Treatments in health service to be assessed

FOR THE first time the Government has declared its intention to provide 'rigorous assessment' of any new treatment made available to the National Health Service.

The independent assessements would cover anything from a drug, to a new type of wound dressing, to an advance in heart surgery. They would avoid the piecemeal introduction of advances, which tend to spread out from the research centres, as well as abandoning those that do not work.

Such assessments would be powerful tools in the hands of clinicians arguing for the provision of a new service.

They could also avoid the current situation in which 'test-tube' baby techniques are rarely available on the NHS.

In addition to answering the questions 'does it work' and 'is it safe', the NHS assessement would consider many other implications of any new idea, including its cost and affordability, any ethical or social implications and its impact on death rates, life at home or the organisation of health services.

The proposals are contained in a discussion paper, Effects of Health Technologies, Principles, Practice, Proposals, commissioned by Professor Michael Peckham, NHS director of research and development, from the Advisory Group on Health Technology Assessment. The term technology is used to describe any new method or idea.

It argues for maximum openness and says it should be 'scientific misconduct' not to report findings.

Some will view the recommendations as a way of rationing health care and as a constraint on innovation; others will see it as a long-overdue attempt to provide the best treatments fairly across the country and as a counter to the powerful lobby of the pharmaceutical industry.

The report points out that there are five-fold differences in European countries between the use of cholesterol-lowering drugs - Britain is one of the the lowest users. It says that in the United Kingdom there are three-fold differences in rates at which GPs in adjacent practices refer their patients to hospital specialists.

The report says: 'If an approach is beneficial, cost effective and affordable for particular patients it should be widely available to them. If it is not then it should be abandoned.'

It says that the effect of new technologies on families and friends must be considered and points to the feasibility of giving sick children artificial life-support at home. 'Even though parents have been found to be overwhelmingly in favour of trying to care for their children at home, it is clear that setting up domiciliary artificial ventilation causes substantial emotional and financial problems for parents,' it says.

It accepts it will never be realistic to establish all the effects of a new technology and that some assessments would need to be very large and conducted over a long time. But it took a study of 17,000 heart attack cases to find out that 'a technology as simple and inexpensive as low dose aspirin could reduce the risk of premature death by a fifth'.

Looking at the importance of making information freely available, the report gives the example of the choice of suture material to repair tears after childbirth, which was found to make a difference of between 10 per cent and 20 per cent in women who had pain during intercourse three years afterwards.

Professor Peckham said the Department of Health was developing a coherent strategy for evaluating health care in the light of the report's findings. 'It is essential reading for all those interested in and involved in improving health,' he said.