Time to cut waste in clinical care

06 Nov 2014

A new report issued today by the Academy of Medical Royal Colleges has identified nearly two billions pounds worth of cost savings the NHS could be making if it tightened up just sixteen areas of clinical practise.

While the authors acknowledge that it would be impossible to identify the true figure that could be saved by clinicians, health service managers and patients, the guidance being made available to doctors shows how a series of relatively simple measures could cut costs, increase efficiency and improve patient care.

Using data obtained by the National Institute of Clinical Excellence and first-hand accounts from doctors, the document reveals:

• Improving doctor’s awareness of the possibility of adverse drug reactions (ADRs), particularly among the frail and elderly could save the NHS £466m a year. One analysis showed that over half of the patients being treated could safely have their medication reduced or stopped altogether. ADR’s account for 4 in every 100 hospital bed days.
• The simple measure of increasing the frequency of ward rounds means patients can often go home sooner. At the Royal Liverpool University hospital ward rounds were increased from 2 a week to twice daily. It reduced bed occupancy by 7.8%
• Maximising the use of operating theatres and managing operating schedules better saved the University Hospital Bristol Trust £2m a year. There are 160 acute trusts in England

President of the Royal College of Physicians and Surgeons of Glasgow, Dr Frank Dunn, said "As a member College of the Academy of Medical Royal Colleges of the UK, we are fully supportive of this initiative to protect resources by cutting waste in clinical care. This responsibility rests with all healthcare professionals and if implemented would make a significant impact on the current financial deficit in the NHS budget."

The report recognises that operating at 100% efficiency round the clock would be impossible in an organisation as large and, of necessity, as flexible as the NHS needs to be; but calls for a change in culture by England’s 150,000 doctors, arguing they have an ethical duty to cut waste. It suggests they should ask not if a treatment or procedure is possible, but whether it provides real value to the patient and genuinely improves the quality of their life or their prospects for recovery.

Chair of the Academy, Professor Terence Stephenson, one the UK’s leading paediatrician said, ‘Maintaining NHS services in the future depends on doctors engaging with the issue of wasting resources today. A doctor’s central concern; promoting value and quality of care are really two sides of the same coin. One doctor’s waste is another patient’s delay; potentially it could be another patient’s lack of treatment.’

The research was carried out over a twelve month period by Dr Daniel Maughan, the Royal College of Psychiatrists sustainability Fellow at the Centre for Sustainable Healthcare and Mr James Ansell, a clinical leadership fellow at the Wales Deanery.

The report lays out a series of challenges to NHS doctors. It makes clear that if the finite NHS resources are spent on costly interventions that have little benefit, then the service provided will be of little value and the resources we have will be wasted. Deciding how and when to use these resources are clinical questions that can only be answered by those with sufficient training and experience. Waste arises from using these clinical resources inefficiently or unnecessarily. Inappropriate use of clinical resources is waste and this waste relates directly to clinical practice and needs to be tackled by those best equipped to do so; doctors.

The report provides a framework for a way in which doctors can think critically about waste from a clinical perspective and provides examples of doctors improving the value of health care by reducing waste.

The report can be accessed here.

The Academy of Medical Royal Colleges brings together the voices of its 20 member colleges and faculties for overarching generic healthcare opportunities. The Academy’s role is to promote, facilitate and at times, co-ordinate the work of the Medical Royal Colleges and their Faculties for the benefit of patients and healthcare. The Academy comprises the Presidents of the Medical Royal Colleges and Faculties who meet regularly to agree direction.

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