NHS 'wastes pounds 1bn on ineffective treatments'

NICHOLAS TIMMINS

Public Policy Editor

At least pounds 1bn of National Health Service resources could be released for improved patient care by cutting out unnecessary and ineffective treatments, according to Sir Michael Peckham, the director of research and development on the NHS executive.

In an interview marking his departure from the post, Sir Michael said the steady application of science-based medicine should leave the NHS affordable into the future, squaring the circle of an ageing population and continued medical advance.

Sir Michael - who is to head a new science and health forum at University College, London, and act as a consultant to the Canadian and other governments on introducing the "evidence-based" approach to treatment which the NHS has been developing since 1991 - said he rejected the "gloomy" view advanced by Sir Duncan Nichol, the former NHS chief executive, and others, that the NHS is likely to become unaffordable in its present form.

"Of course all the pressures are there," he said. "But if in 1948, when the NHS was founded, you had been presented with what the service is now, or even presented with what Heathrow looks like now, you would have said 'this is unsustainable'."

In 1948, he said, transplantation did not exist, there was no treatment for heart failure other than salt-restriction and diuretics, and much modern technology such as keyhole surgery did not exist. "But the fact is, all this has been absorbed. It is true that we will have new drugs for Alzheimer's disease and for chronic neurological illness and for disability and new surgical techniques, but I see no reason why, with a good connection being made between the health service and science, and with the scientific method brought to bear on health service problems, that should not be perfectly well managed within the NHS as we know it."

Assessing what worked, and what did not, had led to reductions in some procedures, such as D & Cs - scraping of the lining of the womb - in women under the age of 40, and a wide range of studies had been commissioned from comparing different medical and surgical treatments for coronary artery disease to assessing which artificial hip joint worked best.

A system for disseminating the results was now in place that could inform doctors of best practice and affect the contracts that health authorities placed, he added. "What we are engaged in is a science-based rationalisation of health care, as an alternative to arbitrary rationing. We are saying that the power of this approach is such that we can absorb the new things - recognising that many innovations have ultimately been cost-reducing, for example the replacement of surgery for ulcers, first by drugs ... and now by a simpler and cheaper use of antibiotics.

"We have a healthier population now, there are many more things we can do and are doing, and these seem to me pointers to a manageable NHS, but it is essential that it is science-based."

However, Sir Michael added that as yet "we do not know what the real payback of moving to an evidence-based NHS will be". The research and development directorate is developing an economic model to provide better estimates of that, he said. But "we have a whole range of anecdotes and individual examples and if we begin to aggregate these it is not difficult to get to pounds 1bn that could be released for improved patient care, while improving the quality of existing care. I suspect it could be more."