The Challenges of De-Adoption of Low Value Surgical Procedures in the NHS


Will Hollingworth, Professor of Health Economics,

Population Health Sciences, Bristol Medical School, University of Bristol

Will’s applied research has focussed on measuring cost-effectiveness of healthcare interventions in randomised controlled trials and using decision analysis models.  He has particular interests in the economic evaluation of diagnostic tests and surgical interventions for musculoskeletal problems, but collaborates widely with colleagues with interests in other clinical topics including cancer care, public health prevention, mental health and child health. His methodological research interests centre on the use of variations in clinical practice as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in healthcare.

Will joined the University of Bristol in 2007, having trained in health economics at the University of York and after previous appointments at the University of Washington and the University of Cambridge. He is co-director of the Health Economics Bristol (HEB) research group.


The English National Health Service (NHS) is under intense pressure following a decade of austerity and the challenges of caring for a growing and ageing population. During this period, elective surgery activity has increased substantially. Evidence suggests that some surgical procedures which have become embedded in clinical practice are of ‘low value’. ‘Low-value’ care refers to healthcare with risks or costs that outweigh its benefits, comprising care that is harmful, ineffective, or not cost-effective. Stopping or reducing (i.e. de-adoption) such surgical procedures is essential for the long-term sustainability of NHS care.

The de-adoption process requires decision makers to identify and prioritise ‘low value’ care, engage with evidence to inform decisions and implement findings into practice.  The process faces challenges at every phase.  Theory indicates that there are unique organisation and psychological barriers to de-adoption, but empirical evidence is scarce.  In 2019, NHS England’s Evidence Based Interventions programme (EBI) programme identified 17 procedures considered to be ‘low value’ with an additional 31 procedures announced in 2020. In this seminar, I will discuss theory and evidence on de-adoption in the NHS with reference to the EBI programme.

Register for you free place today.

The start time for this seminar is 15:00-16:30 GMT.

Tuesday, 8 December 2020