In a wide-ranging supplement, HSJ looks at the different ways NHS trusts have been improving efficiencies and reducing costs, in areas including pathology, service design, diagnostics and the workforce

HSJ’s efficiency supplement is free to download.

Equipment management

With the focus on cutting NHS procurement costs, the bill for maintaining equipment can be overlooked. Barriers to getting better deals include the difficulty of
keeping track of hundreds of contracts for a typical acute trust. Now some trusts are turning to outside specialists to review their maintenance contracts and
save money through tactics such as bundling contracts together, switching service suppliers and renegotiating deals.


Trusts must ensure NHS staff at all levels have the skills needed to cope with increasingly demanding roles and avoid future failings in care. Now some are bringing in outside help to analyse and address the skills gap.


Collaboration between trusts to provide more efficient patholog services has been growing. Many are looking to set up joint ventures to build economies of scale but in doing so must negotiate a regulatory minefield.

Service redesign

Trusts are looking to share or outsource a wide range of services, with a notable tactic being setting up joint ventures with the private sector. Such projects are not just about savings but can bring in extra capital.

Estates management

The Francis report and the DH’s review of critical infrastructure have upped the pressure on trusts to tackle the huge buildings maintenance backlog. But with funds scarce, they may need to start thinking outside the box to find the income to do this − by, for instance, creating more retail space in hospitals or building hotels for friends and family on site


As C. difficile rates in the NHS have dropped in recent years, trusts have been hit with tougher targets for the number of cases − and big fines if they miss these. Some trusts are now looking at spending more on molecular tests that deliver quicker results, thus cutting the risk of a target-busting outbreak.


An ageing population means rising numbers of atrial fibrillation sufferers, who face a high risk of stroke. But could the cost to the NHS of monitoring the drugs they take be reduced − and outcomes improved − through self monitoring?

Inventory management

How trusts could save money through better systems to manage stock. Such systems can ensure that, for example, items are always ordered in the right
quantities to avoid waste or shortages, are easier to find, and are used before they expire.

HSJ’s efficiency supplement can be downloaded as a PDF.