Doctors have ‘ethical duty’ to help cut £2bn waste in NHS

Doctors have an ethical duty to reduce waste in the NHS, which costs it nearly £2bn, according to a new report published by the Academy of Medical Royal Colleges. 

The report, ‘Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care’ outlines how the NHS could make large cost savings if it provided more appropriate care in just 16 areas of clinical practice. 

It was stated that there are many examples of wasted resource in the NHS, but the authors suggest a focus on three core areas: overuse of medication, overuse of diagnostics or monitoring tests and unplanned admissions. 

While the authors acknowledge that it would be impossible to identify the true figure that could be saved by clinicians, health service managers and patients, the guidance being made available to doctors reveals how a series of relatively simple measures could create savings, which can be reinvested to improve patient care and raise standards across the healthcare system. 

Using data obtained by the National Institute of Clinical Excellence and first-hand accounts from doctors, the document highlights that improving the awareness of clinicians to the possibility of adverse drug reactions (ADRs), particularly among the frail and elderly could save the NHS £466m a year. 

One analysis showed that over half of the patients being treated could safely have their medication reduced or stopped altogether. In addition, ADR’s account for four in every 100 hospital bed days. 

Chair of the Academy Professor Terence Stephenson, one the UK’s leading paediatricians, said: “Maintaining NHS services in the future depends on doctors ensuring the best use of resources today. Quality of care is a doctor’s prime concern. 

“But, delivering quality care and promoting value are really two sides of the same coin. One doctor’s waste is another patient’s delay; potentially it could be another patient’s lack of treatment.” 

Professor Sir Bruce Keogh, the NHS England Medical Director, welcomed the report adding that “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 noted that the latest report ‘neatly’ embodies some practical ideas for more efficient practice. 

The research was carried out over a 12-month period by Dr Daniel Maughan, the Royal College of Psychiatrists sustainability Fellow at the Centre for Sustainable Healthcare and Mr James Ansell, a clinical leadership fellow at the Wales Deanery. 

While the report recognises that operating at 100% efficiency, round-the-clock, would be impossible in an organisation as large and flexible as the NHS, it does call for a change in culture by England’s 150,000 doctors, arguing they have an ethical duty to protect resources and promote value. 

The authors also provide a framework for a way in which doctors can think critically about waste from a clinical perspective and provide examples of doctors improving the value of health care by reducing waste. 

Dr Ian Wilson from the British Medical Association said doctors already play a leading role in helping to find more efficient ways of delivering patient care. 

“While staff and management should work closely to maximise the use of the NHS’s very limited resources, a doctor’s primary duty is to their patient, and it is vitally important that decisions around patient care are around clinical value,” he added. 

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