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NHS 'must strain every sinew'

The NHS must look abroad to countries like India, Ghana and Mexico for solutions to its £30 billion funding crisis, a health regulator has said.

The health service needs to undergo a "radical change" if it is to survive, according to Monitor, which published a raft of proposals to close the funding gap.

These include stopping procedures such as tonsillectomies that have "little" clinical benefit, finding ways that GPs can see more patients and keeping people out of hospital.

It said innovations in overseas countries also had the " potential to transform NHS care", with just two examples offering savings of £1.7 billion to £1.9 billion in England.

The first from Mexico involves patients consulting a nurse by telephone, leading to two-thirds of patients resolving their queries over the phone and only one third being referred to a doctor.

" If the NHS were to introduce a similar service and it reduced 50% of first visits to general practice, where patients would otherwise have seen a doctor, we estimate it could free up GP time worth in the region of £0.6 billion to £0.8 billion, taking into account the cost of nurses to run the phone service," the report said.

"The GPs could spend the freed time on care for more complex patients."

Another project, Aravind Eye Care in India, focuses on the principles of "mass marketing and industrial engineering".

"By streamlining the workflow of care to maximise the use of staff skills, Aravind is able to perform 60% of the number of NHS cataract surgeries but at one-sixth of the cost to the NHS and achieve better clinical outcomes."

Other schemes in Ghana involve capturing patient information and images on a mobile phone and sending them "for interpretation by a doctor at a different location".

The report added: " In the USA, dermatology services use digital cameras and computers to transmit clinical images for cancer screening and diagnosis by central diagnostic specialist teams."

Figures from the Nuffield Trust and NHS England suggest the NHS funding gap could grow to £30 billion a year by 2021, the report went on.

It said health services "must change fundamentally or the quality of care that patients receive will fall" and suggests ways to improve efficiency, such as more telephone appointments for patients instead of face-to-face GP consultations.

The report recommended stopping at least 30 procedures that were deemed to be either relatively ineffective from a clinical point of view or solely cosmetic.

It added: "Evidence suggests that up to 95% of such these elective procedures could be safely eliminated, ranging from 10% of jaw replacements to 90% of tonsillectomies or knee washouts."

Other proposals include getting patients to better manage their own health, concentrating services in fewer areas than at present and increasing the number of people seen in the community rather than by hospital consultants.

David Bennett, chief executive and chair of Monitor, said: "Over the next eight years, the health sector faces its greatest financial challenge in recent times.

"We are all going to have to strain every sinew to meet it.

"While there are individual things the sector can do - like be more efficient in its procurement or introducing new ways of working in hospitals - what is required is a step-change.

"In short, the NHS must undergo radical change if it is to survive.

"Monitor, as the health sector regulator, will not only be supporting, but actively enabling changes that deliver better services for patients and reduce costs."

A Department of Health spokeswoman said:"The NHS is already on track to make £20 billion of efficiency savings by 2015 by making changes to the way it works - changes that will continue to deliver savings beyond 2015.

"We've protected the health budget and increased health spending in real terms.

"But we know that to meet rising demand the NHS will need to work even harder to become more efficient and we welcome Monitor's contribution to the debate on making that happen."


From Belfast Telegraph