With NHS finances being stretched to the limit and budgets constantly under pressure, it is apparent that resources need to be managed more efficiently to minimise waste across the sector.
The question is not ‘how can resources be managed more effectively?’, it is actually a case of identifying ‘who’ is best placed to own the problem and tackle the issues related to resource efficiency.
The NHS service is under huge pressure with cracks appearing in overall performance yet there are vast cost savings to be achieved through streamlining of processes throughout the service, processes which could save millions if implemented effectively.
NHS doctors are the first port of call as far as the patient is concerned and as such, they play an integral role in the way that the patient is managed through the healthcare process.
They can have a knock on effect on the resources and time spent in managing the patient. In this respect, they are the obvious candidates to lead the way in combating wasted resources throughout the NHS. However, their primary function should remain focussed on patient service and the responsibility to save money and drive up efficiency should come from the management tier that sits behind the patient focussed clinician.
A report by the Academy of Medical Royal Colleges emphasizes the ethical duty Doctors have towards the reduction of waste in the NHS after experts found potential savings of nearly £2 billion.
The Academy says a series of a “relatively simple measures” could generate savings which could then be reinvested to improve patient care as well as raise NHS standards. The report ‘Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care’ highlights the challenges for doctors and looks at various types of clinical waste and how they can be managed better.
The report provides a framework for workers in the healthcare sector to think of waste from a clinical perspective and highlights how doctors can become leaders in waste reduction whilst improving the value of health care as a result of the waste reduction.
The study found 16 examples of changes to clinical practice which have saved money and benefited patients.
Examples include potential savings of more than £220 million by stopping unnecessary scans, increasing ward visits by consultants and using operating theatres more efficiently.
While the Academy of Medical Royal Colleges said it was “impossible” for the NHS to achieve 100% efficiency, it called for a “change in culture” amongst England’s 150,000 doctors in an attempt to protect NHS resources.
A doctor’s primary motivation for reducing waste is that it’s given to them as directive by their management. Achievement of the directive will enable the savings to be used elsewhere in the budget, the assumption is that should allow for more patients to be treated. This process creates a higher value health care system where resources: cash, carbon and staff time, are released from some parts of the system to meet the demand on an already over-subscribed service or where possible to develop new interventions.
Reducing waste in today’s climate of constrained resource is really about creating the health care system that we want to have. It is not just about reducing spend. As responsible stewards, doctors can provide a more effective use of constrained economic and environmental resources.
The report provides evidence for the benefits that doctors can achieve by tackling waste in the clinical domain.
Realignment of clinical decision-making is required – where patient benefit and patient preference are balanced against patient harm and resource usage. Performing the right test or procedure at the right time is fundamental to reducing waste in clinical decisions. Dissemination of best practice is key, alongside local agreement to adopt best practice guidelines. A culture of ‘find the best way of doing something and do it everywhere’ will certainly lead to less waste of clinical resources.
The 12-month study had the following recommendations:
- The Royal Liverpool University Hospital identified an estimated £11.5 million which could be used elsewhere by switching from twice-weekly to twice-daily consultant led ward rounds, which cut bed occupancy rates by 7.6%. What this meant was more patients could go through the system for treatment and waiting times were reduced.
- Prescribing lower-cost statins could produce cost savings of £85 million. Whilst on paper, this looks like an achievable objective. What the savings don’t take in to account is the impact of tolerability to lessor or different products because of their mode of action, or quite simply, patients experience different side effects on what appear to be similar molecules, these patients will then continue to cost the NHS whilst their tolerability issues are resolved.
- Reducing the number of X-rays for lumbar spine or knee problems – which often “contribute little to clinical management” – could save the NHS £221 million a year.
Professor Sir Bruce Keogh, the NHS England Medical Director, welcomed the report.
“We need to be innovative to tackle the huge financial challenges we are facing, but there are also some more everyday changes that we can make to improve efficiency. This report neatly embodies some practical ideas for more efficient practice”
Early this year, on the subject of waste management in the healthcare sector, one of the UK’s leading waste management companies, GPT Waste produced the Whitepaper, “Cost savings for healthcare estates delivered through improved waste management”, which provides a reference tool for Healthcare Estates Managers and Finance Directors to demonstrate the opportunities for cost savings through the implementation of more effective waste management strategies.
It is based on a simple example, a new approach and the impact it has had on a healthcare organisation’s bottom line.
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