Alderwich, H., Robertson, R., Appleby, J., et al. Better value in the NHS: the role of changes in clinical practice. The King’s Fund, 2015.
“The reasons why overuse happens are complex. They include failures to follow professional guidelines, lowering thresholds for treatment, lack of access to alternative treatment and supply-induced demand for services. Overuse can also be driven by ‘silent misdiagnosis’: the gap between what patients want and what doctors think they want. In fact, what patients often want when they are involved in decision making is less treatment….” (pg 49)
- 40% of patient who died in hospital in the course of one month had no medical need to be there.
Over use of low value interventions
- Monitor estimated that between £0.2 billion and £0.6 billion could be saved every year by stopping elective procedures of low clinical value, like tonsillectomies or knee washouts.
Overdiagnosis and use of diagnostic services
- Over diagnosis of mild depression in primary care – this can lead to potential harm for the patients, unnecessary costs from overprescribing of antidepressants
- Eliminating unnecessary pathology testing could save the NHS (England) as much as £1 billion every year
- Overprescribing of antibiotics in primary care for patients with respiratory tract infections
- Overprescribing of antibiotics in hospitals for patients after surgery
- Overprescribing of inhaled drugs used to treat COPD
Note that this paper also goes on to discuss under-use and mis-use of NHS care.