Published: 24/01/2002, Volume II2, No. 5789 Page 20
The role of economic advisers in the Department of Health is to cost the policy wheezes of sometimes silly politicians and ensure that public money is well spent. It seems that such economic advice is not being asked, or if it is, ministers and their medical advisers do not seem to give a damn about wasting taxpayers'money.
In January 2001, a bunch of boffins on the spongiform encephalopathy advisory committee (SEAC) advised the Whitehall mafia of a theoretical risk of transmission of variant Creutzfeldt-Jacob Disease from re-usable surgical instruments, as the infection prion agent is not completely eradicated by normal sterilisation. SEAC endorsed tonsillectomy as a pilot scheme to evaluate single-use instruments.
The level of risk of vCJD was not made clear and the policy cost was not stated. It was not clear what the theoretical - let alone actual - cost-benefit ratio was.
By October 2001 a hazard notice was issued because of adverse incidents associated with single-use instruments: typically, increased bleeding - but also one death. These real risks, compared to the theoretical risks of vCJD, led the DoH to advise that surgeons should now use re-usable instruments, sterilised in the normal way.
One hopes that an unsleepy MP will ask these parliamentary questions of the health secretary:
nWhy were the disposable instruments so poor?
nWas it a product of poor manufacture by firms pursuing the quick buck?
nWhat was the cost of this sad episode? Trusts were instructed to throw out their re-usable instruments and use disposables.
Now hospitals have to buy new re-usable instruments - a bonanza for the manufacturers.
nHow many children and adults are now waiting for surgery who would have been treated?
This is not an isolated event. It is the product of 'expert' committees not having adequate membership and advice. To allow the boffins to manufacture public policies which ignore economic consequences is plain stupid. The chief medical officer and his merry men and women are well intentioned, but act as if risks - theoretical in this case - can be tackled regardless of their economic implications.
Resources should be targeted at those risks which can be reduced at least cost.
But, you may argue, this is just an isolated event. Not so - many NHS policies are well intentioned but inefficient because they are based on incomplete advice (usually from medical 'experts').
A nice example is the issue of consent. As a consequence of the Bristol disaster, it was recognised that the children's parents were very poorly advised about the risks of paediatric cardiac surgery. The Kennedy report confirmed that the way in which consent is acquired in the NHS leaves much to be desired.
Patients need to be briefed about treatment options, costs and benefits, and be given time to think about their choices.
The new departmental guidelines require all trusts and primary care organisations to introduce new consent forms by April and adopt model consentto-treatment policies by October.
Patients have to be advised of the consequences of treatment options and given the chance of a second discussion. Such consent procedures, if honest, would reveal to women that the risks of cervical cancer are generally exaggerated by the public health doctors, and the clinical and costeffectiveness of breast cancer screening is unproven.
The time consequences of informing patients are considerable: fewer will be treated. This does not mean that policy change is wrong. It shows again that if costs and benefits had been calculated and balanced, current policy changes would have had a better evidence base and less adverse effect on NHS activity levels.
If economic advice had been accepted, the Humber Bridge and Concorde would not have been built.While economic advice should not dominate, nor should the good intentions of scientists who pursue risk reduction regardless of opportunity cost.
The medical mafia in the DoH mostly have training in public health medicine. This obliged them to study economics in the distant past. Given they have clearly forgotten what they learnt, they are no longer fit to practise. The General Medical Council should strike them off before they do any more damage to patient health.
Such an outcome is highly unlikely.Most likely, the NHS (and private sector, which has to emulate policies such as these) will be beggared with further poor policies to implement.As ever, politicians and the public will then criticise the service for failing to deliver waiting-list and national service framework targets whose funding has been consumed by misconceived policies like those for vCJD and consent. That is life in the NHS.
Alan Maynard is professor of health economics at York University.