London Letter: health service can save big by changing little things

Britain’s National Health Service spends about £2 billion (€2.8 billion) a year on dressings, syringes and other basics, along with about £3 billion on replacement hips and knees or items needed for heart surgery.

The figures mentioned are only estimates because an investigation into the spending practices at 22 hospitals by Lord Carter of Coles has found that the information held about locally run purchases is "patchy", as he put it.

He believes that as much as £5 billion a year can be saved. Every penny is urgently needed as the NHS must shave nearly 2 per cent off its non-wages spending each year over the next five years.

However, an ageing population, rapidly rising costs for drugs and ever-increasing demand for operations means that that may not be enough to keep it solvent – even with the £8 billion extra promised by George Osborne.

Sometimes, the room for improvement is all too visible. Some hospitals are paying a third more than others for aprons. One hospital realised that its oil boiler was costing a fortune only after it merged with another hospital and compared bills.

Change

However, change is happening, albeit slowly. In Bolton, a hospital is now using insoluble prednisolone tablets, which cost 2p each, for liver patients, rather than the soluble version, which cost £1.50 each. The soluble ones are now kept only for children and adults with swallowing difficulties. The single change has saved the foundation hospital £40,000 a year, enough to pay the salary of a senior staff nurse.

Too often, the NHS buys too little of too many products: “We know that global best practice for everyday consumables is a catalogue of around 6,000-9,000 product lines with price variances of 1-2 per cent. In the NHS it is as much as 500,000 lines with price differences sometimes over 35 per cent,” says Lord Carter in his interim report, which will be followed by final recommendations later in the year.

The NHS faces pressure from a variety of directions. More nurses are needed to ensure that recent hospital scandals such as that at Mid-Staffs, where patients ended up drinking water out of vases, do not recur. However, the number of nurses quitting has risen by nearly a third in two years, increasing the need for expensive agency staff. Sometimes, however, the NHS fails to use its existing staff to best effect.

“For example, non-productive time for nurses can vary from 22 per cent to 26 per cent,” says the Carter report, adding that one hospital hopes to save £750,000 by tightening up on annual leave, sickness, flexible working and rosters.

The NHS also faces recruitment troubles. Yesterday, it was reported that one ambulance service was recruiting paramedics from the Czech Republic and Slovakia after failing to get enough qualified British candidates to apply.

However, it’s not just about money. Sometimes, choices made in hospitals result not only in a waste of money, but also poorer quality care.

Surgeons’ habits are not helping either. Uncemented stems and sockets are used frequently in hip replacements on elderly patients, even though they work best on younger patients once the bone grows around them. However, uncemented hips are more expensive: the cheapest bought by the 22 hospitals investigated cost £1,266; the most expensive cost just shy of £2,000. By contrast, the cemented ones cost between £600 and £850.

Infection rates

Using the wrong ones, says Lord Carter, can increase clinical costsand infection rates, and mean a higher number of patients have to be brought back to hospitals. Litigation also increases.

Hospitals are paid £7,500 or so to carry out hip replacements if the patient can be brought in, operated on and released in a few days; the figure rises by £1,000 if a longer stay is needed.

Two years ago, the north Bristol hospital decided to tighten up its buying rules for replacement hips. Surgeons agreed to use only cemented hips on over-70s patients. The hospital cut spending on implants by a fifth.

Within 12 months, hip surgery, which had been a loss-maker – started to produce an 8 per cent profit, with better patient results.

The number of patients who have had to be brought back to hospitals in England alone after hip operations went wrong grew by nearly half between 2005 and 2010 – from 6,000 to over 9,000. The figures for returns by patients who have had knee replacements are even worse: they doubled over the same five years, from just more than 3,000 to nearly 6,000.

If the infection rate for both was cut to NHS averages for all operations, it would save up to £300 million every year, according to NHS England. Every little helps.