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

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.