NHS could save £500 million by cutting out ineffective treatments
The NHS could free up £500 million a year to spend on better care for patients by carrying out fewer ineffective or inefficient treatments, a report by the Audit Commission suggests.
The call comes as the NHS faces up to the challenge of making £20 billion in efficiency savings by 2015, despite increasing demand for services and during a time of significant reorganisation.
The report found that a single approach to defining which treatments to cut down on would help to reduce the duplication of effort between primary care trusts (PCTs) and help ensure consistency across the country.
Many PCTs highlighted NICE as the “ideal body to champion decommissioning and to provide a single evidence base” to help achieve the cost savings.
NICE already makes recommendations on clinical practices that should be discontinued completely or should not be used routinely in the NHS, through the “do not do” database.
The database contains recommendations that have been made since 2007, taken from NICE cancer service guidance, clinical guidelines, interventional procedures and technology appraisals guidance.
In its report, Reducing expenditure on low clinical value treatments, the Audit Commission looked at some PCTs' efforts to decommission treatments of low clinical value.
The potential for reducing spending varies from PCT to PCT, but, based on one of the more widely-used lists produced by Croydon PCT, some could save more than £12 million each year by reducing their use of these, or other, treatments.
Treatments that could be reduced include: tonsillectomy, hysterectomy in cases of heavy menstrual bleeding, wisdom teeth extraction and potentially cosmetic procedures like orthodontics.
If PCTs are able to reduce activity to ‘expected' levels, the Audit Commission estimates that reductions in spending of £179 million are achievable. This is an average of just over £1 million for each PCT.
But if all PCTs achieved top quartile performance, £441 million a year could be available for investment in higher priority treatments.
For every person in a PCT's population, an annual £10 saving is possible by reducing treatments with low clinical value. Nationally, this would suggest an annual reduction in spending of about £500 million, the report concludes.
Andy McKeon, from the Audit Commission, said: “We were surprised at the variety of lists used. PCTs across the country are currently paying for treatments that cost the taxpayer money, and according to clinical experts have little or no real value to patients. This needs to change.
“Some PCTs have successfully addressed the issue and are now able to spend the money they have saved on more effective treatments. Many others are seeking to do something similar.
“Our report provides practical advice on how best to do this. A single national evidence base would also reduce variation in the treatments available and duplication of effort.”
Dr Gillian Leng, NICE Deputy Chief Executive and Chief Operating Officer for NHS Evidence, said: “NICE has regularly made clear recommendations for changes in the use of old technologies where a more focused application would yield savings to the service as well as benefits to patients.
“Over the past few years NICE has been giving greater prominence to highlighting those recommendations that direct the NHS away from less effective practice.
“Implementing NICE guidance provides a way for commissioners to ensure that patients receive treatment that is proven to be both clinically and cost effective, and also free up resources and capacity that can be channelled into other services.”
The QIPP (Quality, Improvement, Productivity and Prevention) collection on NHS Evidence is an important tool in helping staff locally and nationally meet the efficiency challenge, said Dr Leng.
“Resources include access to a growing database of over 100 evidence-based case studies showing how staff are improving quality of care in the most efficient way possible, as well as monthly reports on potential disinvestment topics for the NHS which are derived from reviews conducted by the UK Cochrane Centre,” she added.
14 April 2011