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Protecting resources, promoting value

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 provided more appropriate care in just sixteen areas of clinical practice.

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 create savings which can be reinvested to improve patient care and raise standards across the healthcare system.

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 two 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

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, but calls for a change in culture by England’s 150,000 doctors, arguing they have an ethical duty to protect resources and promote value. It suggests they should ask not simply 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.

Academy Chair Professor Terence Stephenson said,
“Maintaining NHS services in the future depends on doctors ensuring the best use of resources today. Quality of care is a doctor’s prime concern. But, delivering quality care and promoting value 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 recent “Five Year Forward View” published by NHS England sets out the scale of efficiency savings that will have to come from within the NHS alongside necessary increases in funding. Ensuring that clinical processes and interventions are always appropriate and effective in the ways outlined in this report can make a significant contribution.

These measures can be applied everywhere and so I hope that that this “win-win” of improving quality whilst saving costs is embraced across the NHS in the four countries of the UK’

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 hard-hitting challenges to a doctor’s role in the NHS today, including asking doctors to remember 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.

It points out that 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 authors also provide a framework for a way in which doctors can think critically about waste from a clinical perspective and provide examples of doctors improving the value of health care by reducing waste.

The report is attached

pdfPromoting Value Report: a doctor's guide to cutting waste in clinical care