Does the NHS have a ‘Duty’ to Reduce Waste?
Monday, November 10, 2014
A new Report issued by the Academy of Medical Royal College has identified that almost £2 billion worth of cost savings could be achieved by the NHS if improvements were made in the way its waste and resources are managed.
The Report – Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care – provides a framework for doctors, and others within medical care, to think critically about waste from a clinical perspective.
The Report argues that the NHS has an ethical duty to prevent waste, protect resources and promote value, and that doctors should be the leaders in waste and clinical waste reduction.
The Report outlines the challenges faced by doctors in the NHS in reducing waste arisings but also provides examples of doctors that are improving the value of healthcare by reducing waste. It also looks at the different types of clinical waste and how these wastes could be reduced through improvements in clinical practices, staff training and more efficient and appropriate resource use.
Case studies provided within the Report include the better management of medication, test materials, hospital beds and the generation of waste within operating theatres. The examples outline the successful changes to clinical practices that were made and how benefits included waste reductions, cost savings and wider patient benefits to the care they received.
One such example from the Royal Throat Nose and Ear Hospital in London shows how surgeons at the hospital have reduced the number of instruments required for cochlear implant operations from 98 to 28. Other examples highlight how hospitals have reviewed treatments and procedures that require resources to determine whether they are essential, and whether they actually provide real value to the patient.
The Report also emphasises that the key to waste minimisation within the NHS is to focus on reducing waste in all of its forms and that deciding how and when to use these resources are clinical questions that can only be answered by those with sufficient training and experience.
The authors also provide a framework for a way in which doctors can think critically about waste from a clinical perspective. The following are some of the key recommendations made within the Report:
- Doctors should embrace the values of resource stewardship in their clinical practice and use the ‘waste reduction toolkit’ provided in the Report to maximise the value of every intervention.
- Medical Royal Colleges and specialist societies should establish mechanisms to identify the areas of waste within their specialism and provide leadership in tackling them using tools, such as the ‘NICE ‘do not do’ recommendation database’ and the ‘Choosing Wisely’ list of low-value interventions, for their speciality.
- Local Education and Training Boards, cleaneries and medical schools should support the development of clinical and leaderships skills for high value care.
- NHS organisations across the UK should provide doctors with appropriate time and support to review their clinical practice to find areas where they can reduce wasted resource.
- Health Commissioners should encourage the reduction of waste in clinical processes.
- Public health authorities across the UK should create and support initiatives that reduce wastes resource in clinical settings.
- All those working in healthcare should take steps to increase their understanding of the carbon costs of healthcare activities.
The Report identifies a range of potential savings. Once such example is the simple measure of increasing the frequency of ward rounds, enabling many patients to go home sooner. At the Royal Liverpool University hospital ward rounds were increased from two a week to twice daily which reduced bed occupancy by 7.8%.
Another example from the University Hospital Bristol Trust saw the hospital save £2 million a year by maximising the use of its operating theatres and through improved management of operating schedules.
Using data obtained by the National Institute of Clinical Excellence, the Report also suggests that improving doctor’s awareness of the possibility of adverse drug reactions could save the NHS £466 million a year. One analysis also showed that over half of the patients being treated could safely have their medication reduced or stopped altogether.
Other suggestions included the review and reduction of unnecessary scans which could save more than £200 million a year, and the reduction of unnecessary X-rays for lumbar spine or knee problems, which could save £221 million a year.
The full Report by the Academy of Medical Royal College can be accessed here.
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