The competition for limited health care resources is intensifying. We urgently need an acceptable method for deciding how they should be allocated. But the goods that health care produces are of very different kinds. Health care can extend the lives of children and of older people. It can make it possible for a person to walk, when without health care that person would be permanently bedridden; and it can reduce the pain and distress of people who are terminally ill. How can we possibly decide which of these - and many more - diverse achievements of health care are more deserving than others? We need a common unit by which we might be able to measure these very different goods. The Quality-Adjusted Life Year, or QALY, is the most developed proposal for such a unit of measure. In this book a distinguished team of ethicists and economists defend the core of the QALY proposal: that health care resources should be used so as to produce more years of life, of the highest possible quality. This leads to a discussion of such fundamental questions as whether all lives are of equal value, whether health care should be allocated on the basis of need and whether the QALY approach incorporates an adequate account of fairness or justice. The result is the most thorough account yet of the ethical issues raised by the use of the QALY as a basis for allocating health care resources.

The NHS Experience is an accessible and engaging guide for all those journeying through the NHS, whether as patients, carers or professionals. It draws on the experience of staff and families at Great Ormond Street Hospital to provide good practice guidance for both users and providers of health care. Based on the successful Snakes and Ladders drama programme developed at Great Ormond Street Hospital, this unique book uses the story of Daniel, a fictional child with the life-limiting disease cystic fibrosis, to provide insight into the enormous challenges faced by patients, their families and the professionals involved in their care. Asking difficult questions about how we can improve the NHS experience for everyone at the front line, Daniel's story builds on information from a wealth of sources to highlight: the practical, ethical, resource and financial dilemmas integral to the NHS the vital issues around communication, trust, management of clinical errors, consent, shared decision-making and bereavement the realities of fragmented care, bed shortages, uncertain diagnoses, and complex and difficult treatment choices. This is a book that should be read by all healthcare professionals and everyone who uses the NHS.