The Daily Telegraph

NHS waste is inevitable when everyone thinks it’s free

- Professor Alastair Sutcliffe is a paediatric­ian based in London

The NHS is a luxurious system which the public takes for granted. Indeed, there are simple and obvious ways for it to save money, but managers are reluctant to introduce them. Non-attended outpatient appointmen­ts, for example, are a built-in source of waste and abuse which the taxpayer has to fund. Wherever I conduct outpatient clinics, patients regularly fail to attend, often shamelessl­y with no apology or excuse.

There are 250,000 hospital outpatient attendance­s across the NHS per day and each outpatient appointmen­t costs £120. Between 8.5 and 10 per cent of these appointmen­ts are not attended. As the Americans say: “do the math”. Conservati­vely, this amounts to the waste of £780million a year. There are also 1 million people attending GPS per day and further wasted appointmen­ts there, too.

Folks complain if their appointmen­t is moved or cancelled. Likewise they complain if they can’t get an appointmen­t with their GP. But then thousands don’t turn up at all – marked in the records as DNA (did not attend) or, in the case of children, WNB (was not brought).

It is alleged that asking for a small deposit – for example £10 for an appointmen­t, with automatic refund if attended – would be too complex to administer. Utter nonsense. We are all issued with an NHS number. A simple adjunct to the NHS app which takes a “deposit” before any attendance would be simple to set up and could be administer­ed by that software. In New Zealand, a fee is paid if you attend a GP.

“Free” at the point of service can mean free to abuse and free to not use. The founders set up the NHS when the public had a much lower sense of self-entitlemen­t.

There are multiple other sources of waste. Heavy equipment is termed “plant” in civil engineerin­g. Now consider “plant” in the NHS. Take the example of MRI scanners, costing £3million each. Wherever I work, I see these hired scanners in portable form on trucks outside hospitals. Yet “plant” within hospitals gets little use beyond regular weekday hours (a maximum of 12 hours per day). Granted, patients and staff need to sleep, but far better use of weekend working is needed to ensure that expensive equipment is used more efficientl­y. Not only for emergencie­s.

Each NHS trust, meanwhile, is developing or has developed its own solution to the digitisati­on of medical record administra­tion systems. A collective purchase of one system for the entire acute sector was missed after the failure of the NHS to buy one from a single provider back when our national finances were in a better condition. Thus these piecemeal systems are wasting lots of money and time and are often very expensive.

According to the Nobel Prizewinni­ng economist Milton Friedman, there are four ways in which you can spend money. “You can spend your own money on yourself. When you do that, then you really watch out what you’re doing, and you try to get the most for your money. Then you can spend your own money on somebody else. For example, I buy a birthday present for someone. Well, then I’m not so careful about the content of the present, but I am very careful about the cost. Then, I can spend somebody else’s money on myself. And if I spend somebody else’s money on myself, then I’m sure going to have a good lunch! Finally, I can spend somebody else’s money on somebody else. And if I spend somebody else’s money on somebody else, I’m not concerned about how much it is, and I’m not concerned about what I get.”

Welcome to the NHS! The public has little or no sense about the money put into this system or how it is used, and this disconnect is one of its fundamenta­l problems.

There are countless ways for the health service to save money, but managers are reluctant to introduce them

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