How do we stop or reduce treatments that don’t work or aren’t cost-effective?

Theme Surgical and orthopaedic innovation

Workstream Innovative translational research methods

Status: This project is complete

Stopping or reducing how often a treatment is offered by the NHS is called ‘de-adoption’. De-adoption could mean stopping a treatment altogether, or only giving it to patients where we think the benefits justify the risks/side-effects and NHS costs.

De-adoption is a challenging process, especially in surgical and orthopaedic care. Reasons why a treatment could be de-adopted include evidence showing the treatment is:

harmful
ineffective
not cost-effective
there is uncertainty around its benefits relative to its harms and costs

In 2019, NHS England launched the Evidence-based Interventions (EBI) programme. The programme is aimed at improving the quality of care offered to patients by reducing unnecessary interventions and preventing avoidable harm. It identified 48 surgical/orthopaedic interventions for de-adoption.

Project aims

The aim of the Olivia study was to develop recommendations on how to improve de-adoption in surgical and orthopaedic care by investigating the acceptability and impact of the EBI programme.

What we did

During the project we:

Examined whether the surgical procedures and diagnostic tests identified by the EBI programme were offered less frequently
Investigated the views and actions taken by commissioners and healthcare professionals in response to the EBI recommendations and how they felt this affected the way care was delivered and organised
Investigated patients’ and carers’ experiences of healthcare in the context of the EBI programme
Developed recommendations to support future de-adoption
Organised workshops to get feedback about our recommendations from representatives from surgical specialties, commissioners, general practitioners, and the public

What next?

Although our immediate priorities focused on surgical and orthopaedic care, we hope that the recommendations developed during this study will be used to support de-adoption in a range of clinical and social care contexts.

Identifying potentially low value surgical care: A national ecological study in England

Read the paper

People involved

Dr Leila Rooshenas

Training lead

Leila.Rooshenas@bristol.ac.uk

Partners

Bristol, North Somerset and South Gloucestershire Integrated Care Board
The Integrated Care Board (ICB) is responsible for the day-to-day running of the NHS. The NHS Bristol, North Somerset and South Gloucestershire ICB takes account of population needs, arranges for the provision of services and manages the NHS budget.
Canterbury Christ Church University
Inspired by its Church of England foundation, the University’s mission is to pursue excellence in higher education: transforming individuals, creating knowledge, enriching communities, and building a sustainable future.
NIHR Applied Research Collaboration West
The NIHR Applied Research Collaboration (ARC) West, conducts applied health research with partners and others in the health and care sector, alongside patients and members of the public.
University of Birmingham
For more than a century, the University of Birmingham has been pursuing and sharing knowledge through outstanding teaching and world-leading research. Each year it welcomes more than 30,000 from across the world. Its thriving student population enjoys a wide range of courses, and exceptional campus and research facilities.
University of the West of England (UWE Bristol)
UWE Bristol is one of Britain’s largest universities with a consistent reputation for high graduate employment, quality in teaching and growth in research. It is at the heart of dynamic partnerships that deliver real impact in the world. UWE hosts the Bristol Robotics Laboratory, the largest academic centre for multi-disciplinary robotics research in the UK.