Challenging ineffective practice in the Welsh NHS

As we know all too well, times are hard in our public services, and almost the last thing they should be doing is spending money on things that don’t work.  The VERY last thing they should be doing is spending money on things that not only don’t work, but might actually be harmful.  Surely none are?  Well…

As the evidence base evolves it becomes clear that some interventions are effective. However that is not true of all interventions in healthcare. Indeed some treatments are shown to offer no benefits but risk of additional harm.

Health Boards in Wales are committed to reducing harm and waste. So they are drawing up lists of procedures which are believed to be either harmful or of low enough effectiveness to be a waste of resources compared with other options. They have been assisted in this by Public Health Wales who have reviewed evidence not already covered by NICE guidance. Now Public Health Wales is producing a report highlighting variation in provision of surgical procedures of questionable effectiveness.

Variation is not of itself a problem.  It may be a sign of provision of specialist care targeted to selected individuals who might gain particular benefit from a treatment not generally advised. The report by Public Health Wales is not able to demonstrate whether the variation is justified in this way. The use of procedures of questionable effectiveness should be justified, however, and the report on variation in provision is the starting point for further investigation by the Health Boards.

This is not the stuff of accountancy penny-pinching.  In a finite budget, spending money on things that DON’T work means denying money to things that DO.  That’s unethical.

Written by Marcus Longley, Professor of Applied Health Policy and Director of WIHSC

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2 Responses to Challenging ineffective practice in the Welsh NHS

  1. There are other areas where money and resources are not put to effective use within the health sector.

    There are still too many errors being made, because of incorrect identification of patients, and/or drugs and their administration. These errors cost money both directly in terms of compensation, and indirectly in terms of extended stays in hospital with the knock on effects of delayed treatment for other patients.

    Another less dramatic area is that of asset management. In particular it has been estimated that up to 25% of nurse time is spent “looking for things”, this is a direct problem, but also has indirect consequences in that by improving asset management and usage less assets are needed.

    Many case studies exist to back up these problems, and that in most if not all cases better identification and logging of these assets and procedures using Automatic Identification and Data Capture techniques (AIDC)will drastically reduce if not totally eliminate these problem areas.

  2. John Desmond says:

    The report produced by Public Health Wales has been invoked as the starting point for further investigation by the Health Boards into the justification of the use of medical procedures of questionable effectiveness. My response is that to invoke the report as a starting point is to look through the wrong end of the telescope. A lesson from psychology might be helpful. There is another ethical issue which precedence over the issue about whether a medical procedure is of questionable effectiveness. That issue is whether the use of the procedure is justified by objective evidence for its necessity. In recognition of the maxim primum non nocere, the use of a procedure should be justifiable. The concept of the justifiability of medical procedures is intricate and, of course, in each particular case, context-dependent. But it needs to be invoked if the issue about the effectiveness of potential medical procedures is to be put into perspective. Otherwise there is the risk of succumbing to the mistake of looking through the wrong end of the telescope.

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