News Roundup [abridged Versions Appear In The Paper Journal]

NICE is to root out ineffective treatments in NHS

BMJ 2006; 333 doi: (Published 14 September 2006) Cite this as: BMJ 2006;333:568
  1. Zosia Kmietowicz
  1. London

    The National Institute for Health and Clinical Excellence (NICE) has been charged with purging from the NHS treatments that do not improve health or are poor value for money.

    The health minister Andy Burnham said guidance to address poor clinical practice will help make health services more equitable across the country and reduce ineffective practices. Any money saved will be ploughed back into the NHS for interventions that have been proved to work. NICE's guidance will apply to England, Wales, and Northern Ireland.

    “This is not about cutting services that benefit patients,” said Mr Burnham. “New drugs and treatments are continually emerging, and trusts have to make difficult decisions about how to invest funding. I believe this important new work will show how the NHS can free up millions of pounds from obsolete or ineffective treatments. NICE has an excellent track record in identifying and recommending the most effective new treatments for widespread use in the NHS. But we need to ensure that we balance this with better advice on unnecessary and ineffective interventions that can be stopped.”

    The proposal to advise on abandoning ineffective interventions was first floated by the chief medical officer, Liam Donaldson, in his 2005 annual report (BMJ 2006;333:216, 29 Jul). In his report Professor Donaldson highlighted the fact that unnecessary tonsillectomies and hysterectomies cost the NHS £21m ($40m; €30m) a year, despite other treatment options being available.

    NICE said it plans to work with NHS healthcare professionals to identify areas of clinical practice where new guidance is needed. It aims to achieve results by issuing technology appraisals and clinical guidelines on reducing ineffective practices, such as how to manage sore throats in children, which would include advice on when to prescribe antibiotics.

    Another approach will be to send out “recommendation reminders” from past NICE guidance where savings might be made. One reminder will inform trusts on the savings to be made from treating patients with end stage renal failure at home rather than at hospital or at satellite centres. Currently just 2% of patients receive dialysis at home but 15% to 20% would like the option. Increasing the proportion of patients receiving dialysis at home to 15% could save the NHS £9.7m each year, says NICE.

    Commissioners will also receive guidance from NICE on how to commission routine services in line with its recommendations. This will include spreadsheets on the costs involved and any potential savings that can be made.

    Sam Everington, a GP and deputy chairman of the BMA, said: “Doctors will welcome national guidance based on common understanding and scientific evidence on the most effective treatment options for their patients.

    “However, we would not want to see a blanket ban imposed on certain treatments, since there may be occasions where individual patients, with specific health needs, would necessitate a particular intervention. Any decision must be primarily based on clinical evidence and not simply an exercise in cost cutting.”

    Nigel Edwards, director of policy at the NHS Confederation, which represents over 90% of NHS organisations, said: “It is very important to both patients and tax payers that we spend NHS money wisely. Every penny wasted on ineffective treatments is a penny that could have been better spent on other services for the benefit of patients.

    “Whilst this programme will deliver some cost savings, more importantly it is about making the best use of NHS resources and delivering the best care for patients.”

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