As a clinician with an interest in management, the waste in the NHS astounds me. There are huge variations in drugs that do practically the same thing, such as statins, and numerous different types of joint replacement and procedural systems that work efficiently in one hospital but are unworkable in the next, particularly with respect to day-case work, writes Michael Davies

The National Institute for Health and Clinical Excellence is useful as far as it goes, but its role should be extended. Groups of doctors with training in management from each specialty should be brought together to decide on the most cost-effective way of controlling each pathway in clinical practice. This should then be imposed with treatment and equipment standardisation across the country.

The time has come to stop clinicians making poor budgetary decisions supported by melodramatic speeches about "potential" harm which in the world of evidence-based medicine does not exist in most cases.

Dr Michael Davies, London

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