As many as one in seven hospital procedures are unnecessary due to the “over treatment” of patients that wastes billions of pounds a year, the NHS’s medical director has disclosed.
The country’s most senior doctor described the level of waste in the NHS as “profligate,” saying that there was no shame in admitting the problem and tackling it.
Sir Bruce Keogh, a former cardiac surgeon, said that “a substantial proportion” of spending in the NHS was wasted on ineffective care, and he estimated that ten to 15 per cent of medical and surgical treatments should not have been carried out on patients.
His officials at NHS England said unnecessary operations and medication were now costing the NHS up to £1.8 billion a year. That would be enough to pay the wages of all ambulance staff for three years.
Needless operations can also place patients in danger, putting them at “high risk of adverse events” for surgery they didn’t need.
The reasons for overuse of treatment include a lowering of thresholds for interventions in such conditions as cataracts, the most common operation in the NHS; people being offered expensive treatments when cheaper alternatives are available; and misdiagnoses of illnesses.
New analysis by Sir Bruce’s officials suggests one-in-seven women are having hysterectomies when they don’t need to – equivalent to about 6,600 hysterectomies a year; while in as many as one-in five cases patients are being needlessly prescribed antibiotics by GPs for coughs and colds, fuelling dangerous levels of antibiotic resistance.
NHS England believes patients are being over diagnosed with illnesses such as prostate cancer, asthma, chronic kidney disease and attention deficit disorder which they don’t actually have. Such patients are then set on a path to expensive procedures and prescribed medicines.
The NHS England analysis also estimates that more than one-in-20 hospital admissions – about 850,000 out of 15 million admissions a year – were a waste of money.
Sir Bruce’s comments come at a time when the NHS is facing a £22 billion black hole over the next five years and amid demands for it to spend its £115 billion a year budget far more efficiently.
Sir Bruce said: “We know a substantial proportion of expenditure in our health care system and in other Western health care systems – ten, 15 per cent – is due to over use of treatment.
“We also have a massive duty to look into all our organisations and to look into the waste. The waste is profligate in our system. I don’t think we should be ashamed of pointing that out and certainly we shouldn’t be ashamed of dealing with it.”
Sir Bruce said it was time for doctors to take more notice of budgets when deciding what course of treatment was best for a patient. He said the NHS was heading “towards a cliff edge in the next financial year” and that it was vital to “get to grips with the scale of the problem”.
Sir Bruce told a conference of senior doctors and managers: “Historically, doctors and to a lesser extent nurses have felt that the money is someone else’s problem ... I think we need to collectively challenge that because we are in a tax-funded system which does as well as our economy does and when the economy sneezes the NHS catches a cold – and at the moment the money is relatively stagnant for the foreseeable future.”
In a new 158-page report entitled Better Value in the NHS, The King’s Fund detailed a series of treatments in the NHS, which it believed were unnecessary or ineffective or both. Among the report’s findings, the respected think tank disclosed:
* £500 million a year could be saved by reducing the use of “low value” treatments and procedures such as cataract and hernia operations and tonsillectomies. Currently the NHS carries out more than 300,000 cataract operations a year at a cost of just over a quarter of a billion pounds a year, 79,000 hernia repairs at £147 million a year, and 52,000 tonsillectomies at £63 million
* Up to £1 billion a year could be saved by eliminating unnecessary testing across the NHS. The NHS currently spends £1 billion a year on pathology and diagnostic testing alone
* At least £300 million a year is wasted on medicines that people leave unused, return to pharmacies or dispose of. Jeremy Hunt, the Health Secretary, is planning to put the cost to the NHS of drugs on packets prescribed to patients to cut down on waste. New figures last week showed a 55 per cent rise in prescriptions issued in the last decade
* £36 million a year could be saved if the NHS stopped over treating patients dying of terminal illnesses such as cancer in hospitals. It would be better, and cheaper, for dying patients to receive expert palliative care outside of the hospital environment
John Appleby, the King’s Fund’s chief economist and co-author of the report, said the NHS needed to drastically rethink the number of procedures and operations it was carrying out each year.
Surveys on patients who had undergone hernia operations showed that in half the cases they reported that the operation had had no effect or had even made things worse. The problem, said Prof Appleby, was identifying which 50 per cent of patients should not undergo the operation before it actually took place.
“The NHS is facing a squeeze on its funding and if it is going to meet the demands placed on it, then it must find ways of using the money more efficiently.
“The over use of treatment is one area of waste where the NHS is spending money it really shouldn’t.”
The King’s Fund study highlighted huge variations in treatments across the NHS. For example, the rate of tonsillectomies among children varied from 145 operations per 100,000 population in one part of the country to 424 per 100,000 population in another, suggesting massive over treatment.
The report concluded: “Unwarranted variations in clinical practice and health outcomes are widespread across the country. These variations highlight the scale of inappropriate care in the NHS – and in many cases this scale is staggering.”