I was never a fan of the erstwhile British Prime Minister Margaret Thatcher. (Indeed, it is now difficult to find people who admit that they ever were, although somebody must have voted for her). However, I recently found myself thinking in a way that was reminiscent of her. She used to compare the running of the British economy to the shopping of a careful housewife-hunting for good value and using her money wisely. Don't take much notice of the experts, she seemed to say, it is all common sense really. Now health economics is complex. Furthermore, it often seems to be bedecked in baffling formulae and arcane jargon. So perhaps because I don't understand it, I sometimes find myself doing a Maggie and thinking that it must all boil down to common sense really. For instance, there seems to be something wrong when I hear people say that longterm follow-up outpatient therapy of anorexia nervosa after inpatient treatment is too expensive and cannot be afforded. Now sometimes such therapy is difficult to arrange-certainly in the seamless fashion that seems ideal-but not to provide it for economic reasons seems strange. A week in most hospitals costs as much as 6 months of weekly outpatient therapy. So where is the sense in having that extra couple of weeks in hospital literally at the expense of a year of therapy? Are we so bedazzled by the weight issue and the feeling of doing something active and definable that we are willing to-as the old saying goes-risk the ship for a ha'porth of tar? Or are our financial and clinical systems so rigid and insensitive that the requisite flexibility of resource use is not there? Or what? I am really not sure what is going on. Also I have to admit that where the treatment of anorexia nervosa is concerned there is precious little good evidence about what should be best practice to guide the allocation of resource. Opinion rules. But I don't see the sense in spending so much of our precious budget on the most expensive intervention-the fillet steak as it were-and not to have money for ongoing therapy-the potatoes that need to go with it to make a proper meal. And, of course, a decent sandwich is enough for most people.
What would Mrs Thatcher have done? Better not to ask.