Reducing wasted clinical resource in the NHS

I was the lead author for an Academy of Medical Royal Colleges Report about wasted use of clinical resources in the NHS. It was launched last month and can be found here. The report states that to sustain the standards of care provided across the NHS, waste must be reduced. Around 20% of mainstream clinical practice brings no benefit to the patient. Investigations, medications, hospital beds, and theatre time are clinical resources that can be wasted if not used appropriately to maximise value for patients.

This report received significant media coverage and I spent an exhausting morning doing 14 live radio interviews for BBC regional radio stations, followed by a live interview on BBC News 24. Sir Terence Stephenson, Chair of the academy, was interviewed on the Today programme and by the Guardian. The real scoop however, was when he was asked to present the report to the Parliamentary Health Select Committee last week, for a session looking at financing the NHS. I attended this and it proved to be an interesting meeting as while the other presenters stated that there is simply not enough money in the system and more funding is needed, Professor Stephenson was able to give a nuanced discussion about how providing a high quality health care system would actually lead to reduced costs.

As responsible stewards of the NHS, he stated that we could provide more effective use of constrained resources. He discussed the many influences that affect how we use clinical resources including individual practices, defensive practices, time pressures, and responding to senior or patient pressures among many others. He called for a move towards targeted, focused and specific use of clinical resources.

Reducing waste is a fundamental principle of sustainability and has a triple imperative; it improves value, while reducing costs and carbon emissions. 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 relates directly to clinical practice and needs to be tackled, not by managers, but by clinicians.