Dear Alex,
You might be interested to know that Sir Muir Gray,
the Guru of EBM is the Head of of the QIPP 'RightCare'
Workstream, and as a consultant in public health medicine
with a specialty interest in evidenced-based health services
commissioning, I too am proud to be associated closely with
the workstream. I moderate a UK wide public health health
services commissioning network which consists of more than
270 consultants in public health who are all specialists in
evidenced-based health services commissioning.
While it would be too much to go into all the details
of the QIP Workstream, can I add that that if if
left-leaning academics like you (who have no
practical knowledge of working at the coal face of the NHS
and of dealing with tight NHS finances) had supported us
when we first put such evidenced-based proposals to the then
Labour government to contain burgeoning NHS costs and
transfer the savings to reducing health inequalities, we
wouldn't have been in such sh-t now. The problem with Labour
is that they always speak the right words on reducing health
inequalities but they do precious little practically in
putting their words where their mouth is, especially where
the NHS is concerned. Instead of supporting evidenced-based
care (which has to be affordable), Labour pandered to the
likes of big pharma and the medical device manufacturers
(300 million on setting up 3 proton beam therapy machines to
treat 4500 cases, for which there is hardly any robust
evidence-base) and the healthcare wants of
the vociferous, voluble, well-connected, well-heeled and
literate middle class whose votes they were desperately
seeking. Today we are reaping the seeds of what Labour has
sowed!!! And you all call yourselves supporters of the poor,
I say 'shame on you armchair academics'!!!!
The NHS is free for those at the point of healthcare
need, NOT at the point of healthcare wants. Labour found it
very difficult to make difficult and unpopular
prioritisation choices and so now we have a proliferation of
healthcare wants, not needs, and the NHS cannot afford it
any more.
You might like to read a recent JAMA article that I
have co-authored with an eminent american Prof of Oncology
and EBM on 'From Efficacy to Effectiveness in the face of
uncertainty: indication creep and prevention creep'
I am willing to engage in a full public debate with
you or with anybody else on the merits of health care wants
versus health care needs, if you want to.
Kind regards,
Ash
Dr Ash Paul
Medical Director
NHS Bedfordshire
21 Kimbolton Road
Bedford
MK40 2AW
Tel no:
01234897224
From:
Alex Scott-Samuel
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To:
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Sent:
Monday, 1 August 2011, 15:20
Subject:
"Reducing spending on low clinical value treatments"
I have only just come across this document, which is
presumably one of the triggers for the unpublicised,
un-consulted-on clinical rationing taking place in many
areas. While its encouragement to eliminate ineffective
treatments makes total sense, its assertions on
treatments with 'a close benefit or risk balance in mild
cases' seem questionable. These include cataract surgery
and joint replacements.
I would be very interested in your knowledge on how this
is being applied nationally, often I gather, in
conjunction with "the ‘right care’ workstream" of the
so-called QIPP programme.
Thanks, Alex
Audit Commission. Reducing spending on low clinical
value treatments. Health Briefing, April 2011.
http://www.audit-commission.gov.uk/sitecollectiondocuments/downloads/20110414reducingexpenditure.pdf