More than £1bn can be saved if the NHS wipes out variations in elective care productivity, according to a new report from Monitor.

  • NHS could save £1.4bn by clamping down on variation in elective care productivity
  • Monitor found 13-20 per cent efficiency opportunity in orthopaedics and ophthalmology
  • Savings can be achieved by cutting length of stay, getting nurses to undertake routine tasks and improving theatre throughput

The report, shared exclusively with HSJ, says savings of £1.4bn could be unlocked if good practice already present in the NHS and abroad was consistently implemented throughout the health service.

Operating theatre light

Monitor worked with eight NHS providers and five international hospitals on the research

Examples include reducing length of stay after operations, getting nurses to undertake routine tasks currently performed by consultants, and improving throughput in operating theatres.

Monitor arrived at the figure after working closely with eight NHS providers, five international hospitals and the Royal College of Ophthalmologists and British Orthopaedic Association.

Focusing on orthopaedics and ophthalmology – the two largest elective specialties – Monitor scrutinised the patient pathways for six procedures.

It found “wide variation in performance between NHS providers at every stage of each care pathway… in staff costs, overhead costs and number of appointments”.

For example, for an average cataract surgery case mix, the theatre throughput ranged from 4.5-8 procedures per four hour session across the NHS hospitals Monitor looked at.

The NHS providers were more productive in ophthalmology than any of the international sites, but compared less well on length of stay following joint replacement. The average length of stay was 3.5 days for the international hospitals, and under two days for some of the centres. In the NHS the average length of stay for hip and knee replacements was five days in 2013-14.

According to the report, “if every NHS provider followed the good operational practices adopted by the highest performers at each stage of their… pathways, they could save 13-20 per cent of today’s spending on planned care in these two specialties”.

At City Hospitals Sunderland Foundation Trust nurses were trained to give topical anaesthesia for routine cataract surgery.

This sort of “task shifting” could result in significant savings while freeing up consultants’ time for more complex cases.

Because the efficiencies relate to “general aspects of care delivery”, Monitor believes they could be applied more widely to all elective procedures.

If this was implemented across the NHS, Monitor estimates that as much as £1.4bn could be saved.

The biggest savings opportunity relates to reducing length of stay – an area which Monitor says is significantly influenced by patient expectations.

In the Five Year Forward View, national NHS leaders said the health service needed to make £22bn of efficiencies in the next five years, to help fill an estimated £30bn financial gap by 2021.

The government has pledged to increase NHS funding by an extra £8bn over this Parliament.