Dr Ash Paul, Consultant in Public Health NHS SWL CCG
and member of the National Expert Advisory Group, NHSE EBI Programme
As a member of the Evidence-based Interventions programme’s Expert Advisory Committee (EAC), which gives advice on what tests and treatments should be offered to NHS patients, I believe that it is vitally important to ensure that interventions patients receive are fully necessary and based on robust evidence. On the Committee, I work with other doctors representing their professional bodies, patient groups, commissioners, data scientists and experts from the National Institute of Health Research and from NICE – it’s a very multidisciplinary group which ensures informed and balanced decisions. Together, we go through a long list of interventions provided to us by technical teams, handing back a shortlist of recommended interventions for reduction.
With all these clinicians coming together, there could be potential for disagreement, however, we have very experienced co-chairs who are fantastic at bringing all views together and finding a common ground in the rare event of a disparity of opinion. The contribution of patient groups to our decisions also ensures that NHS England and Improvement sticks to its promise of ‘Nothing about me, without me’, encouraging patient involvement in making decisions about their own care.
It is very frustrating when patients do not receive the right treatments at the right time and place. As a public health doctor with a long career in the NHS, I have seen inappropriate and ineffective treatments taking place and this is why I am so pleased that the EBI programme is taking steps to create a more sustainable NHS for the future.
Far from being stand-alone, EBI is based on the pioneering Choosing Wisely Programme which began in the USA and since spread around the globe. EBI has never been as important as it is now as we face the aftermath of the global Covid-19 crisis, which has left a huge list of patients waiting to be treated by NHS England and Improvement in its wake. It is a vital programme which not only protects patients from receiving inappropriate treatments, but also reduces waste and frees up time in the NHS so that the long waiting lists can be more rapidly taken care of.
This is not a cost-cutting scheme for the NHS, but instead aims to protect patients and the system by preventing inappropriate treatments from going ahead. The side effects of overdiagnosis, over-testing and overmedicalisation cannot be emphasised enough: they all cause some form of harm to patients, and stretch the system beyond its limits.
Once implemented, the recommendations for unnecessary interventions will apply across the whole NHS – helping to highlight and tackle variations in care across different services and trusts.
I am proud to be part of the EBI programme, and grateful to the Academy of Medical Royal Colleges for their unstinted support as the programme’s principal sponsor and driver. Working as part of a dedicated team at NHS South West London, I look forward to seeing EBI become a long-term and lasting success.