Asthma and Parkinson's losers in policy battle

The board has analysed the health and efficiency impact and potential for quality improvement in dozens of areas. This forms part of its attempt to ensure policy is based on evidence rather than “those who shout the loudest”.

The problem in the past has been those who shout the loudest got the resources

Provisional results of this analysis, seen by HSJ, suggest the most obviously neglected topics – which have a large impact and proven potential for improvement – are asthma, Parkinson’s disease and back pain.

Those that appear to have been made “high priority” unjustly – because they have a low prevalence, or have little impact on public health – include anxiety disorders, dementias other than Alzheimer’s, cervical cancer and chlamydia.

The work has been led by a committee of the quality board chaired by NHS medical director Sir Bruce Keogh. Its method was developed and consulted on last year but, the board says, will be open to challenge and change.

A paper to the board says it will help “identify and advise ministers where there is greatest scope and potential to improve healthcare quality”.

It adds: “The key strength is that for the first time it brings together a firmer broad based set of evidence across several criteria, with enhanced focus on quality improvement.”

Health Foundation clinical director Martin Marshall, former deputy chief medical officer at the DH, said: “It is undoubtedly good to see a more systematic approach towards prioritisation.

“The problem in the past has been those who shout the loudest got the resources.

“Asthma is clearly important and there is a recognised quality gap but it hasn’t had the same politicking or lobbying behind it that heart disease or cancers have had.”

However, Professor Marshall questioned whether improvement was best led by national priorities.

“When something is successful and removed as a priority, it is quite likely to come back again, because I don’t think we have embedded systems for improvement [locally],” said Professor Marshall.

NHS East of England medical director Robert Winter was appointed joint national clinical director for respiratory disease in December.

Dr Winter said he welcomed the decision to review the prioritisation status of asthma.

He said: “The whole direction of travel is incredibly bright – we are starting to weave quality measures into everything we do.”

Asthma UK chief executive Neil Churchill said: “This chimes with our experience. There had been a complacency but they have looked behind that and seen there is wide variation [in quality].”