Health chief declares war on old treatments

Stephen Dorrell, Secretary of State for Health, yesterday pledged to use science more effectively to improve patient care by identifying the best treatments faster, and weeding out those that have no place in a modern health service.

Mr Dorrell, who has already declared war on inefficient hospital managers, signalled that research and development (R&D) in the NHS is also high on his agenda at the Department of Health, claiming that it has the potential to make the "single biggest contribution to patient care in this country as we approach the next century". He promised to commit "real resources and management support" to ensure that the most up-to-date knowledge of which treatments are effective - and which are not - is made available to clinicians.

Speaking in London at the first international conference on the Scientific Basis of Health Services, Mr Dorrell said: "It is no longer sufficient to rely on clinicians reading articles in the learned journals. They need ready access to research results - an effectiveness index on tap as it were." He emphasised the need to make a serious commitment to ensure that the results of modern medical science are made easily available to NHS clinicians, and cited the example of "clot-busting" drugs for heart- attack victims. Despite strong evidence of their benefits in saving lives, the drugs took more than a decade to begin to permeate medical practice. Up to a fifth of patients who would benefit still do not receive the life- saving drugs.

Mr Dorrell also said that, in the past, there had been a "development gap, a hiatus between research and practice", where the results of clinical trials worldwide had been unavailable for use.

But he warned that the "rigorous assessment" of new ideas must also be applied to existing practice, and obsolete methods phased out. "If we want to see the outputs of science and technology used to best effect, ineffective and unnecessary procedures need to be abandoned. We need to identify and address the use of ineffective drug therapies, as well as other practices, such as the use of unnecessary gynaecological procedures on younger women and examples of ear, nose and throat surgery in childhood which appear to be of doubtful value."

Mr Dorrell denied this would lead to rationing by the back door, but said health-service managers had an obligation to set priorities. Expensive treatments that offered only marginal improvements on existing treatments should be used sparingly, but those which represented a big step forward in treatment should be a high priority regardless of cost.

He is hoping to reassure critics who say that R&D is a prime casualty of the changes in the health service. A government task force last year reported claims that short-term cost pressures were driving out investment, and the clinical science base was being eroded.

The NHS scientific community has also been hit by the resignation of key researchers following the reorganisation of London hospitals. But Mr Dorrell said that R&D was now a "core activity" of the NHS, established as a new programme in 1990 to create a link between the health service and the methods and products of science.

Five years on, the Government is committed to a target expenditure of 1.5 per cent of the health budget on R&D, and each health authority is required to make a contribution towards that fund.

Sir Richard Sykes, chief executive of Glaxo Wellcome, who gave the inaugural address of the conference to more than 1,000 delegates from 40 countries, said the biological, technological and information revolutions had dramatically improved treatment and had immense potential to achieve further breakthroughs. But he warned: "We shouldn't just rush off and use this technology at a whim. It's going to be very, very expensive."