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A listening ear

I should be pleased. At last, the Government is doing what we always wished it would; instead of rushing through an ill-thought piece of health policy, focused on catchy sound bites rather than sound evidence of both benefits and harm, they are taking things slowly, listening carefully, waiting patiently for the evidence to be established.

I’m far from the only one who has begged our leaders to do this more often, who has hollered and screamed when they have not, but I’ve lost count of the number of times they have ploughed on regardless, with, at best, a passing nod to a pilot study that was designed only to give the answers they seek. Like the cough for 3 weeks cancer campaign where the pilot study was declared a great success because more people went to their doctor with their cough, and more chest x-rays were ordered, while the inconvenient fact that cancers were not picked up any earlier was quietly ignored. Or the national roll-out of the hugely expensive NHS Health Check programme despite the report from the Cochrane Collaboration that population-wide health checks make no difference to mortality and are not cost effective.

Then we have policies where there is no evidence at all, but the Government line has been that if you deny the very possibility of harm then you negate the need to look for it – like case finding in dementia via the GP DES and the hospital CQUIN. If you hear any policy maker in this area concede, for even a moment, that overdiagnosis is a possibility in dementia then please let me know – I’ve been looking for a while and have drawn a blank so far.   

QOF, of course, provides a wealth of examples where policy is in contradiction to evidence – like the 140/90 blood pressure target for those aged below 79, tight HbA1c control in diabetes, measurement of ACR in older people with normally ageing kidneys – the list could go on. Now NICE may need to share the blame in part for QOF targets, and the Government could claim to be listening at last by removing many of the worst offenders next April, but you suspect this is more for political reasons than a true respect of the evidence base.

So I should be pleased. If I am to be consistent, how can I criticize them for waiting for all the evidence before making a decision? Am I not a hypocrite if I berate them for listening? Of course I would be – so I shall keep quiet. I just wish it weren’t the Tobacco Industry that had their ear, and shall hope for industrial quantities of cerumen to save the day #plainpacks.

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68