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From the Director of Health Studies

Mr Charles Medawar	15 July 1998
Social Audit Ltd, PO Box 111
London NW1 8XG

Dear Mr Medawar

I'm replying to your letter of 18th June to Andrew Foster which has been passed to me this morning.

I completely agree with you that iatrogenic illness is a serious problem and one that needs tackling. However, I'm not sure that we can do this very effectively through the external audit regime Much of the avoidable iatrogenesis is a result of individual clinical decision-making which should properly be the subject of clinical audit. The Government's proposals on quality in healthcare include systematic mandatory clinical audit based on guidelines issued by the National Institute for Clinical Excellence. It seems to me that this is the correct way forward for minimising iatrogenesis.

There are two areas in which we are active that have some bearing on this issue. First, we are currently carrying out an audit of prescribing in primary care in which we are looking at the way in which Health Authorities monitor and advise GPs. And second, we have on our list of possible studies, which will be considered shortly by the Commission for inclusion in the forward programme, an audit of hospital pharmacy. Although this audit will I suspect be primarily concerned with logistics of procuring and distributing hospital drugs, it is possible that it could also look at arrangements for combating iatrogenesis.

I thank you kindly for your letter and for the suggestion we should look at this area

Yours sincerely

Dr Jonathon Boyce

Director, Health Studies

1 Vincent Square, London SW1P 2PN

Telephone  0171 828 1212    Fax 0171 976 6189

www.audit-commission.gov.uk

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