Sally Gainsbury: PROMs prove McKinsey right - nearly

This tells us everything and nothing about NHS finance.

On the “everything” side, the finance director’s mind immediately leaps to the so-called “Croydon list” of procedures deemed as having potentially “low clinical benefit”, upon which each of the four PROM-ed procedures – hips, knees, varicose veins and groin hernias – appears, in some form or other.

When McKinsey notoriously took that list and translated it into projected savings, the procedures accounted for roughly a quarter of the total £800m the experts reckoned could be saved each year if 30-80 per cent of them were cut.

On balance, the PROMs data suggests McKinsey may be right.

On knees, for example, McKinsey estimated 15-30 per cent of such procedures may have little benefit. Results from the PROMs show that a quarter of patients reported feeling either no better or worse. If there was a money-back guarantee on those ops, that would equate to a saving of around £100m a year.

The PROMs results are nearer the lower end of McKinsey’s estimated cut for hip replacements (15-30 per cent) and varicose veins (20-80 per cent), taking the potential saving from a maximum of £110m to a more conservative £49m.

However dissatisfaction among groin hernia repair patients blows McKinsey’s cautious 10-30 per cent suggested decommission out of the water, as a shocking 50 per cent reported feeling either worse or no better. That would take the potential maximum saving from £5.8m to £9.5m.

A fortnight in hospital for no benefit sounds bad enough; to come out of it feeling even worse – as 17,200 PROMs participants did last year – is, as NHS medical director Bruce Keogh says, a “disaster” for the patient concerned.

Here, then, is where the results tell us absolutely nothing about NHS finance, as it is only by completely eliminating the suspicion that referrals are blocked for financial reasons that these personal disasters will be stopped.

Sally Gainsbury is a news reporter for the Financial Times.