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Bottomley tells NHS doctors that treatments 'must work'

Nicholas Timmins
Thursday 17 February 1994 19:02 EST
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HEALTH ministers yesterday gave their clearest signal yet that they will increasingly expect doctors to demonstrate that treatments provided under the NHS work - and that the NHS should not pay for treatments that do not.

The move means that purchasing authorities and GP fund-holders when setting contracts will increasingly be expected to insist that doctors follow clinical guidelines and audit their work.

In a key speech on the issue, Virginia Bottomley, Secretary of State for Health, was keen to avoid any impression of overriding doctors' clinical freedom. But she told a conference in Birmingham that education, clinical guidelines and contracts must be used 'to promote what works and stop what does not'.

She told her audience: 'We need dramatically to improve our understanding of what works and what does not . . . There is little point in holding hospitals to delivering X per cent more treatments if they are X per cent ineffective treatments'.

Doctors have been developing clinical guidelines for many years, she said. 'The opportunity which now presents itself as a result of the health reforms is for health authorities and GPs to write research-based specifications into contracts and encouraging practice to follow appropriate guidelines.

'We need to concentrate our money on the things that we know bring the most benefit. Ineffective treatments are not necessarily inexpensive; money doesn't always buy quality. Quite the contrary, we can find ourselves wasting serious sums of money on interventions which are of little use to the patient and which make poor use of the resources available.'

Mrs Bottomley insisted 'it is not for the grey suits to tell white coats what works'. But managers did have a role in reminding clinicians that when a decision was made, a cheque was written. 'Good doctors accept the legitimacy of this relationship. They welcome it,' she said. 'After all, making tough decisions on the basis of clinical effectiveness is a far more rational way than some of the alternatives which have been considered.'

Mrs Bottomley's speech heralds a stream of information being prepared on effective and ineffective treatments, clinical guidelines and health outcome performance indicators. It is also an attempt to emphasise that the NHS reforms are about quality and not just price and competition.

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