uncover the values behind the decision rather than relying on data.

“There is a question about the fair distribution of harms and benefits. In times of prosperity it may be that we are thinking more about the fair distribution of benefits but in times of austerity we may want to make sure that any potential harms to the public are distributed fairly,” he said.

The inquiry - led by the Centre for Innovation in Health Management at the University of Leeds - was based on one-to-one interviews with managers.

It highlighted inconsistencies in the way decisions were made and often a lack of shared understanding around concepts such as equity and equality.

Boards are being urged to adopt a ‘checklist’ to guide decision making on ethical issues and to ensure that decisions affecting large groups of people get at least as much time as those affecting individuals. Co-author Martin Fischer warned that with open access to information, “contestability is going to increase dramatically”.

“If you follow the steps in the inquiry this is a way of reducing the amount of time spent on challenges to your decisions,” he said.

NHS Confederation deputy policy director Jo Webber welcomed the report, saying it highlighted some of the ethical issues around everyday decisions. “It’s very easy to look at things like car parking or whether to have a Burger King in the entrance rather then whether we do one cycle of IVF, or two or three,” she added.

But managers might struggle to find the headspace to tackle some of these harder issues at the moment as they dealt with changing structures and the need to save money, she said.