During 2011, England’s NHS was tasked with finding £20 billion of efficiency savings over four years, in part by reducing the use of ineffective, overused or inappropriate procedures.
However, a report published today by researchers at Imperial College London (ICL) has found that an absence of clear national guidance about which procedures to perform less has caused inconsistency among NHS commissioning groups.
“Our research revealed a lack of consistency between commissioning organisations regarding which procedures were cut,” said Sophie Coronini-Cronberg, from the School of Public Health at ICL, who led the study.
“Arbitrary decision-making needs to be replaced with objective, consistent, evidence-based policies
Study leader Sophie Coronini-Cronberg
“With little national guidance about which procedures to remove or restrict funding for and under which circumstances, commissioners may be turning to locally developed, unofficial lists and criteria of low-value treatments,” Coronini-Cronberg said.
“This urgently needs to be addressed to avoid local variations. Arbitrary decision-making needs to be replaced with objective, consistent, evidence-based policies.”
To conduct its research, an ICL team looked at hospital statistics for six procedures that appear on unofficial lists to see which had been affected and whether cuts were applied consistently across primary care trusts in the first year of the savings programme.
For example, myringotomy, a procedure to relieve pressure in the ear which is considered relatively ineffective, declined by 11.4% overall.
However, findings in the report suggest that although the number of procedures fell in 25% of trusts, they increased in 6%.
Two further procedures considered only ’effective in certain circumstances’ also fell overall.
According to the ICL report, hysterectomy for heavy menstrual bleeding declined by almost 11% overall, but while 13% of trusts recorded a fall, 4% saw an increase.
Meanwhile, there was no significant change in three other ’low-value’ procedures: spinal surgery for lower back pain, inguinal hernia repair, and primary hip replacement, or in two ’benchmark’ procedures: coronary revascularisation and gall bladder removal, the report found.
“During this period of austerity, each pound spent needs to be squeezed to deliver the maximum health value. The data suggest the NHS may indeed be managing costs in a rational way by reducing some procedures that have limited or low clinical value,” Coronini-Cronberg said.
“However, we cannot be sure that it is those patients who would not benefit from surgery that are being excluded.”