Department of Health

Website of the Department of Health

Please note that this website has a UK government access keys system.

You are here:

NHS could save more than £700m by increasing productivity

  • Published date:
    12 June 2006

New report outlines how patient care can be improved at the same time as cash being saved

The NHS could improve patient care and save more than £700m a year in the process by improving efficiency, Health Minister Andy Burnham said today.

Launching the NHS Institute for Innovation and Improvement, he published its first report detailing the savings that could be made by addressing areas such as:

  • reducing avoidable emergency hospital admissions;
  • increasing the number of operations carried out as day cases;
  • cutting patients' length of stay in hospital;
  • slashing agency staff costs; and
  • reducing the number of wasted bed days. 

The report contains recommendations for acute trusts and Primary Care Trusts (PCTs) on how to improve patient care and increase efficiency.

Andy Burnham said:

'The NHS has come a long way in the last few years.  The Chief Executive's report, published last week, detailed many of these achievements such as waiting times at all-time lows, the fastest ever treatment for cancer patients, and reduced death rates from the big killer diseases.

'The quality of patient care and NHS productivity is increasing, but we still need to do more to show value for money from the record investment that is going into the NHS.'

The £700m-plus savings the NHS could make include:

  • a reduction in avoidable emergency admissions for conditions such as asthma, heart problems and angina could save the NHS over £120m a year;
  • if all acute trusts achieved an average of 75 per cent day cases across all specialties then at least 390,000 bed days and £88m would be saved each year; and
  • reducing unnecessary outpatient appointments by up to 50 per cent could save over 800,000 return appointments and £50m annually.

Mr Burnham added:

'Increasing efficiency and productivity does not mean compromising services.  The best trusts are already delivering on both - increasing efficiency and successfully managing their finances as well as providing high quality patient care.

'For example, cutting the number of avoidable emergency admissions doesn't mean poorer services.  We know patients would rather be treated at home than in hospital and by doing this where it's appropriate the NHS can save money as well as improving patient care.'

Notes to editor

1. The NHS Institute for Innovation and Improvement's report, Delivering Quality and Value: Focus on Productivity and Efficiency can be found at the link above.

A summary of the report is below:

Reducing avoidable emergency admissions

  • More care closer to home and better assessment processes can reduce the requirement for hospitalisation, reduce costs and improve a patients way of life.  In 2004/05, the NHS spent £1.3m on admissions for people with common aliments such as asthma, chronic obstructive pulmonary disease and angina.

Reducing unnecessary outpatient appointments, follow-ups and Did Not Attends

  • Alternatives to follow-up outpatient appointments could save over 800,000 return appointments and £80m annually.

Improve day case performance

  • Day case surgery is cheaper than inpatient surgery and patients prefer it.  Day surgery should be treated as the preferred form of surgery unless there is good reason to perform it differently.  However, most hospitals perform operations on an inpatient basis more frequently than is recommends.
  • If all acute trusts achieved an average of 75 per cent day cases across all specialties, then the potential saving is at least 390,000 bed days and £88m (based on £225 per elective inpatient bed day).

Reducing wasted bed days

  • Admitting patients to beds a day or days in advance of procedures for non-clinical reasons wastes valuable hospital bed space and increases costs.  Some trusts admit a small percentage of patients the day before their main procedure whereas others admit over 60 per cent of patients the day before their main procedure.  Pre-operative stays accounted for 1.05m bed days in 2004/05.  If above average trusts were reduced to the average, the potential savings is at least 390,000 bed days.
  • Similarly, patients are often admitted to hospital but have no main procedure carried out, either because they were admitted for diagnosis only (which could have been carried out without an admission) or were found to be unfit for surgery (which could have been picked up by a pre-operative assessment.  The percentage of patients who are admitted but have no surgical procedure varies between trusts.  For example, in general surgery this ranges between less than 6 per cent and over 24 per cent.  If above average trusts were reduced to the average, the potential saving is at least 27,000 bed days and £13m.

Reduce variation in length of stay

  • There is a huge variation between hospitals in the length of time patients stay in hospital for particular treatments.  One of the most effective steps to reduce length of stay is improving the discharge process so that patients are discharged as soon as they are ready rather than when the system is ready to discharge them. 
  • For patients admitted as an emergency, the reduction in the weekend discharge rate (compared with the weekday average) varies from over 75 per cent to less than 40 per cent.  Nationally, on Saturdays and Sundays, over 3,000 fewer patients (admitted as emergencies) than expected are discharged from hospital.
  • For patients who have suffered an acute stroke, the reduction in the weekend discharge rate (compared with the weekday average) varies from nearly 80 per cent to less than 50 per cent between trusts.  For emergency acute stroke patients alone, if all NHS trusts achieved a more even discharge pattern (similar to the best performing trusts) there would be an annual saving of 19,192 bed days or nearly £4m.

Improving staff productivity

  • Most NHS resources are invested in staff.  Utilising staff as effectively as possible is critical for financial efficiency, staff satisfaction and patient care. Finished consultant episodes (FCEs) and patient admissions per consultant or member of medical staff vary by over 100 per cent between trusts.  If all trusts with below average FCEs/staff ratios came up to the average, then staffing could be reduced by 7 per cent for consultants and 9 per cent for medical staff as a whole.

Actively manage staff recruitment and costs

  • Sickness absence costs are easily identifiable and can cost an average trust £5.4m per annum.  Average costs of sick absence per NHS employee was £556. 
  • The average trust spends £2.3m on agency staff, which is 4.2 per cent of its staffing costs compared with 2.9 per cent seven years ago.  If all NHS trusts reduced their agency spend to the national average, it could save around £78m.
  • Electronic recruitment via NHS Jobs has the potential to creats savings of £80m per year through a reduction in recruitment advertising spend, administration and temporary staffing costs.

2. 

Calcualtion of estimated savings from Focus on: productivity and efficiency £M
Reduce avoidable admissions - less than total than three figures in document due to overlap of savings 120
Outpatient referrals, follow ups and do not attends 221
Day case rates 88
Wasted beddays 113
Length of stay 4
Staff costs 158
TOTAL 704

3.  The NHS Institute was established as a Special Health Authority in July 2005 to improve health outcomes and raise the quality of delivery in the NHS by accelerating the uptake of proven innovation and improvement in healthcare delivery models and processes, medical products and devices in health care leadership. The NHS Institute works with the frontline to create NHS-specific, high impact products  to deliver a significant and positive impact on patient care. More details can be found at the link above.

4. Case studies

Day case rate improvement

Ashford and St Peter's Hospitals, Surrey

Contact: Antonia Ogden Meade, Operations Director 01932 722217 or 07980 586622.

Improved their day case rate to 75.77 per cent by:

  • Establishing a clinician led Day Surgery Group to focus service improvements
  • Reviewing waiting lists with all Surgeons to review their waiting lists to identify opportunities for transferring inpatients to day cases
  • Developed services to support day case procedures ( out of hours help lines staff by senior nurses, change of surgical technique, development of day surgery pain control protocols)
  • Monitoring Day Case rates at monthly performance meetings.

Bed days saved (length of stay management)

Guys and St Thomas's Hospital, London

Contact: Adrian Hopper, Clinical Director, Elderly care (via Press Officer Antony Tiernan 020 7188 5577).

Achieved a reduction in length of stay by 20 per cent for medical patients in the last 18 months by:

  • Driving improvement with Senior Consultant leadership
  • the introduction of the OPAL team (Older Person's Assessment and Liaison team)  ensures there is a geriatrician at the front door every day (A& E) which identifies patents as they come in
  • Length of Stay data (by consultant) circulated to all consultants and junior doctors
  • Weekly performance monitoring across all professions (therapists, nurses etc.) kick started by the introduction of an elderly care weekly scorecard
  • Clear recording of discharge dates for all patients on a white board on the ward (this may sound trivial but they regard this as being invaluable to changing cons. decision making during ward rounds.

5.  Media enquiries only to the Department of Health Press Office on 020 7210 5010 or the NHS Institute for Innovation and Improvement on 024 7647 5844/07770 704 127.   General enquiries to 020 7210 4850.

Additional links

Travelling?

Access keys