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OCR for page 131
Profile of the Consensus Development
Program in the United Kingdom:
The King's Fund Forum
Jackie Spiby
NATIONAL CONTEXT
The consensus development program in the United Kingdom was
initiated by Barbara Stocking and Bryan Jennett. These two indi-
viduals had observed the consensus development program in the
United States and were eager to develop similar conferences in the
United Kingdom. They approached various funding bodies to sup-
port the initiative and eventually obtained funding for the first con-
ference from the Kings Fund. This funding was then extended for
three additional conferences and subsequently for another four, for a
total of eight.
The King's Fund is an independent charitable organization con-
cerned with the development of health services, management train-
ing, and policy analysis in the heady care arena. The independence
of the Fund allows the consensus development program to bring
together a wide variety of individuals from different organizations
to work together and speak freely on medical technology assess-
ment. The King's Fund has a very extensive network within the
health services and is generally wed regarded.
The purpose of the consensus development program is to promote
public debate about important controversial issues. The program
aims to produce an authoritative independent consensus statement
that can be used to initiate changes in health services and stimulate
i3i
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132
CONSENSUS DEVELOPMENT
research. The initial program was also established to experiment
with and investigate the usefulness of consensus development con-
ferences within the U.K. context.
The primary users of the statement vary according to the topic but
include national and local policymakers, clinicians, hospital manag-
ers, health professionals, and consumers.
SCOPE OF THE PROGRAM
The King's Fund established the consensus development program
specifically to investigate the applicability of the format of a con-
sensus development conference for different topics in health care;
therefore, the program has included clinical, public health, and so-
cial policy issues (Table I).
The topics are chosen by the King's Fund Fora Steering Group, a
multidisciplinary group of senior members in the health care field
that oversees the whole program of conferences. This group is chaired
by Bryan Jennett. Suggestions for topics are received from a variety
of sources, and a short list is produced by the Steering Group.
The main criteria used for inclusion of a topic in the program are
the following.
It is an important public health issue.
There is multidisciplinary involvement.
There is real controversy.
There are data available.
There is public interest.
· It is timely.
· It is considered that the consensus development format is ac-
ceptable for investigation of the particular problem.
· It is considered that change can be identified and that there is
potential for initiating change.
Specific technologies or clinical problems may be assessed in the
program. Once the Steering Group chooses a topic, all relevant
issues are included in the assessment, for example, legal, economic,
political, social, and organizational issues. A technology may be
considered at any stage in its life cycle.
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KING'S FUND FORUM
TABLE ~ Consensus Development Conferences in the United
Kingdom, 1984-1989
133
Title Date Special Features
Coronary Artery Bypass Surgery
Breast Cancer Treatment
Role of Asylum in Society
Prenatal Screening
Treatment of Spoke
Intensive Care
December 1987
Cholesterol Measurement In the June 1989
Prevention of Coronary
Heart Disease
November 1984
October 1986
April 1987
First U.K. conference
Nonrnedic al charm an
Broader policy issues
considered
Major ethical issues
considered
June 1988 Return to more clinically
based topic
April 1989 1h collaboration with the
K~ng's Fund Institute-
expert panel producing
statement prior to the
conference
Less than half of the panel
was medically qualified
FORMAT AND CONDUCT OF THE PROCESS
The consensus development process for each conference lasts
approximately one year from the time the Steering Group selects the
topic to the publication of the final consensus statement. The actual
conference itself lasts for three days.
Staff of the King's Fund Fora conduct a wide-ranging search to
identify speakers and other contributors. They are informed in this
process by a planning group that participates in the development of
each conference. Each conference has a unique planning group.
The search includes a computer search; interviews; literature re-
view; and discussions with leading experts, policy institutes, the
Department of Health, etc.
The King's Fund staff and the planning group choose the 12-
person panel to provide a broad range of expertise. No more than
six members are medically trained. Any panel would generally in-
clude clinicians, an epidemiologist, a statistician, an economist, a
consumer, a nurse, and a manager. However, the final balance of
the professionals is dependent on the actual subject. The pane} is
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34
CONSEI`JSUS DEVELOPMENT
nonexpert on the topic of the conference. However, one or two
unbiased experts are included with the intent that they ensure that
the pane} does not misinterpret the information.
The relationship between the speaker and the data varies depend-
ing on the particular topics. Speakers may be asked to present their
own data, but often speakers present an overview. On occasion, the
Fora program has commissioned specific work, especially economic
analysis for a conference.
The general format of the conference follows the style of the U.S.
National Institutes of Health quite closely. The first day and a half
consist of expert presentations and audience discussion. Sufficient
time is provided for audience discussion, and the chairman is ex-
pected to ensure that the public is allowed to participate. Consider-
able effort is made to ensure that the audience is composed of profes-
sionals from different disciplines. Space in the audience is provided
for members of the public. On the second day of the conference,
during an open session, approximately ten members of the audience
provide three-minute presentations on the topic. The panel then
retires for the second afternoon and the morning of the third day to
produced their statement. Each panel has managed to get some
sleep on the night of the second day. The statement is then taken
back to the audience for general discussion on the afternoon of the
third day. The panel finalizes the statement during the end of the
afternoon of the third day. Approximately 50 percent of the audi-
ence return to discuss the statement, and a lively debate usually
occurs. The consensus statement cannot be modified once the panel
completes the review during the conference.
DOCUMENTATION AND USE OF EVIDENCE IN
CONSENSUS DEVELOPMENT
The King's Fund Fora staff assembles the information for the
consensus development process. Initially, the staff conducts com-
puter searches and wide-ranging literature reviews, along with inter-
views of experts and other knowledgeable people, to identify major
issues and controversies. In view of the variety of issues considered
by the conference, the staff uses many different types of literature in
the search process (e.g., national reports, clinical trials, epidemio-
logic studies, literature reviews, editorials, and books).
Before the conference, the pane} members receive a comprehen-
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ACING'S FUND FORUM
135
sive selection of readings from the literature. The reading packet
has included one or two introductory texts for those members who
lack specific knowledge of the topic. Pane} members also receive a
1,000-word abstract on the conference presentations from each
speaker. There is no prior weighting of the evidence by the confer-
ence staff.
The panel is instructed to place considerable primary emphasis on
the scientific evidence presented. Expert opinion should serve to
support the available scientific evidence. inevitably, during the course
of the conference, the pane} receives conflicting expert opinions.
The comments of consumers from the audience are often important
to the panel. The conference organizers try to provide an objective
consumer view based on available scientific research.
The consensus statements do not cite references. Citations are
not relevant for the statement, as it is produced in a format of ap-
proximately 3,000 words. References and identification of the evi-
dence used can be found in the abstract book produced for each
conference.
DISSEMINATION AND IMPACT
The announcement of the conference is made both in the relevant
journals and by direct mailings. Evidence from the field of market
research and from an unpublished study on the conference indicates
that direct mailing is much more successful in increasing attendance.
A press conference is held on the afternoon of the third day of the
conference to make direct contact with members of the press. Sev-
eral of Me conferences have succeeded in attracting attention from
the radio and television media. Within a week, the statement is
published and copies are sent to the press, relevant organizations,
every district and regional health authority, and relevant clinicians.
The statement is then available on request. The statement is usually
published in the British Medical Journal the week following the
conference. Editorials and articles in other relevant journals are
also produced.
The intended impact of the statement depends on the content of
the statement. The program aims to influence national and local
policymakers, clinicians, other health professionals, and consumers.
The statement does not always influence all of these groups. The
statements are used by organizations as appropriate for their pur-
/
/
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136
CONSENSUS DEVELOPMENT
poses. The King's Fund uses me statement within the Acute Serv-
ices Program to develop standards and create health service develop-
ment.
The Fora program has been evaluated formally and informally
(Table 2~. The results of these evaluations provide an ongoing form
of assessment and are continually used to modify and enhance the
program. Table 2 provides evidence of the impact of the consensus
development process. The King's Fund continues to review and
evaluate the consensus development program.
TABLE 2 Evaluation Activities in Relation to King's Fund Fora
Program
Program Aspect
Evaluation Activity
Consensus meeting procedure
Role of consumers
Intemational comparison
Review of impact
After all conferences the panel, speakers, and
audience are surveyed as part of the regular
monitoring and development of the program.
Following the breast cancer conference, the role of
the consumer in a consensus development
conference and the accessibility of the state-
ment to the public were reviewed.
Ph.D. thesis comparing U.S. and U.K. conferences.
Survey of managers and clinicians following
Coronary Artery Bypass Surgery conference to
assess awareness of tile statement and resultant
change.
Survey of nurses and consumers following Breast
Cancer Treatment conference to review use
made of statement.
Survey of regional health authorities to consider
impact of genetic screening statement on
influencing regional policy.
First phase of a study to review the impact of the
statement of the Impact of Stroke conference
has been undertaken to identify how close
services mirror the recommendations. Follow-
up is to take place two years postconference.
Contact established with a small group of indi-
viduals who identified themselves as wishing to
utilize the statement of the Impact of Stroke
conference to initiate change. The progress
that has been achieved is being monitored.
Representative terms from entire chapter:
fund fora
