Letters

Alan Maynard's fundamental message (Looking Askance, 10 June) is important: all of us should be assessing our contribution to meeting health targets and ensuring that data is used to quantify the impact.

NHS managers and clinicians are increasingly aware of basic economic concepts. But economics itself has had only a marginal impact on local NHS decision-making.

The solution is for health economists to work closely with, or in, the system to get their message across. Mutual respect for public health colleagues is a condition for this. Both expend much public money in developing highly specialist skills throughout their training and practice. Both professions must ensure this ultimately adds value in improving health.

As the NHS awaits the national service framework on coronary heart disease, decision-makers will continue to grapple with issues such as the targeting of statins in secondary prevention. Clinical effectiveness alone will not be the issue; the NHS will have to consider cost-effectiveness too. People who understand the underlying epidemiology and the complexities of sound economic analysis should work together to develop feasible implementation strategies.

Work on preventing CHD in North Yorkshire has involved distilling the best available evidence on clinical and cost-effectiveness, and working with primary and secondary care clinicians to improve care. It is a slow process. Above all, it has recognised the need to be explicit about economic realities, rather than perceive them as lying outside the decision-making framework.

Brian Ferguson Professor of health economics Leeds University and assistant director North Yorkshire HA; Dr John Wilkinson Deputy director of public health North Yorkshire HA and visiting fellow York University