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Vascular screening is localism gone mad

Everything these days is going local – from plans for extended opening to the QOF, and from public health programmes to implementation of Lord Darzi’s review of the NHS.

Everything these days is going local – from plans for extended opening to the QOF, and from public health programmes to implementation of Lord Darzi's review of the NHS.



The days when the Department of Health dictated policy from the centre are, apparently, over – give or take the odd polyclinic. Instead, PCTs are being handed the reins, given a gentle nudge in the right direction, and told to get on with it.

There is much to commend this outbreak of democracy.

The arguments for local policies tailored to local health needs are well rehearsed but no less powerful for that. Challenges such as obesity, substance misuse or difficulties in access to healthcare do indeed vary substantially from one area to the next, and some element of local flexibility on policy therefore makes sense.

But the Government often seems to approach strategy like a teenager does fads, growing bored of one and moving excitedly and obsessively to another.

Once national targets were all the rage, with 62 set by the DH alone. One mood swing later and everything is now localised, even where some national direction would seem essential.

Wild variations

No Government policy illustrates localism gone mad better than the vascular screening programme, which in fact is not a programme at all. A programme implies common aims, an agreed methodology and a consistent set of criteria for evaluating success. Vascular screening has only a vague aspiration, sketched guidance and implementation plans that vary wildly from one area to another. GPs are paid from £1 to £25 per patient screened. Some areas use pharmacists, others are employing battle-buses outside supermarkets. There is not even any agreement over the methods used to assess risk or consensus over how those at risk should be managed once identified.

Such acute variation makes a mockery of any notion that this is a clinically driven intervention that can be assessed by cost-effectiveness like any other major NHS initiative. If costs vary by fivefold or more, then presumably screening could fall within the cost-effectiveness threshold in some trusts, but not in others. And if screening is performed in such a colourful variety of ways, how can the Government ever expect to assess whether it is working?

In truth, this never was a clinically driven intervention. The National Screening Committee was caught by surprise when it was announced, and at least one member was strongly opposed. Screening was always politically driven, and localism is the new political buzzword.

editorial

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