Around £500million a year could be saved if NHS commissioners reduced the amount of low clinical value treatments given, claims a new report published today.
The report from spending watchdog the Audit Commission says the money could be saved if the NHS carried out fewer ineffective or inefficient treatments and spent that money on more “clinically effective” treatments that have better outcomes for patients.
Reducing spending on low value clinical treatments says the types of low value treatments it identified includes:
- those considered to be relatively ineffective, such as a tonsillectomy
- those where more cost-effective alternatives are available, such as not performing a hysterectomy in cases of heavy menstrual bleeding
- those with a close benefit and risk balance in mild cases, such as wisdom teeth extraction
- potentially cosmetic procedures, such as orthodontics.
All NHS organisations are expected to make collective efficiency savings of £20billion by the end of 2014-15, which means PCTs are under pressure to make savings.
The Audit Commission looked at 10 PCTs' efforts to decommission treatments of low clinical value although there is variety around the country over how to define these.
The report says that currently there is no single national list of low clinical value treatments, so PCTs had been developing their own approaches and lists.
“All the PCTs we spoke to were keen to have quality, pooled evidence as a tool to support local decisions,” said the authors. “It is surprising that NICE has not produced this, given that it is responsible for several of the different lists.”
Many of the people that the Commission spoke to said NICE would be the ideal body to champion decommissioning and to provide a single evidence base.
The potential for reducing spending varied from PCT to PCT, said the authors, but, based on one of the more widely-used lists, some could save more than £12 million each year by reducing their use of these, or other, treatments.
Nationally, the NHS could save up to £500 million a year by carrying out fewer ineffective or inefficient treatments. By decommissioning some treatments, money would be freed up to spend better on other treatments, but decisions could be controversial and raise ethical questions.
Strong leadership within PCTs, therefore, was crucial as well as groups of PCTs working together and having good engagement with GPs and hospital consultants as well as good communication between PCTs, GPs, patients and the public.
Andy McKeon, managing director for health at the Audit Commission, said: “PCTs were keen that the Commission looked into how best to tackle this sensitive issue as they have all been developing their own approaches. We were surprised at the variety of lists used.
“PCTs across the country are currently paying for treatments that cost the taxpayer money, and according to clinical experts have little or no real value to patients. This needs to change.
“Some PCTs have successfully addressed the issue and are now able to spend the money they have saved on more effective treatments. Many others are seeking to do something similar.”