The National Institute for Health and Clinical Excellence has rejected calls to identify more drugs and treatments that should be used less - or not at all - ahead of NHS investment cuts.
Former Healthcare Commission chair Sir Ian Kennedy and primary care trusts are calling for NICE to publish more explicit guidance on what they should stop paying for.
PCTs say it could eliminate millions of pounds of wasteful spending but claim they need national backing to take on potential opposition from clinicians, interest groups and
providers. In an interview with HSJ, NICE chief executive Andrew Dillon said it planned to be clearer on where existing guidance could reduce costs, but insisted there was little more it could do to find new disinvestment savings.
“We have been identifying interventions and forms of treatment that we know the NHS is either using inappropriately or using too much [for several years].”
Mr Dillon said it had considered a disinvestment programme in the past but decided it would be unsuccessful.
“I’m not sure there are a huge [number] of topics NICE can link together and put into a programme around affirming their uselessness.”
But Mr Dillon said NICE would make it easier for PCTs to see the financial benefits of its guidance. “We need to be much better at communicating the things we already come across that the NHS ought to be doing differently.
“PCTs are full of intelligent, perceptive people and they know what is coming up in terms of changes in the NHS [financially], but they are fantastically busy. We need to make it easier for PCTs to see the point that we are making.”
NICE is planning more work on money-saving technologies and diagnostics, he added, and is in discussions with the Department of Health about referral management and service redesign projects, which could help cut costs.
Sir Ian, who reviewed the institute’s work for a study published last week, told HSJ: “There needs to be more rigorous attention to disinvestment within NICE so it becomes an active stream [of work].”
He said the institute was well placed to make the case for disinvestments. “I’m sure there are going to be people who say: ‘This [treatment/drug/procedure] works very well for me’, but NICE is for the whole population, not just one group of the population.”
Buckinghamshire PCT chief executive Ed Macalister-Smith called for more explicit guidance. “The PCTs in South Central are looking at disinvestment together and we are going to try every area we can find. It would be enormously helpful if an authoritative body like NICE could help.”
Birmingham East and North PCT chief operating officer Andrew Donald said lack of national guidance was not an excuse for PCTs not acting themselves. But he added: “We will get people locally arguing against us and you need an authoritative body to say: ‘This is not clinically effective and we shouldn’t be commissioning this.’”
York University professor of health economics Alan Maynard said: “NICE should be doing what the NHS actually needs. That is what it is paid for.”
Procedures believed to be commonly carried out where there are more cost effective alternatives include tonsillectomies, arthroscopic washouts and varicose vein procedures.
HSJ’s analysis of results from trials of patient-reported outcome measures in the NHS suggested tens of millions of pounds a year are being spent on procedures with little obvious benefit.