Jeremy Laurance: Patients will be alarmed – but change is long overdue

In an era of austerity, the temptation for the NHS to cut corners will be strong

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Not everything the NHS does is worth doing. Take the practice of prescribing antibiotics for children with sore throats and earache, for instance. GPs frequently respond to pressure from anxious parents by reaching for the prescription pad, but in more than nine out of 10 cases, the sore throat will be caused by a virus and antibiotics will be useless.

Reducing antibiotic prescribing is one of the areas targeted by Nice for potential savings, which it says could yield £3.7m a year nationally, if its recommendations are followed.

It was highlighted by Sir Michael Rawlins, a former chairman of Nice, in 2007 who suggested at that time that GPs might hand parents a piece of paper from Nice explaining why giving antibiotics in those circumstances was a waste of money.

With the chill economic winds blowing through the public sector and the NHS facing a real-terms budget that is static at best, managers are demanding £20bn of savings over the next four years to enable the NHS to meet growing demand. Nice is preparing to play its part in delivering that target. Nice has never been popular with the public, although the model has been copied by countries around the world. Since its launch a decade ago it has been involved in a seemingly endless series of battles with charities, patient groups and pharmaceutical companies angry at its refusal to approve their drugs for use on the NHS. It does itself no favours by using the language of accountancy – "cost effectiveness" and "value for money" – in reaching decisions, which can make it appear inhumane. It is widely seen as a rationing body even though its decisions have added £1.6bn to the annual NHS drugs bill.

What will alarm patients about its latest initiative is any suggestion that the savings it recommends are being driven by economic necessity rather than best practice. In the new era of austerity that lies ahead, the temptation for NHS trusts to cut corners will be strong. On the other hand, a vast amount of what the NHS does is outmoded, because treatments are obsolete or have been superseded by more modern approaches. Hysterectomies, tonsillectomies, surgery for glue ear are all costly procedures of (mostly) questionable benefit. Sir Liam Donaldson, the Government's Chief Medical Officer, first drew attention to the need for "disinvestment" from outdated practices and treatments in the NHS in his annual report for 2006.

Nice can only make recommendations – it is for NHS trusts to implement them. Sir Liam suggested changes to the NHS tariff system to encourage some treatments and penalise others. The use of carrot and stick to drive change may become increasingly familiar in the NHS.

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