The NHS does not deserve more money because it wastes so much on poor care, according to the senior surgeon who has the job of driving up standards.
The health service must put its house in order before asking for extra taxpayers’ cash, said Tim Briggs, who is conducting the most comprehensive clinical efficiency audit of the NHS yet undertaken.
His review found huge variations in the cost and quality of common treatments, with low-performing hospitals routinely ignorant about superior methods adopted elsewhere.
The NHS could save hundreds of millions, if not billions, a year if the best and most efficient practices were applied across the country, Professor Briggs concluded.
His programme is backed by the health secretary, Jeremy Hunt, who urged hospitals yesterday to act on the findings, as well as Simon Stevens, the head of NHS England.
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More than 300,000 patients a year are needlessly admitted to emergency surgery beds when they do not need an operation, Professor Briggs’s team found after visiting every hospital in the country.
If all hospitals copied the best units by getting a consultant to run tests quickly, many of these patients would be sent home immediately, freeing up a ward in each hospital and saving the NHS £108 million a year. “I’ve now been to every single trust in England, Wales, Scotland and Northern Ireland and there is significant waste out there,” Professor Briggs told The Times. “I do not think at the moment we deserve more money until we put our house in order and we actually make the changes that will improve the quality of care.”
Waiting times are lengthening as hospitals struggle to treat rising numbers of patients with finances that have not kept pace with an ageing population. Many in the NHS have used the inconclusive general election result to press the case for more money.
Yet Professor Briggs and the leading surgeon John Abercrombie report that in bowel-cancer surgery alone death rates vary from zero to 14 per cent, while hospitals are spending £23 million a year too much by keeping in patients for ten days when the best send them home in five days.
Some hospitals are paying 350 times more for basic surgical equipment than others for no clear reason, while there is no consensus about the best way to carry out some common procedures.
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Today’s general surgery report is one of the first instalments in a project looking at 34 specialisms covering 90 per cent of hospital activity and Professor Briggs said there were “huge gains to be made”. For example, infection rates in hip replacements are 25 times higher in some hospitals than others, he found. “If you could get the infection rate across the country down to 0.2 per cent just in hip and knee replacements, you’d save the NHS every year £250 million [to] £300 million, just by improving the quality of care,” he said.
Mistakes in childbirth cost the NHS more than £400 million a year in legal claims, yet some hospitals pay out only £75 per birth rising to £6,980 at the worst performer, Professor Briggs found.
While saying that social care was different, Professor Briggs insisted that the NHS had to make sure that “every pound of taxpayers’ money was spent to the best effect. Then, once we’ve got that, we can speak to the politicians as the population ages about whether the NHS needs more money. But at the moment there are significant changes we can make to improve our practice that will allow us to do a lot more work with the amount of money we have.”
Mr Hunt urged hospitals to adopt the findings, saying: “By reducing variation we can improve care and eliminate waste at the same time. As this excellent work led by Professor Tim Briggs shows, some hospitals are already working smarter with their money to save time and get better outcomes.”
Mr Stevens has demanded more efficiencies as part of a £22 billion savings programme but has also argued that cost-cutting will not be enough on its own to do everything the NHS wants.
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Professor Briggs began his “getting-it-right-first-time” programme in orthopaedic surgery and it has been formally adopted as a national scheme by NHS Improvement, the financial regulator, where he is now national director of clinical quality and efficiency.
Specialists in each area gather data from hospitals then sit down and discuss individual results with clinical staff in each unit, learning from the best and helping poor performers improve. “Just putting it in a drawer and forgetting about it is no longer an option,” he said.
Profile: Tim Briggs
After a long and distinguished career as a hip and knee surgeon, Tim Briggs admits that he is out of his comfort zone as a crusader for NHS clinical efficiency (Chris Smyth writes).
Yet the former Blackheath rugby forward does not flinch from tackling colleagues.
A consultant at the Royal National Orthopaedic Hospital since 1992, Professor Briggs grew used to seeing patients with complications caused by botched surgery. It was obvious not everywhere was doing as well as they could.
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In 2012 as the president-elect of the British Orthopaedic Association, he gathered data on all orthopaedic units, visiting them to discuss their results. It is this, he insists, that makes the “getting it right first time” programme different from the plethora of audits the NHS has seen come and go.
