How can we save the NHS money? Share your ideas with the BBC
In a series of features this week, the Radio 4 Today Programme is inviting listeners to submit ideas for saving the NHS money.
The BMA would suggest targeting external management consultants (£350 million in England last year), Independent Sector Treatment Centres (which underperfomed by an estimated £927 million during the first wave of ISTCs in England) and the use of the PFI.
You can send them your own ideas here
Unfortunately the public has used, abused and complained about the NHS for so long Government has felt bound by opinion to interfere. The result is a dispirited work force trying to meet impossible targets set by politicians who have no comprehension about what it takes to run the NHS. As far as I see, this results in demoralised staff (like myself) leaving which only adds to the woes of those left.
The NHS is now what the general public deserves.
Saving money in the NHS:
1. remove most of the intermediate administrative tier of the NHS at PCT level. Go back to Health Authorities that contracted directly with GPs and services without the “big Brother” supervision and distrust
2. Reduce over-prescribing by removing rigid protocols (and audits based on them) that give no room for clinical discretion. After all a “natural distribution curve” of results of any measure has an inherent substantial number at either end of the curve for whom that measure would be inappropriate)
3. Reduce waste of medication that is dispensed and then sits in cupboards or thrown away by more patient – responsive systems via community pharmacists.
Above all NOT BY CUTTING CLINICAL STAFF OR SERVICES!!!
I think the frontline staff in the NHS do a tremendous job but my husband got MRSA due to unclean hospitals. Stop the outsourcing of cleaners and bring in permanent staff. Reduce the administrative tiers in the service and many of the admin jobs. Get rid of targets – they do nothing but hinder the service.
Lets face it, the NHS is a pretty bureaucratic organisation with tremendous waste and underperformance. The tariff that the government pays, at least in most specialties are very generous and there is simply no value for money. There is no incentive for the NHS trust to improve except for competetion and it should be welcomed.
Stop hospitals buying in expensive locums from agencies. Get the locums through their own advertisment
The NHS needs management. Doctors cannot run it alone. Their views are central, however, to running trusts well. A Chief Exec. often used as a troubleshooter for failing trusts once told me the best way to turn around a failing hospital is to put Doctors on the board. But we still need people doing things below the board.
The trouble is that the junior management are always responding to the over-sensitive government, who change policy and target with public opinion too rapidly and without thought to the resouce it takes to record and demonstrate compliance. This means it is hard to proactively plan, and there is less freedom to do so, within the NHS. Don’t axe all the beurocrats: lead them in the right direction and get them working on real problems proactively. We need to separate policy and planning in the NHS from politics somehow, though I admit we must be accountable to the public. It is so immediate it is now detrimental.
Too much medicine is undermined by our legal system. The law needs to support the whole public, not just the ambulance chasers. A no fault system of compensation allied with a genuinely independent licensing authority, like the New Zealand system, would mean less of the NHS funds paying lawyers, quicker compensation, and better ferretting out of genuinely ineffective or dangerous doctors. The result of fishing for cash by inappropriately sueing doctors should be much more a deterrent than it seems to be now.
Everything the NHS supplies should be free to its users: prescriptions, dentists etc. or it undermines the principles of the NHS.
The NHS is currently in a quagmire of buerocracy supported by a many tiered management structure that sees its primary role as servicing that beurocracy. The management are not directly accountable to anybody, with very protected contractual arrangements. Even major revelations of poor clinical performance in a hospital will only lead to a change in the top tier of management, with the middle management tiers rarely reaching any spotlight.
As well as adding to the inneficiency of the NHS and their direct expense
the layers of management also has the desasterous effect of suffocating any communication from frontline staff to those with the power to make positive changes in trusts, including the commissioners.
The commissioners themselves are immensely powerful figures within trusts, as they hold the purse strings. They are hidden from any direct consultation or accountability to frontline staff, the public or patients. The only people with such access are the upper tiers of management.
And so there is a rift that runs throughout the NHS in its current form; with the real work of the organisation being done by frontline and support staff.
Frontline staff serve their respective vocations in helping patients in their own professional capacities, whilst also being forced to bend to the ever changing dictats from the many layers above them, right up to the DOH.
Where the lines of top down communication are stong with tangible power pehind them, any communication from the front line is stifled. Inneficiencies and concerns go unaddressed throughout the range of Hospital and community trust services. The effort required to make even the simplest improvement is immense, and ever more daunting when clinical time is ever more eaten into by the recording of information for NHS beurocratic processes.
I once heard a hospital trust chief executive deascribe his job as being 90% about making the PM look good at Prime minister’s questiontime.
All of the recent major incidents of individal and service level poor clinical care were raised as concerns by frontline staff, who were ignored, some time before monitoring processes highlighted concerns, with disasterous results.
This is the rot at the core of the NHS.
It was not always so. And I believe that a simple change in culture would improve services, morale, safety and realise a multiplicity of efficiencies that would save the NHS money across the board.
My prescription would be for the DOH to halt its continual collection of beurocratic information and its contiuous production of new changes whilst the NHS has a period to consolidate.
Channels of two way communication should be opened up, so that frontline staff can be empowered to be able the changes in clinical services and supporting structures. A responsiveness to frontline staff with an true quality, efficiency and troubleshooting remit should be the new primary role of the middle tiers of management.
Higher management and commissioners should have their decision making processes opened up to transparent scrutiny and be made accountable to clinical staff, the patients and the public.
Improvements in quality would result, both as a direct effect of this shift as well as the improvement in staff morale. Patient satisfaction would improve with the better morale and efficiency of clinical staff which would be self reinforcing, and self evident, such that it would not have to be measured, with the focus going back to clinical outcomes.
Administration costs and transaction fees in the NHS have increased from 5-6% in the mid 1970’s to over 20% today. This is due primarily to the introduction of markets within the health service and a massive management expansion (there are now more managers than doctors and nurses). Before long it may reach the extraordinarily inefficient 34% common in the US for profit hospitals unless the privatisation agenda is abandoned[2]. A fully publicly funded NHS could reduce administration costs to below 10%, saving the £10bn a year that’s required, without any reduction in services, indeed services would improve without the duplication and inefficiencies that competition has introduced.
The NHS spent £350 million on external management consultants in the last financial year. More than £273 million of this was not related to direct patient care and equates to the cost of 330 fully staffed medical wards, each with 28 beds[3].
And the costs for IT have more than doubled to at least 15 billion so far with estimates that it might increase to over 30billion[4].
The PFI initiative means that for an investment of 10bn, private companies charge the NHS over £50bn in rental over the next 25 years. The PFI companies are borrowing money from the same banks that we own, and then we are paying their profits (rent) as well[5].
With these phenomenal wastes of money, it’s scandalous to suggest increasing private sector involvement, let alone closing hospitals or cutting clinical services.
Finally, another cost cutting option;
A few years ago I started a project with MEDACT to look at making the NHS sustainable. The possible savings for the NHS would be phenomenal if money was invested in making hospitals more energy efficient. The Royal Free in Hampstead invested in a combined heat and power plant and is saving over £1million a year with all savings going back into clinical services[6].
Imagine if this could be replicated throughout the NHS?
Jonathon Tomlinson
GP Hackney, London
07880953148
Also Sent to BMA Save Our NHS Have your say June 20th 2009
[1] http://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdf Chapter 12
[2] New England Journal of Medicine vol 336 1997, pp 769-74
[3] http://www.rcn.org.uk/newsevents/news/article/uk/nhs_spending_on_management_consultants_is_shocking
[4] http://en.wikipedia.org/wiki/National_Programme_for_IT#cite_note-15
[5] http://212.58.226.17:8080/1/low/health/8081936.stm
[6] http://www.guardian.co.uk/society/2003/mar/20/hospitals.publicvoices
Get rid of choose and book. It hasn’t been welcomed by patients. Nearly all of my patients want to go to their local hospital and those that don’t have usually decided on an alternative already. The whole set up is a gigantic waste of public funds. The IT spine is way over budget and appears to be unworkable. It is time to pull the plug.
I agree with Dr Baker in that there are several management posts in the NHS whch are unnecessary and are created by managers to pease each other. The biggest waste of money is in the NHS IT sector. I wonder who is making the decision to buy new computers on a daily basis, and who is receiving the commission. NHS can be managed by 20% of the managers.
We have experienced the collapse of Banking sector and recently the expences of politicians and if the goverment does not take action now NHS will be the next in line.
The Mayor of Doncaster may not be politically correct, but the stopping of interpretation services would save millions. Where else in Europe can you get similar services for free.
I have just received a circular from the DOH with 23 translations! This is getting way out of hand – if I want to live in France I learn French and integate with the locals, what is wrong with that!
Huge numbers of substantive non career grade doctors have left the NHS and are back doing their own jobs as agency locums at vastly inflated hourly rates(many earning significantly more than Chief Execs and Consultants with much less responsibility). The DoH must cap the hourly rates to be paid to locum doctors to a level that makes more sense for them to work substantively in the NHS. Given that the NHS provides the vast majority of the healthcare, this should be feasible. Moreover, most of the doctors who have wanted/forced to leave the UK following the MMC and MTAS debacles have already gone – there is little left to lose. International recruitment is the only way we can have enough doctors at reasonable renumeration packages.
Disposable items should carry a bar code which would allow staff to know the cost of such items. Electronic bar code readers are now available and are reasonably cheap.
The last government invested heavily in the NHS and mad some great improvements especially over waiting times,the introduction of NICE and smoking ban but they also wasted money on schemes that offered little or no clinical benefit
In particular I would recommend the immediate scrapping of NHS direct,nurse led walk in centres except for those in airports and inner cities with poor primary care provision and the provision of all day access centres in all areas.All such services cost millions but have made no significant differences to my work load apart from sucking into the NHS patients who used to self manage their minor and usually self limiting illness
There has to a significant change of political direction and public health policy and in particular an end to the obsession with providing 24 hr access for all conditions however trivial. we need to get people to look after their health and deal with trivial illness without the need for NHS which should instead focus on serious illness major accidents and in particular better care for the elderly.
Patients need to understand that in order for the NHS to be able to provide the best care for them and their families when they are in true need that they must treat themselves when they are not
Make more effort to get aids like walking frames,walking sticks etc returned after a patient no longer requires them at home.Home toilet seat extensions should be returned & sterilized not instruct the patient to throw away,these cost under £5 but there must be tens of thousands thrown away annually