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Alf Collins

@alfcollins.bsky.social

1.6K followers 690 following 470 posts

Doctor, patient advocate, Trustee Patients Association and Picker Institute. Person centred, high value care, esp. shared decision making and support for self management. Ex Health Foundation, NHS England. Rugby, family, good food, trying to stay alive.

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Alf Collins @alfcollins.bsky.social · 8h

It’s late. Don’t get me started on value, allocative efficiency, opportunity cost. And while you are at it, don’t mention provider capture of the market and unwarranted variation.

Reposted by Alf Collins

steve the skeptic @policyskeptic.bsky.social · 9h

Indeed. I've quoted it recently to demonstrate the absurdity of raising the QALY threshold since NICE already approves too many low value (high cost/QALY) interventions.

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Alf Collins @alfcollins.bsky.social · 10h

Yes and…here’s well evidenced high value work with people living with MLTcs that reduces cost and treatment burden and improves QOL: patientprioritiescare.org

Home - Patient Priorities Care

Choosing what matters. Doing what works.

patientprioritiescare.org

Alf Collins @alfcollins.bsky.social · 11h

Yup. Meanwhile the good old reliable non amazing stuff gets marginalised.

We wonder how to make healthcare financially sustainable and the answer is right in front of us.

Alf Collins @alfcollins.bsky.social · 11h

I’d add that this comprehensive review by Sally Gainsbury and Huceyin Nasi makes the same argument: www.nuffieldtrust.org.uk/news-item/th...
It is unconscionable that we accede to big pharma.

The tough choices at the heart of the government’s dispute with big pharma

The government has been locked in a dispute with pharmaceutical companies for a number of months over how much the NHS pays for new branded medicines. Sally Gainsbury and Huseyin Naci set out the issu...

www.nuffieldtrust.org.uk

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Alf Collins @alfcollins.bsky.social · 12h

A 2025 review in the Lancet (www.thelancet.com/journals/lan... shows that our current spending on new medicines skews overall health spend away from more effective interventions. But it looks like we are about to spend more on meds, thus depriving our population of more effective healthcare.

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Reposted by Alf Collins

Sarah M @sarah-owl.bsky.social · 15h

Don’t get me started on “brave” people who “fight” cancer or “lose their battle with” a disease 😡

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Alf Collins @alfcollins.bsky.social · 15h

You’ve probably seen this. Bottom line is that new meds tend to skew spend away from higher value interventions. www.thelancet.com/journals/lan...

Population-health impact of new drugs recommended by the National Institute for Health and Care Excellence in England during 2000–20: a retrospective analysis

During 2000–20, NHS coverage of new drugs displaced more population health than it generated. Our results highlight the inherent trade-offs between individuals who directly benefit from new drugs and ...

www.thelancet.com

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Alf Collins @alfcollins.bsky.social · 16h

Sadly, I can believe it.

Alf Collins @alfcollins.bsky.social · 17h

Oh my word yes…..☹️

Alf Collins @alfcollins.bsky.social · 17h

A handful of us used to speak about psychologically informed care a couple of decades ago. Sue Roberts, (ex diabetes czar/Year of Care programme)was preeminent. But like much work in person-centred care, other priorities/concepts supervened and it was lost. So bravo for you!

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Alf Collins @alfcollins.bsky.social · 17h

Lovely blog. And if anywhere can achieve the required shift it’s Scotland with Gregor’s exemplary leadership

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Alf Collins @alfcollins.bsky.social · 17h

Totally Charlie. I have a wordcloud slide of the psychosocial impact of living with LTCs (grief/loss/identity/isolation etc) and the question: ‘why would we not feel these things?’ And yet in the medical world, these feelings are either not acknowledged or are labelled as mental health probs
.

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Alf Collins @alfcollins.bsky.social · 18h

Having worked in policy for almost a decade I completely agree. But the mental models held by senior policy makers are of a service that is transactional and medical.

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Alf Collins @alfcollins.bsky.social · 19h

Can’t wait to read it. It’s amazing to me that given that the bulk of the workload of the NHS is working with people with LTCs, many of us are stuck in ‘fixer’ mode. The failure to appreciate this does all of us- patients and clinicians- a disservice.

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Alf Collins @alfcollins.bsky.social · 1d

Dunno the back story but JO……knows his own mind.

Alf Collins @alfcollins.bsky.social · 1d

I just walked for an hour through Belgravia and I didn’t see a single Black person. It’s a disgrace.

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Alf Collins @alfcollins.bsky.social · 1d

I’m 65 years old and only today realised that crabs don’t have 8 legs

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Reposted by Alf Collins

Tim Onion @bencollins.bsky.social · 2d

This guy sounds like a fucking lunatic.

Aaron Rupar @atrupar.com · 2d

CNN: Isn't that hyperbolic to call them terrorists?

STEPHEN MILLER: No. If anything I'm understating the severity of the situation

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Alf Collins @alfcollins.bsky.social · 2d

I honestly don’t believe he knows who he is. He seems to utter racist obscenities in an attempt to define himself as well as to test out a political position.

Alf Collins @alfcollins.bsky.social · 2d

And a patient perspective.
I was a pain management specialist for decades and now have intrusive hip pain. I habitually run 4-5 km 3-4 times a week. Every step now hurts (maybe 2/10) so exercise is just not fun anymore. I score low on the Oxford Hip Score so an op is not on cards. It ain’t easy!

Reposted by Alf Collins

Tim Onion @bencollins.bsky.social · 5d

Famous words of many Nobel Peace Prize winners.

FinTwitter @fintwitter.bsky.social · 5d

🚨 TRUMP: IF THIS LAST CHANCE AGREEMENT IS NOT REACHED, ALL HELL, LIKE NO ONE HAS EVER SEEN BEFORE, WILL BREAK OUT AGAINST HAMAS.

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Alf Collins @alfcollins.bsky.social · 5d

Don’t we already know this? The literature stretches back for decades. Eg one cited study in this review is the use of decision aids. There are already at least 4 systematic reviews of decision aids (eg Cochrane 2024- 209 RCTs).
Different search criteria yield different results but really..

Reposted by Alf Collins

Steve Senior @stevensenior.bsky.social · 5d

Just. Reduce. Child. Poverty.

Wellcome Trust @wellcometrust.bsky.social · 5d

We want to transform early intervention for youth mental health.

Our new funding award will help achieve this.

We're supporting teams to accelerate the evaluation and roll out of effective social and psychological interventions.

Applications close 11 Nov ⤵️
wellcome.org/research-fun...

Benny Prawira, Lived Experience Advisor at Wellcome says, "My wish is that new psychosocial interventions can do more than just make youth 'feel better' – but actually help them stay in school, find jobs and rebuild relationships."

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Alf Collins @alfcollins.bsky.social · 5d

Fab article as you’d expect.

I’d add that the website and tables are, in part, supposed to support patient choice. But the language is *absolutely not* patient friendly and when I ran it through a literacy check, more than half the population are excluded on that criterion alone.

Must do better

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