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Countless column inches have been devoted to the issue of waste in the NHS, often focusing on apparently simple fixes that commentators suggest could save taxpayers’ money (eg axing ‘non-jobs’ or cutting senior manager pay). But curiously, some of the biggest opportunities to improve value for money receive remarkably little attention either from the press or from government.
Take medicines waste. The NHS in England spends at least £300 million each year (probably significantly more) on medicines that end up being thrown away. There are multiple causes but a key underlying issue is that it is not sufficiently clear who is responsible locally or nationally for measuring, monitoring or addressing the problem. As a result of this lack of clarity, medicines waste remains largely invisible to the people involved in prescribing, dispensing and administering drugs, and so the system as a whole fails to learn and improve.
Wasteful expenditure on energy is another huge issue. In the last financial year the NHS spent £1.4 billion on energy for trusts alone. Bills are higher than they need to be because under-investment in capital over many years has saddled the NHS with inefficient buildings and outdated technologies. NHS England estimated in 2021 that investment in technologies to improve energy efficiency could save £346 million per year. We have seen some progress since then – for example, recent commitments on solar power are expected to save the NHS around £325 million in lifetime costs – but the pace of change needs to increase to make best use of resources.
Wasteful spending on energy is exacerbated by inflexible accounting rules that make it hard for NHS organisations to enter into power purchase agreements. These long-term arrangements could give hospitals a secure source of low-cost energy and free them from dependence on volatile international energy markets. Failure to take advantage of these arrangements now is something that taxpayers will pay for in the future.
A third example is wasteful expenditure on single-use medical products and devices – from gowns and drapes to sophisticated surgical devices such as ultrasonic scalpels which are normally used once and then disposed of. The NHS has not been immune to the throwaway culture that has infected other parts of our lives, despite evidence indicating that reusable products can be cheaper in the long run and just as safe. The scale of the waste generated is often staggering – for example, a typical maternity unit throws away tens of thousands of plastic baby bottles each year, each used a single time before being discarded. Recent research (see here and here) shows that the opportunities for cost savings from a concerted NHS-wide shift to reusable products could run into millions of pounds annually. To take just one case, Mid Yorkshire Trust found that switching to reusable tourniquets saved £20,000 in a year as well as almost a tonne of plastic waste.
Left unchecked, the trend for single use products could continue to grow as new technologies such as wearables come onto market. There has been some welcome leadership from the Department of Health and Social Care on this issue recently in the form of the Design for Life programme and work on value-based procurement which it is hoped will generate significant savings in future. This work needs to be accelerated and given more clout in the system if the full opportunities to reduce costs and improve supply chain resilience are to be realised in practice.
One of the threads connecting these different forms of waste is that accountability for addressing the problem and for using resources more efficiently is currently weak. That accountability gap is the subject of new research underway by The King’s Fund and the Centre for Sustainable Healthcare, with support from the Health Foundation, due to be published in the spring.
A key message from our work is that to ensure we get better value for money from health spending, we need to bear down hard on wasteful use of resources that threatens to undermine the financial and environmental viability of the NHS. Trusts have small sustainability teams that were created to tackle the sorts of issues described above, but accountability cannot sit solely with these teams because they lack the power to bring about the kinds of changes needed. Instead, board-level leaders need to be held to account for making decisions that maximise long-term value, with the backing of visible political leadership from government.
Unfortunately, some NHS organisations are currently being driven to scale back their sustainability teams in order to live within their annual budgets. This may save small sums in the very short term but at a national scale it adds up to an egregious false economy.
The examples of medicines waste, single-use products and energy costs illustrate something important about waste in the NHS. Money is not wasted because people are irresponsible. It is wasted because we have a system that is hard-wired to put the short-term ahead of the long-term, and a political culture which largely encourages it to do so. Turning that around means focusing determinedly on long-term value and sustainability – and holding people to account for doing so.
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