WIREDGOV

The NHS could save up to £500 million a year by carrying out fewer ineffective or inefficient treatments. This money could then be spent on more clinically effective treatments that have better outcomes for patients.

A single approach to defining these low value treatments could help to reduce the duplication of effort between primary care trusts (PCTs) and help to ensure consistency across the country, the Audit Commission has found.

In its briefing, 'Reducing expenditure on low clinical value treatments', the Commission looked at some PCTs' efforts to decommission treatments of low clinical value. The approaches they took and the list of treatments they targeted varied. The Commission is not advocating any particular list, but the types of low value treatments identified included:

• those considered to be relatively ineffective, eg a tonsillectomy;
• those where more cost-effective alternatives are available, eg not performing a hysterectomy in cases of heavy menstrual bleeding;
• those with a close benefit and risk balance in mild cases, eg wisdom teeth extraction; and
• potentially cosmetic procedures, eg orthodontics.

The potential for reducing spending varies from PCT to PCT, but, based on one of the more widely-used lists, some could save more than £12 million each year by reducing their use of these, or other, treatments.

Decommissioning treatments can free up money that could be better spent on other treatments, but it is not always easy. Decisions can be controversial and raise ethical questions. Strong leadership within PCTs is therefore essential to successfully decommissioning treatments, and groups of PCTs working together are often more effective than those operating alone. Engaging GPs and hospital consultants is also essential.

Good communication between PCTs, and GPs, patients and the public, is crucial for the successful decommissioning of treatments. The briefing says that the public will want to know that appropriate research and reasoned consideration have influenced decisions about which treatments have low clinical value.

Andy McKeon, MD Health at the Audit Commission, said:

'PCTs were keen that the Commission looked into how best to tackle this sensitive issue as they have all been developing their own approaches. We were surprised at the variety of lists used. PCTs across the country are currently paying for treatments that cost the taxpayer money, and according to clinical experts have little or no real value to patients. This needs to change.

'Some PCTs have successfully addressed the issue and are now able to spend the money they have saved on more effective treatments. Many others are seeking to do something similar. Our report provides practical advice on how best to do this. A single national evidence base would also reduce variation in the treatments available and duplication of effort.'

Notes to editors

1. The Audit Commission is an independent watchdog, driving economy, efficiency and effectiveness in local public services to deliver better outcomes for everyone.
2. Our work across local government, health, housing, community safety and fire and rescue services means that we have a unique perspective. We promote value for money for taxpayers.
3. On 13 August 2010 the Secretary of State for Communities and Local Government announced that he plans to disband the Audit Commission.

For further information please contact:
Louise Neilan, Media Relations Manager
Tel: 020 7166 2132
Mob: 07766 697 801
Email : l-neilan@audit-commission.gov.uk