The French have long understood the value, psychological as well as financial, of helping the disabled and those with chronic conditions to stay clear of hospitals and institutional care. Their physiotherapy, rehabilitation and “hospitalisation at home” schemes are among the world’s best. More recently, the US has experimented successfully with “self-care” schemes to help people stay clear of hospitals. Perhaps because Britain has only recently overcome an almost pathological aversion to talking about sickness and health, policy in this country has mimicked the assumption that either you are ill and in hospital, or there is nothing wrong with you. It is therefore encouraging to find signs of policy belatedly catching up with international best practice.

Over the past four years, trials of the NHS’s innovative Expert Patient Programme have shown the benefits of self-help schemes. The idea is to help the 17 million people in England who suffer from chronic conditions such as arthritis, diabetes or multiple sclerosis to be more self-reliant. Patients are taught how to treat themselves without calling on the services of their GP, hospital outpatient or accident and emergency department. As a result, outpatient, emergency and regular hospital admissions for those on the schemes have fallen by between 10 and 16 per cent, and visits to GPs’ surgeries have also declined.

An emphasis on flexible strategies that treat patients as responsible individuals is long overdue. The scheme may not, at least initially, save much on hospital costs, dearly though ministers must hope that it will. But it will do much to improve quality of life. The Government’s plans to treble the programme’s budget, and secure rapid expansion of the scheme by giving it “semi-privatised” autonomous status, illustrate what is best and most creative about current thinking.

The revised draft guidelines on Alzheimer drugs issued yesterday by the National Institute for Health and Clinical Excellence (Nice), by contrast, show public policy at its insensitive, callous, worst. Nice proposes to repeal its earlier cost-based blanket ban on NHS use of drugs that can slow the progress of the disease — but replaces it with a cruel compromise.

Nice now agrees that the three main treatment drugs are clinically effective. But, judging that the cost (about £2.50 a day) of “buying” an extra year of good quality of life for those with mild symptoms is too high, it proposes to restrict drugs to those with more severe symptoms. They would not become eligible for drugs designed to hold back the disease, until the point when they had already got so much worse that they were no longer able to look after themselves.

If this guidance holds, doctors face the prospect of having to tell patients that they are seriously ill — but not yet ill enough to be treated with drugs that would in many cases limit or at least delay the need for institutional care. A holistic approach to healthcare is impossible when bureaucrats have such a narrow definition of their responsibility.

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