Montgomery Judgement

Bill Fulford speaks about a new legal departure towards co-production

 Bill Fulford (Click to download Slides) introduced the day’s proceedings at the second seminar of ESRC series Re-imagining professionalism: towards co-production with an overview of the work of the Collaborating Centre for Values-Based Practice at St. Catherine’s College, University of Oxford. Bill addressed the relationship between values-based practice (VBP) and co-production, pointing out that VBP is developing strongly in bastions of evidence-based practice (EBP), notably surgery. Bill emphasised that EBP and VBP are partners in clinical decision-making (VBP ‘links the science of EBP with people’). At the heart of values-based decision making is dissensus.  Dissensus is a decision-making strategy which respects and acknowledges people’s differing values. This contrasts with the usual organisational/institutional approach of attempting to enforce consensus. Bill referred to the recent (2015) Supreme Court Judgement on consent in the case of Montgomery v Lanarkshire Health Board. This strongly endorses co-production. It specifies that for consent to be legally valid: 1) clinicians (of any kind not just doctors) must engage in ‘dialogue’ with their patients, to the point that, 2) they have sufficient understanding of the risks and benefits of the options available such that, 3) their individual values are ‘taken into account’ in the decision made. This judgment marks and gives new legal weight to established principles of person-centred decision-making (as in the GMC’s ‘Good Medical Practice’ for example). It shows the extent to which principles of co-production are becoming more influential not just in mental health but across health and social care as a whole. The Collaborating Centre will shortly be announcing a conference on the Montgomery Judgment: Lady Hale, one of the Montgomery judges, is a Keynote speaker.  (Hold the date, Friday October 28th.)