NHS Factcheck 3: Is there ‘too much waste’ in the NHS?

Factcheck 3: A very often-heard comment in the media or from the general public is that “There is too much waste in the NHS”

Factcheck 1 Does the NHS already have enough money?
Factcheck 2 Is the NHS a funding ‘black hole’?
Factcheck 3 Is there ‘too much waste’ in the NHS?
Factcheck 4 There isn’t enough money to fully fund the NHS

Latest in our Factcheck series by Sally Ruane

Sally Ruane is a member of Keep Our NHS Public Executive. She is a member of the Institute for Applied Health Research at De Montfort University, Leicester. She has published in books, academic journals and magazines in the UK and Spain.

Waste can arise because of lack of spending

In one international comparison, the NHS scored 4^th out of 11 rich countries when their health systems were compared for administrative efficiency[1].

However, while there are some areas of waste in the NHS they do not negate the need for additional funding.

This is because ironically, a lot of waste  arises because of a lack of funding which results in resources not being properly used.

For example, resources are wasted when:

• Patients have to go into hospital because there is not enough care in the community – we see this when patients go into A&E rather than get an appointment with their GP, where in primary care there are over 6000 vacancies[2].
• Operations are cancelled at the last minute. Resources are wasted when a surgical team must wait all day to see if a space is freed up in intensive care unit (ICU) because they cannot operate unless an intensive care bed is available but there aren’t enough ICU beds in the hospital.
• Patient care is delayed or adversely affected by buildings falling into disrepair
• Doctors and nurses must spend time working on out-of-date IT systems.
• Money is paid to private hospitals for services they do not provide (as happened during the pandemic[3]).

We want to eradicate these forms of waste by investing more in the services we need

For example, GP services need to be expanded by training more GPs and other members of the GP team such as practice nurses and by investing more in primary care so that patients do not go to A&E unnecessarily. ||

Some economists have argued that we need to invest more in expanding NHS capacity (e.g. having more NHS staff and operating theatres) in order to improve NHS productivity[4].

Just recently the NHS Confederation (which represents NHS managers) said that capital spending (on buildings and equipment) needs to increase in order to allow the NHS to work more efficiently – for example by investing in digital care[5].

Wasted resources on the market system in the NHS in England

Resources are wasted because of the way the health service is organised – for instance, when the health system was set up to operate like a market and NHS organisations had to go through competitive processes before they can receive funding to provide healthcare and large sums of money must be spent on negotiating contracts, drawing up contracts, checking their financial and legal details, monitoring them[6]. We would like to end this waste of public resources by getting rid of market competition and moving back towards the NHS as the default provider of services. This would allow us to move resources out of unnecessary administration and commercial work and into front-line patient care or necessary administration.

Sally Ruane, Executive member Keep Our NHS Public

[1] https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly#admin

[2] https://www.pulsetoday.co.uk/news/workforce/one-in-seven-gp-posts-empty-as-vacancy-rates-remain-high/

[3] https://chpi.org.uk/papers/reports/for-whose-benefit/    ;  https://www.hsj.co.uk/finance-and-efficiency/leaks-reveal-two-thirds-of-private-hospital-capacity-went-unused-by-nhs/7029000.article

[4] https://www.bennettinstitute.cam.ac.uk/media/uploads/files/Productivity_in_UK_Healthcare.pdf

[5] https://www.nhsconfed.org/publications/beyond-bricks-and-mortar-capital-funding-NHS

[6] https://chpi.org.uk/wp-content/uploads/2014/02/At-what-cost-paying-the-price-for-the-market-in-the-English-NHS-by-Calum-Paton.pdf