New Audit Commission list of ‘ineffective’ clinical procedures “indiscriminate and damaging”, says leading patient and medical device coalition

• A New Audit Commission study presents an un-evidenced and arbitrary list of procedures as low value or ineffective, many of which are approved by NICE, and highly valued by patients for restoring independence, relieving pain and making normal life possible.
• Study runs counter to efforts to put decision-making into the hands of local clinicians and patients based on the best available evidence of clinical and cost effectiveness.
• The short-term savings that come from eliminating procedures such as knee joint replacement may lead to greater costs for patients and taxpayers in the long-term.

The Medical Technology Group (MTG), the UK’s leading coalition of research charities, patient groups and medical device companies, has expressed deep concern that a new Audit Commission list identifying procedures of ‘low clinical value’ ignores the best available evidence of clinical and cost effectiveness, and will lead to the phasing out of treatments on the NHS such as hip and knee replacements, spinal cord stimulation to relieve pain and cochlea implants to restore hearing, which transform patient’s lives.

The list which is self-selected by a number of London Primary Care Trusts including Croydon PCT, appears in a health briefing by the Audit Commission. The briefing encourages other Trusts to follow Croydon’s lead in identifying procedures to be phased out in order to make cost savings.

The MTG argues that the ‘list’ approach will damage patient care, and any net savings to the NHS, will be marginal.  For some patients unable to access these procedures, their health will deteriorate, leading to higher cost interventions, and a lack of independence in everyday life – including going out to work and participating in society.

Barbara Harpham, Chairman of the Medical Technology Group and Director at Heart Research UK said:

‘This is an un-evidenced, and damaging study which will do nothing for patient care, nor NHS finances.  Other than a cluster of London PCTs, who endorses the self-selecting list?  Not NICE whose guidance verifies many of the procedures to be clinically and cost effective, not doctors wishing to use their clinical judgement for every case they see, and certainly not patients whose lives have been transformed through hip and knee replacements, pain relieving spinal cord stimulation and restored hearing achieved by cochlear implants. 

Procedures should be agreed following a discussion between patient and doctor, based on the best available evidence of clinical and cost effectiveness.  Issuing arbitrary and indiscriminate lists which ignore individual needs is the antithesis of good cost saving and exactly what the NHS should avoid.’