It provides a framework for doctors to think critically about waste from a clinical perspective and provides examples of doctors improving the value of health care by reducing waste.
The report, Protecting resources, promoting value: a doctor’s guide to cutting waste inclinical care, lays out a series of challenges to a doctor’s role in the NHS.
It looks at the different types of clinical waste and covers how doctors should be leaders in its reduction. It looks at everything from reducing physical waste, such as medicines, to saving NHS resources, estimating that around 20 percent of mainstream clinical practice brings “no benefit to the patient”, as there is widespread overuse of tests and interventions.
If the finite NHS resources are spent on costly interventions that have little benefit, then the service we provide will be of little value and the resources we have will be wasted, it says.
The key is to focus on minimising waste in all its forms, the report says, and among its recommendations, asks that doctors should embrace the values of resource stewardship in their clinical practice and use the waste reduction toolkit provided in the report to maximise the value of every intervention.
It points out that deciding how and when to use these resources are clinical questions that can only be answered by those with sufficient training and experience.
Academy Chair Professor Terence Stephenson – “…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”
Waste arises from using these clinical resources inefficiently or unnecessarily. Inappropriate use of clinical resources is waste and this waste relates directly to clinical practice and needs to be tackled by those best equipped to do so; doctors.
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.
Using data obtained by the National Institute of Clinical Excellence and first-hand accounts from doctors, the document reveals:
- improving doctor’s awareness of 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. ADR’s account for 4 in every 100 hospital bed days
- the simple measure of increasing the frequency of ward rounds means patients can often go home sooner. At the Royal Liverpool University hospital ward rounds were increased from two a week to twice daily. It reduced bed occupancy by 7.8 percent
- maximising the use of operating theatres and managing operating schedules better, saved the University Hospital Bristol Trust £2m a year. There are 160 acute trusts in England.
The report recognises that operating at 100 percent efficiency, round-the-clock would be impossible in an organisation as large and of necessity, as flexible as the NHS, but calls for a change in culture by England’s 150,000 doctors, arguing they have an ethical duty to protect resources and promote value.
It suggests they should ask not simply if a treatment or procedure is possible, but, whether it provides real value to the patient and genuinely improves the quality of their life or their prospects for recovery.
Academy Chair Professor Terence Stephenson 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.”