The NHS could save up to £500 million a year by carrying out fewer ineffective or inefficient treatments, according to a new report from the Audit Commission.
For every person in a Primary Care Trust (PCT)'s population, an annual reduction in spending worth £10 is possible if efforts are made to decommission low-value clinical treatments, says the study. There is currently no single national list of such treatments, but a single evidence base and approach to defining which treatments are of low clinical value could help to reduce duplication of effort between PCTs and aid consistency across the country, it adds.
As the NHS faces the challenge of achieving £20 billion worth of efficiency savings by 2015, PCTs have been developing their own approaches and lists of ineffective or inefficient treatments, with some grouping these into either treatments for which they will no longer pay or those for which patients have to satisfy specific thresholds, so that only the right patient gets the right treatment.
The Commission's researchers report that the potential for reducing spending varies between PCTs and that they were "surprised" at the variety in lists of "low priority" procedures currently being used. However, they add, there is some consistency between the lists being developed and estimate that around 250 different procedures with limited clinical value have been identified so far.
The Commission does not advocate any particular list but, it says, based on one of the more widely-used lists produced by Croydon PCT, some Trusts could save more than £12 million a year by reducing their use of treatments such as: - those considered to be relatively ineffective, eg, tonsillectomy; - those where more cost-effective alternatives are available, eg, 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; - and potentially cosmetic procedures, for example orthodontics.
However, the lists need constant refining as new treatments appear and new evidence emerges, it cautions.
"If PCTs are able to reduce activity to 'expected' levels, we estimate reductions in spending of £179 million are achievable. This is an average of just over £1 million for each PCT," says the Commission report.
Using the same methodology to identify savings if all PCTs were able to achieve "top quartile" performance, ie, performing as well as the top 25% of PCTs in the country, £441 million a year could be available for investment in higher-priority treatments, it adds.
Commenting on the report, the National Institute for Health and Clinical Excellence (NICE)’s deputy chief executive, Gillian Leng, said that NICE has regularly made clear recommendations for changes in the use of old technologies where a more focused application would yield savings to the Service as well as benefits to patients.
"Implementing NICE guidance provides a way for commissioners to ensure that patients receive treatment that is proven to be both clinically and cost effective, and also free up resources and capacity that can be channelled into other services," added Dr Leng, who is also chief operating officer for NHS Evidence.