Sue Bailey: Improving value and choosing wisely

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  • Posted:Thursday 26 November 2015

Sue Bailey speaking at our 2015 annual conference about the Choosing Wisely programme, which promotes shared decision-making with patients to reduce unnecessary clinical intervention.

This presentation was given at The King's Fund annual conference on 19 November 2015.


Estimated overuse in health care examples of common interventions from the evidence base: use of antibiotics in children and adults, hospital admissions, carotid endorterctomies, hysterectomies and ambulance transport to ED.

These interventions caused unnecessary harm and cost money, money we don’t have.

So, choosing wisely is to promote conversations between doctors and patients.  I hear the groan when we say GPs have three minute clinics, if we did choosing wisely properly, for those patients who needed it and the GP, we could have twenty minute consultations and the same in SEAL and diabetic clinics where we see people too often to do too little to no end.

So, choosing wisely has to be supported by evidence, not duplicative of the tests or procedures already received, free from harm and truly necessary.

Choosing wisely, we were contact by colleagues in Canada, although the movement started in America, the Royal College of Physicians took this up, brought it to the family of colleges in the academy, there was an international conference in Amsterdam, we supported it in principle, the academy agreed to this initiative and we scoped and engaged in it.  And in May 2015 we had a public launch.  We got opposition and agreement in equal measure, ie. we were listened to.

There’s a lot of working going on around choosing wisely, nationally and internationally, in England in the five year forward, in the Royal College of Physicians, in the work that the BMJ are doing, in commonwealth funding, this has got to be about partnership.

Obviously, as an academy we’re very keen on the evidence base.  As a Psychiatrist, I think this will be only work if we do shared decision making and that is about having conversations and dialogues with our patients that we’ve forgotten how to have.

We need to embed a culture in which patients and clinicians can regularly discuss the clinical value of effectiveness of proposed treatments or interventions, with the explicit aim of reducing the amount of inappropriate clinical activity.

None of us want to stop doing anything.  We do this in our own family lives.  We know there’s no evidence that it improves the quality of our family life, but we keep on doing it because it’s a tradition.  And it’s stopping doing things which is far more difficult than starting doing things.

So, we want to begin the process by supporting colleges and specialist societies, and we’ve now produced template and we’re working with the colleges at this point in time, eight of the colleges have returned their top five with appropriate evidence and these lists will be defined and refined.  And what we’re finding already from the lists individual specialties are sending us is that commonalities across the specialties and certainly Pathologists and Radiologists have a lot to share with us about what we can stop doing.

So shared decision making will develop a tool and guidance for clinicians which will support choosing wisely conversations, because, I think, in some ways we’ve forgotten to have conversations with patients because we’re all under such pressure and we’ve all got one eye on the computer and another eye somewhere else.

Getting the choosing wisely programme going; it will be voluntary diffusion, but we’re not naïve and we will need to go to those who regulate, because we think we’ll need some mandatory diffusion, we’re not naïve because decommissioning is not easy.

The list that we’ve asked the colleges to develop in their specialty have to be relevant to the specialty, have an impact on patients or the NHS, be evidence based, actively involve patients and the public and be measurable and implementable.

So, the process was that they have to demonstrate each specialty that they’ve used the process, that they’ve contacted the stakeholders, so whether it’s cancer or dementia or whatever it is, that the stakeholders are not only being contacted, but have they been involved, have they been engaged and how have they been engaged.

We’re engaged with NICE.  We’ve got to decide how we’re going to inform people of the recommendations, how they can be implemented and how we can impact on evaluation.

Well is it about cuts and denying treatment?  No, it is not.  And this may not even prove to be cheaper.  It may cost more money.  But I don’t mind that if it’s the right thing to do.

Thank you and it’s just a call for you to come and join us in this.  So thank you for listening.


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