Parliamentary report slams NHS imaging spending, oversight

The U.K. House of Commons issued a report Oct. 12 detailing multiple concerns with National Health Service’s (NHS) oversight of MRI, CT and linear accelerator purchasing and operations.

The report noted that NHS has spent £50 million ($80.5 million U.S.) on MRI, CT and linear accelerators in the last three years.

Since 2007, NHS has delegated responsibility for purchasing and operations of these systems to individual trusts. However, the Department of Health is ultimately responsible for healthcare spending in the U.K.

“We continue to question whether the system provides value for money when foundation trusts act independently with no explicit incentive to adopt best practices nor to work together to achieve economies of scale,” the report stated. Currently, NHS has no mechanism to compare imaging system performance, cost and capacity value across trusts.

Fragmentation can lead to waste and variability in system use, waiting time, operating hours and more. The report cited unacceptable response times for certain conditions, and wrote, “For example, 50 percent of people who have a stroke are not getting a scan within 24 hours. Furthermore, an estimated 13 percent of cancer patients are not getting access to radiotherapy when it could prolong their lives.”

According to Parliament, “The NHS needs to make high quality, comparable data available on machine use and cost. We welcome the department's plan to require all trusts to produce data on MRI and CT scan use. A standardized, national dataset would help trusts to compare unit costs and benchmark their performance. It would also enable commissioners to identify the large variations in utilization across trusts and take appropriate action.”

The situation has taken on a sense of urgency as half of the equipment in question requires replacement in the next three years at a cost of £460 million ($740.5 million U.S.). In addition, NHS must produce £20 billion ($32 billion U.S.) in savings by 2015.

The report concluded with six recommendations for NHS:

• The department should clarify who will be accountable for ensuring value for money in the purchase and use of high value imaging equipment in the NHS.
• The department has pledged to produce a dataset by April 2012 covering the use of MRI and CT machines by trusts. From 2012-13 onwards, the NHS Commissioning Board should ensure that this dataset enables local clinical commissioning groups to hold trusts to account for their performance, and to drive improvements in efficiency.
• Twenty percent of imaging purchases are not made using existing purchasing frameworks that lower the acquisition cost. NHS should require trusts to adhere to established purchasing frameworks unless the trust can articulate a clear reason for an alternate method.
• The NHS is not taking advantage of bulk purchasing discounts and should require trusts to share their plans for the replacement of high value equipment with NHS supply chain and/or other collaborative procurement bodies. This would enable NHS to aggregate orders across trusts to secure better prices.
• The department should consider how its contract with the NHS supply chain might be changed so that the NHS supply chain is financially rewarded for negotiating lower prices and generating savings.
• At a national level, the department, and in the future the NHS commissioning board, should put in place the means to gauge whether capacity accurately matches needs. This should take into account the savings that could be made if machines were used more efficiently. At a local level, commissioners should secure the right capacity in the right places to meet the needs of their populations.