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Pain, cost and value

 

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Monday, 13 September 2010

Pain, cost and value

If all PCTs spent the same on cardiac valve surgery as the average PCT, the NHS would save £19 million a year.

There is a five-fold variation in spending across PCTs on cardiac valve procedures – and that’s after the figures have been adjusted for age, sex and need. The argument that the distribution simply mirrors the variation in health needs across the population doesn’t wash – health inequalities are wide but not this wide.

“Right Care” is the name of the QIPP workstream that aims to ensure that well planned interventions at the right time benefit patients and save money. The initiative concentrates on three areas -- respiratory, gastrointestinal and liver, and genito-urinary disease -- that cost the NHS more than £12 billion a year. Its architects believe that the right care workstream could save nearly a quarter of this sum by 2013/14.

Right care is based on the simple idea of identifying high value interventions and eliminating low value ones. Value can be increased for both individuals and populations by improving the quality of healthcare and preventive services, namely by doing things better, safer, and cheaper.

This may sound painfully obvious, but it isn’t how we usually think about these things. Our tendency is to confuse value with cost and to talk about the two sides of the cost/benefit equation in isolation.

Well informed patients working closely with clinicians are more likely to make good decisions about their care. Commissioners working with reliable data and sharp analytical tools are more likely to create the conditions that lead to good health outcomes at the right price than browbeaten middle managers in a poorly organised bureaucracy.

Right care feels right for the times because it prefers networks over structures and evidence over ideology. It takes a patient-centred, clinician-driven view of the world and has a healthy disregard for top-heavy command and control systems.

To be successful demands a more challenging approach to health investment than the NHS has been used to. It will require commissioners who are prepared to decommission services that fail the tests of value for money and health outcomes.

Right care is not so much an idea whose time has come, but the only possible way to think about healthcare in 2010. If some NHS services don’t benefit the patient and don’t make economic sense, why on earth are we even contemplating them?