The National Audit Office (NAO) estimated some years ago that around 10% of NHS medicines dispensed in the community in England are wasted, at a cost of around £1 billion a year, but the real annual cost is no more than £350 million, according to a new report.
The true wastage total in England is only about 4%, and 50% of this is in fact unavoidable, because it stems from factors such as patients' conditions changing, research by University College London (UCL) School of Pharmacy and the York Health Economics Consortium has found. Therefore, the savings to be made from further improving the NHS record in reducing medicine wastage in England are, in reality, unlikely to be greater than £100 million, says a new policy briefing issued by the UCL School of Pharmacy.
The briefing acknowledges that £100 million is "an appreciable" amount, but points out that this is still less than 0.1% of the £110 billion annual cost of the NHS in England, and also that, despite recent advances in areas such as cancer and HIV care, overall hospital and community prescription drugs have fallen as a proportion of NHS spending during the last decade. Because of the "genericisation" of medicines, these costs now stand at about 10% of total NHS costs, which is about the same percentage as in the mid-1960s.
The report dismisses allegations that poor prescribing, unnecessary dispensing and inappropriate use of medicines by patients are leading to levels of wastage that are undermining NHS finances. "There is in fact no evidence that NHS medicines users behave less responsibly than those who pay for treatments, or that levels of drug wastage are higher in Britain than in other relatively rich countries," it says.
And, to suggestions that that one reason for alleged inappropriate use of medicines by patients could be that most NHS prescription drugs are supplied free of charge, it points out that "it has been observed that charges can lead to vulnerable people to stop taking therapies."
However, the School of Pharmacy/York analysis also found that NHS England could make cost savings and health gains of around £500 million a year from better use of supplied medicines in just five therapeutic areas. This finding underlines the importance of investing in better delivery of pharmaceuticals and health care by pharmacists and taking medicines to optimal effect, rather than concentrating narrowly on reducing drug waste, says the report.
Also, while there is evidence that many members of the public would like to see returned medicines re-issued, the costs of doing this safely would normally be greater than the supply cost of the medicines involved, it says. Outside hospitals, it is usually more cost-effective to incinerate returned medicines and to purchase new supplies for use domestically or abroad.
To put this in perspective, a typical medicine in England costs a little under £10 for a month's supply, while employing a health professional in the NHS often costs £10 for 10 minutes' working time, the report points out.
"Such figures highlight the relative importance of using labour prudently in the pursuit of better public health, and wherever possible recognising the abilities of NHS service users to take more independent control over the use of their medicines, as well as adopting healthy lifestyles in order to protect their health," it says.
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