Two rational ways to save the NHS money

The NHS is under the most vicious politically motivated attack it has seen in its lifetime. The level of cuts being made means no part of the NHS is immune to wholesale pruning, with some areas (e.g. experienced primary care commissioning) being destroyed to meet Andrew Lansley's blinkered mantra that the market can deliver more efficiency.

In the midst of such change it makes sense to me that rationality is applied to reforming aspects of the NHS and to making savings that are, at least, logical in terms of least impact on healthcare. 

This is exemplified by the current practice of applying clinical- and cost-effectiveness measures to proposed interventions. For example, if an expensive cancer drug (say £60,000 per round of treatment) is being touted as slowing down the advanced stages of liver cancer (say, by giving two weeks' extra life), should a patient on the NHS be able to get this? If I was the individual with the cancer, or had a loved one with the cancer, I’m sure my gut response would likely be "Of course - if there is a chance it will work then it should not be denied me." But, for an NHS with a finite budget, this response is not good enough and requires further scrutiny.

Firstly, is the intervention actually proven as clinically effective? Is it likely to have the positive impact the drug company claims? To answer this, the NHS needs to rely on real clinical evidence, ideally from randomised double-blind trials with significant numbers of people. "Rule of rescue" - the "we've tried everything else, so let's give this a shot too" is not a clinically sustainable rationale.

And secondly, even if an intervention is clinically proven as having positive impact, there remains another tough calculation that must be considered; the balancing of the health gain of that £60,000 spent on one individual with what else could be done with the same money in other treatments.  Seeking cost-effective treatments (and not spending on a clinically-proven but not cost-effective one) is something that our NHS does, and, for the most part, does well. It is potentially harrowing to take such decisions, but the NHS commissioners who do this are contributing to ensuring the NHS is the most effective in meeting the health needs of the whole population. As it should.

So, in the spirit of the coalition government's strap line "We're all in this together", I have a couple of suggestions of savings that could be quickly made to the NHS, and which would have zero impact on the health outcomes of anyone going through any part of the NHS.

The National Secular Society has just published a study into the money spent by the NHS on hospital chaplains: http://www.secularism.org.uk/uploads/nss-chaplaincy-report-2011.pdf It shows that the NHS could save £29m per year by stopping paying direct costs for chaplains. The study does not cost out the provision of rent-free office space, for example. So, if religions wanted to continue to provide chaplains, there is nothing stopping them doing so (they can visit, and could even continue to have rent free space). But the NHS should not be paying for them; the people who believe the particular set of myths relating to the faith group of that chaplain should.

It is not enough for believers to just claim that, for example, intercessory prayer works; where public money is involved, it is instructive to apply the clinical-effectiveness test to this NHS spend. The 2006  Study of the Therapeutic Effects of Intercessory Prayer (STEP) is the largest scientific study to date on the impact of prayer on health outcomes, involving over 1,800 patients. Its two key findings were:

1) “Intercessory prayer had no effect on recovery from surgery without complications.”

2) “Patients who knew they were receiving intercessory prayer fared worse.”

Or to put it another way, intercessory prayer is not proven to work.

 

This does not mean that it is "wrong" for people to pray for others. Indeed, those doing the praying are likely to report feeling better about the ill health of others, and, for those who believe and know they are being prayed for, they may take comfort from others’ praying. But this is not the same as a positive clinical output.

The STEP study is a robust randomised double-blind trial of the kind we demand from any other NHS spend. Well, almost any other.

In the UK another £4m could be saved every year by not spending NHS funds on homeopathy.  At a time when we are making significant cutbacks in clinically effective interventions, it beggars belief that we sanction the spend of £4m on a quack pseudo-remedy that consistently performs no better than placebo in double-blind trials. If an individual wants to spend their money on sugar pills and water, they can. But we should not spend public money in this way.

Like the religious, followers of homeopathy (once the pseudoscience of "water memory" has been debunked) resort to "it's about belief not science".

Until and unless we have an NHS with infinite funding, the provision of services through it should not be based on unproven belief systems, but through the same scientific rigor we apply to every other intervention.