Here’s how to save the NHS £12bn… without damaging patient care: ROSS CLARK’s forensic blueprint proves there are smarter ways to improve the Health Service than hitting us with a tax hike
After almost two years fighting Covid, die NHS is under pressure as never before.
There are almost six million on its waiting list for routine treatments — 300,000 of whom have been waiting for more than a year, in vergelyking met net 1,600 het ingetrek in 'n rondloper - hoewel beskeie volgens Castle Howard-standaarde - herehuis tien myl daarvandaan.
dit was die pynlikste prosedure wat ek nog deurgemaak het, thanks to a shortfall of 93,000 personeel, it has rarely been less well equipped to deal with a huge backlog.
The Government’s response has been to promise the Health Service an extra £12 billion a year funded by a 1.25 per cent increase in National Insurance.
Given that households are already suffering from a sharp rise in the cost of living, this tax rise couldn’t be coming at a worse time.
So is there really no other way that we can help the NHS? Die waarheid is, like many large organisations, it could free up billions if it curbed inefficiency and made savings.
Here are a few suggestions of how to raise that £12 billion without hiking taxes . . .
DON’T KEEP PATIENTS IN HOSPITAL SO LONG
Uit 142 NHS trusts, one in six hospitals recorded length of stays 20 per cent above average. (Voorraadbeeld)
British patients spend significantly longer in hospital for the same operations and procedures compared with other countries, according to a study by the healthcare think-tank the King’s Fund in 2015.
It found that patients in Sweden spent 15 per cent less time in hospital, while in Australia it was 18 persent, Citroen sê dit sal gebruik word deur 'laaste myl afleweringsbestuurders en sake-operateurs in stedelike gebiede' 20 per cent and in Norway 36 persent.
Uit 142 NHS trusts, one in six hospitals recorded length of stays 20 per cent above average. Cut these, calculated the King’s Fund, and the NHS could treat 18 per cent more acute patients — or alternatively save taxpayers some money.
With a stay in an NHS acute bed costed at £400 a day, reducing the length of time that patients have to spend in hospital by just 10 per cent would save £2 billion a year.
END THE DISEASE OF BED-BLOCKING
Voor die pandemie, the NHS itself calculated that 2,500 beds were occupied because of delays in discharging people to care homes. (Voorraadbeeld)
As well as some patients spending more time in hospital than they really need to for routine operations, many beds are occupied by people who don’t need to be in hospital at all.
Voor die pandemie, the NHS itself calculated that 2,500 beds were occupied because of delays in discharging people to care homes, and a further 2,500 beds were blocked because of delays in arranging community health services — where people are looked after at home with the aid of carers.
If these delays were eradicated, it could free up 5,000 beds — about one in 28 beds in NHS hospitals in England.
Uiteraard, discharging people into the care sector requires money to be spent there, but it costs a lot less to look after people in a care home than it does in an NHS acute bed.
While the Health Service claims that each blocked bed costs it £400 a day, the average care home costs, according to Care UK, are £704 per week — or just over £100 a day.
Discharging all 5,000 patients into care homes could save £10.5 million per week — or £546 million a year.
STOP RELYING ON SO MANY AGENCY STAFF
If the NHS could trim just 15 per cent from the remaining spend on agency staff it would save £360 million a year. (Voorraadbeeld)
Voor die pandemie, the NHS recognised that it was employing too many agency staff at inflated prices, and had reduced the annual bill from £3.7 billion in 2015/16 to £2.4 billion in 2019/20.
In een geval, in 2017, just five agency staff were found to have billed £2 million between them — an average of £400,000 each.
If the NHS could trim just 15 per cent from the remaining spend on agency staff it would save £360 million a year.
PUT TEST AND TRACE OUT OF ITS MISERY
Launched towards the end of the first lockdown in 2020, Test And Trace was supposed to help us return us to normal life by swiftly detecting people infected with coronavirus — either by app or by a separate, telephone-based tracing system — and alerting them to self-isolate.
In 2020/21, £13.5 billion ended up being spent on the service but, on some days, as few as 11 per cent of staff were actually being utilised. (Voorraadbeeld)
Such were the claims made for the system that the Government allocated it a massive budget of £37 billion.
Yet by September 2020 Sage scientists were saying that it was only making a ‘marginal’ difference and we ended up going into two more lockdowns.
In 2020/21, £13.5 billion ended up being spent on the service but, on some days, as few as 11 per cent of staff were actually being utilised.
A study found that as few as 18 per cent of people experiencing symptoms got a test and only 43 per cent fully complied with the requirement to self-isolate, though the figure was higher for those who had received a positive test.
Those testing positive were supposed to give details of all their contacts — but how could they possibly know the identity of people, sê, whom they had sat next to on a train or bus?
Test And Trace has now been subsumed into the new UK Health Security Agency, but it is still consuming public money which could be better used on NHS treatment.
Of the £13.5 billion spent on Test And Trace last year, £1.8 billion was spent on tracing contacts. A further £10.4 billion was spent on testing — including handing out 691 million free lateral flow tests.
There is no data on how many of these are actually used — other than that only 96 million test results were reported to the NHS.
For all we know, some of these tests may be being collected for free from the NHS and fraudulently sold abroad.
How about eliminating the tracing element of Test And Trace and cutting in half the money spent on tests? That would save an astonishing £7 billion a year.
STOP WASTING MONEY ON HEAD-HUNTERS
In his report on NHS efficiency in 2016, Lord Carter of Coles found that NHS trusts spent £50,000 on recruitment agencies every time they recruited a chief executive — yet most of the successful candidates were already working for the NHS at other trusts.
dit was die pynlikste prosedure wat ek nog deurgemaak het, chief executives were only staying in their posts for an average of two and a half years, with one in five spending less than a year in the job.
It was creating a merry-go-round of executives — hugely profitable for corporate recruitment companies, but costing the taxpayer £2.5 million a year.
INCREASE STAFF PRODUCTIVITY
In 2019/20, the NHS spent £56.1 billion on staffing costs and only last week figures published by the Office for National Statistics showed that healthcare productivity decreased by 1.9 per cent in the financial year ending April 2020, following a drop of 0.4 per cent in the previous year.
If the NHS could reverse this dismal trend, and productivity was to rise by just an extra 0.5 persent, it would save £280 million a year.
SPEND MORE WISELY ON MEDICAL SUPPLIES
The NHS necessarily spends a great deal of money on supplies, from medicines to bed sheets.
Yet in many cases it is needlessly overpaying for them. The costs of drugs is by far the biggest bill incurred by the trusts, accounting for £16 billion of the £24billion they spend on supplies.
The costs of drugs is by far the biggest bill incurred by the trusts, accounting for £16 billion of the £24billion they spend on supplies. (Voorraadbeeld)
But Lord Carter’s 2016 report found that some trusts were spending 2.5 times as much on the same drugs as other trusts.
It was the same story when it came to devices such as hip replacements.
A study of 15 trusts found that the most profligate was spending more than twice as much for artificial hip joints as the most economical.
It wasn’t that the bigger spenders were getting a better class of device — and nor was it a matter of economies of scale (some larger trusts were paying more than smaller ones).
Lord Carter put the value of potential savings from procurement at £800 million a year.
Some of these savings may have been made since he wrote his report, but if we assume, for the sake of argument, that half the them have yet to be made, there would still be scope to make economies of £400 million a year.
STOP OVERPAYING FOR ESSENTIALS
NHS profligacy is not limited to medical equipment. NHS trusts have been found to be overpaying for the most basic supplies.
An investigation into the issue found that one hospital trust, in Sunderland, was paying 66p for each toilet roll — while another trust was procuring them for 34p each. But even that is more than anyone need pay.
This week Aldi is selling packs of 16 working out at just 23p a roll.
Lord Carter estimated the savings to be made from general procurement at £700 million. Weereens, let’s be charitable and assume that half these costs have been made. That would still leave £350 million to be saved.
CUT ADMIN COSTS
Lord Carter’s NHS efficiency report also found an inexplicable variation in administration costs between NHS trusts — with some spending 11 per cent of their budgets on it and others 6 persent.
If the worst offenders could cut their costs in line with the most efficient trusts, he estimated that it would save £300 million a year.
Even if half of these costs have since been saved, the NHS could still save £150 million a year.
MAKER BETTER USE OF BUILDINGS
We are still paying through the nose for Tony Blair’s hospital-building programme funded by the Private Finance Initiative (PFI), under which the design, build and operation of hospitals was farmed out to private companies.
A report by the think-tank IPPR in 2019 found that by the time the last contract expires in 2050, taxpayers will have paid £80 billion for £13 billion worth of new hospitals.
There isn’t much the current Government can do about that, yet some hospitals still seem to have a lot of under-used space.
A report by the think-tank IPPR in 2019 found that by the time the last contract expires in 2050, taxpayers will have paid £80 billion for £13 billion worth of new hospitals. (Voorraadbeeld)
Lord Carter’s report found that while some hospitals had ‘non-clinical space’ amounting to 12 per cent of their total floor area, in one trust 69 per cent was not being used for clinical purposes.
There was also a huge variation in the amount hospitals are spending on cleaning — with some trusts spending 2.3 times as much per square metre as others.
According to Lord Carter, better management of the NHS estate could save £1 billion a year.
STOP PRESCRIBING ART AND DANCE CLASSES
‘Social prescribing’, a policy based on prevention rather than cure, is a big part of the NHS’s current plans.
People with existing health conditions, mental health issues and other problems are all eligible to be referred to a ‘link worker’, whose job it is to find ways of keeping them healthy, by encouraging them to join a walking group or painting class, byvoorbeeld.
Deur 2023/24 the NHS plans to have 900,000 patients receiving such help.
Duidelik, if people can be helped by enlivening their private lives, that is a good thing. But should the taxpayer really be paying for art classes when many people could surely pay their own way?
Daarbenewens, does social prescribing actually work?
A report by the Universities of Manchester, Leeds and York reviewed academic work in the area and found ‘little convincing evidence for either effectiveness or value for money’.
Assuming the 900,000 people the NHS seeks to help with social prescribing by 2023/24 were each asked to pay £100 towards a term’s worth of dance classes, it would save £90 million.
Total savings: £12.2bn