NHS wastes over £2bn a year on unnecessary or expensive treatments

The NHS is wasting about £2bn a year and risking patients’ health by giving them too many x-rays, drugs and treatments they do not need, Britain’s leading medical body warns today.

Patients are too readily tested, diagnosed and treated for certain conditions, the Academy of Medical Royal Colleges (AoMRC) claims today in a report that has prompted a debate on whether people are being exposed to unnecessary interventions and stays in hospital in the UK.

The academy is calling on all doctors and nurses to start questioning the value of every test and treatment they recommend for patients in order to help the NHS withstand the unprecedented financial pressure it is under and improve patient experience.

A year-long study by the academy, the professional body that represents the country’s 250,000 doctors, has found that the health service wastes up to £2.3bn a year on a range of procedures and processes that could be done better, more cheaply or not at all.

Well over £1bn could be saved if doctors took care not to overprescribe drugs and not to overmedicalise patients who may not have conditions they are diagnosed with, it says.

One in five patients who have an x-ray for lumbar spine or knee problems do so unnecessarily, which costs the NHS £221m a year and exposes patients to radiation.

Similarly, the NHS could save £466m a year if doctors were less ready to prescribe cocktails of drugs for older people, as the adverse drug reactions some then experience account for 6% of all hospital admissions and 4% of all hospital bed days.

The Royal Liverpool University hospital saved £11.5m by switching from twice-weekly to twice-daily ward rounds by consultants, because that halved length of stay and cut bed occupancy by 7.6%.

Replicating that in other hospitals could save tens of millions of pounds, the AoMRC says.

It also wants to see patients with mild depression no longer necessarily given antidepressants and patients with terminal cancer to be offered the option of “treatment holidays” – breaks from their chemotherapy – in order to improve their quality of life, though it concedes that such a move may reduce the patient’s survival. Prescribing lower-cost statins could save £85m; while enabling more operations to take place by better management of surgical instruments could yield a £320m benefit, it calculated.

Professor Terence Stephenson, the academy’s chairman, said that some of the medical practices the report highlights are the result of doctors doing everything they can to help a patient and were sometimes prompted by “demanding” patients.

“The public can be very demanding, often fuelled by the internet, and can exacerbate this problem by demanding tests and treatments for which there’s no evidence base, such as antibiotics for sore throats. The relentless demand of the public is for treatment here and now.”

Dr Tim Ballard, a vice-chair of the Royal College of GPs’ council, said some doctors were “overburdening patients” with unnecessary tests as part of healthcare that has become “overmedicalised”.

“There’s a significant amount [of overtesting and overtreatment] that goes on, often because of clinicians’ desire to do absolutely the right thing for the patient. But that can lead to clinicians overburdening patients with too many tests and erring on the side of too many tests.”

For example, many of the blood tests done on diabetics up to seven times a year to assess their health could be done three or four times instead, he added.

Too much healthcare is now overmedicalised, Ballard added. “When you get people, especially frail, elderly people, who have multiple problems, such as diabetes, high blood pressure and heart failure, you end up putting them on multiple medications. But they can run into problems by having side-effects. Overmedicalising people can lead to patients having a fall or kidney problems.”

There is growing concern in Britain and the United States about overtreatment. The medical journal BMJ’s recent Too Much Medicine campaign has highlighted how unnecessary care happens when patients are diagnosed and treated for conditions that will never cause them harm, which it says “many” patients are.

It has identified ADHD, thyroid cancer, high blood pressure and chronic kidney disease as among the common conditions where there is a risk of overmedicalisation and overdiagnosis. Screening programmes, expanded definitions of diseases, so that more patients seem to have them, and abnormalities detected when patients are tested for something else are driving overdiagnosis, it says.

Research in 2012 by Dr Don Berwick, an American health expert who last year reviewed patient safety in the NHS for the coalition after the Mid Staffs scandal, found that overtreatment in the US amounted to between $158bn and $226bn in 2011, including through overuse of antibiotics and patients having surgery unnecessarily.

But the British Medical Association, the doctors’ trade union, rejected the academy’s findings.

“Far from being wasteful, the NHS is in fact the most efficient healthcare system in the world,” said Dr Ian Wilson, chairman of the BMA’s representative body.

The Commonwealth Fund, a respected American health thinktank, recently rated the NHS top for both value for money and patient care out of 11 healthcare systems worldwide it studied, he added.

But Prof Sir Bruce Keogh, NHS England’s medical director, said the report’s findings could help the NHS withstand the rising pressures it is facing.

“We know that we need to take steps to make the NHS more sustainable, which is why we gave such a frank account of what that will take when we published the five year forward view last month. … We need to be innovative to tackle the huge financial challenges we are facing, but there are also some more everyday changes that we can make to improve efficiency.” he said. “This report neatly embodies some practical ideas for more efficient practice.”

Jeremy Hunt, the health secretary, said: “Tackling avoidable harm in healthcare has been a major priority following the Mid Staffs inquiry, because we know that safer care leads to better patient outcomes and lower costs.

“We have launched a safety campaign aiming to halve avoidable harm and recently published a report showing the costs of unsafe care may be as high as £2.5bn a year.

“Today’s report builds on this and underlines the potential for savings.”