Sep 2009 25

New Research: NHS Trusts under-using vital equipment7

A new report from the TaxPayers' Alliance (TPA) provides evidence that many NHS Trusts are not adequately utilising expensive treatment and diagnostic equipment. With a crisis in the public finances and patients still forced to wait for important diagnostic and treatment procedures, the fact that many Trusts are under-utilising expensive and important facilities is of serious concern. Whilst NHS Trusts of course vary by population density, strikingly some of the most poorly performing Trusts are in large population centres where there is high demand, such as Hull, Coventry, Cardiff and London. The report demonstrates that there is great potential to increase the efficiency of many NHS Trusts to improve service to patients and value for taxpayers.
 
To read the full report, click here (PDF).
 
Key Findings
 
Using Freedom of Information requests to every one of the 200 Acute NHS Trusts, the report investigates how many times a year each Trust uses each of five different classes of medical equipment:

•  Linear accelerators (Linacs) play a critical role in cancer care as part of radiotherapy treatment. Each patient receives several treatment sessions, known as "fractions":

- The average usage of each Linac machine in 2008 in the NHS was 7,191 fractions per year. That is significantly below the recommendation from the National Radiotherapy Advisory Group of 8,000 fractions per machine per year – a rate which was only achieved by 11 Trusts nationally.

- There is also considerable variation between trusts, with two Trusts (Hull and East Yorkshire Hospitals Trust and University College London Hospitals Trust) providing fewer than 5,000 fractions per machine.

- If all trusts below the national average brought their usage rate up to the average, an additional 128,758 fractions could be provided – equivalent to 18 additional Linac machines.
 
• Positron Emission Tomography (PET) scanners are extremely useful in effectively diagnosing cancer and then planning appropriate treatment.

- The average usage of each PET scanner identified was 956 scans per year. That is significantly below the Department of Health target of 2,000-2,500 scans per year. Only one Trust, University College London Hospitals NHS Trust, achieved that Department of Health target.

- There was considerable variation between Trusts, and three Trusts produced fewer than 500 scans per machine while one met the Department of Health target.

- If all trusts below the national average brought their usage rate up to the average, an additional 2,492 scans could be provided – equivalent to three additional PET scanners.
 
• Magnetic Resonance Imaging (MRI) scanners are a safe means of producing detailed internal scans useful in diagnosis and treatment of a wide variety of conditions. 

- The average use of MRI scanners in 2008 was 4,941 scans per machine.

- There is considerable variation between trusts; eight trusts used each machine less than 2,000 times while nine trusts used each machine more than 8,000 times in 12 months

- If all trusts below the national average brought their usage rate up to the average, an additional 265,732 scans could be provided, equivalent to 54 additional scanners running at the average annual usage.
 
• Computerised Tomography (CT) scanners provide a detailed view of different tissue types not available with traditional x-rays.

- The average usage of CT scanners in 2008 was 7,424 scans per machine.

- There is considerable variation between trusts, with six Trusts using their CT scanners over 15,000 times, while seven had an average
usage lower than 2,000.

- If all trusts below the national average brought their usage rate up to the average, an additional 656,647 scans could be provided, equivalent to 88 additional scanners running at the average annual usage.

• Lithotripters use ultrasound shock waves to break up kidney stones.

- The average usage of lithotripters in 2008 was 457 uses per machine.

- There is considerable variation between Trusts, with three Trusts getting more than 1,000 uses per lithotripter and another just 18 uses per lithotripter.

- If all trusts below the national average brought their usage rate up to the average, an additional

8,528 uses could be provided, equivalent to 19 additional lithotripters running at the average annual usage.

The report also urges Trusts to maximise the efficient use of such important NHS resources, and highlights existing recommendations such as that of the National Radiotherapy Advisory Group that capable linear accelerators should work six rather than five days a week, and be in operation for more hours each day.
 
To read the full report, which includes full data regarding each type of machine for every NHS Acute Trust, click here (PDF).
 
Katherine Andrew, a Research Associate at the TaxPayers' Alliance, said:

"These pieces of equipment are not only expensive, they are crucial to the treatment of people who suffer from a wide variety of conditions. It is simply not good enough that so many Trusts are failing to make the best use of their resources, and in doing so letting down patients and taxpayers. If those Trusts that are lagging behind caught up just with the NHS average, it would make hundreds of thousands of extra treatment and diagnosis procedures available."

UPDATE

Cardiff and Vale NHS Trust have alerted us that there was an error in their response to our FOI.  They gave the number of scans by MRI machines at the Trust at around 1,500, whereas the actual value was over 15,000.  We have now updated the press release above and the linked report to reflect the new value.  This was not an error on the part of the TaxPayers' Alliance.

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  • Bob Smith

    This report just shows how little the Tax Payer’s Alliance or any other outside organisation know about how the NHS works and how to run a healthcare service! Your figures mean absoultely nothing!!!!! What a waste of time – and money!!!!!!!

  • A NHS Manager

    Well we could solve this problem in a instant why not sell off a few of these machines and make the ill travel miles to the nearest centre that’d be a good start or we could subject the population to pointless diagnostic tests to get the figures up they’d enjot that.
    If you could prove that systems were being underused and patients kept waiting as a result that would be worthwhile otherwise this is a pointless excercise

  • Clive Stone

    NHS made surplus of £1.75 BILLION last year and yet patients with kidney cancer are still being denied drugs used in most other countries by NICE which costs us at least £35 million pa and now expected to be £70 million! This is a good report and shows how we are being left behind EU for cancer five year survival rates as evidenced by lack of MRI and PET scans. Early diagnosise is essential to try and beat cancer.

  • http://www.taxpayersalliance.com Katherine Andrew

    The Department of Health and the National Radiotherapy Advisory Group have both highlighted problems of under utilisation within NHS Trusts of the machines in the report, in particular, emphasising Linac, MRI and PET services as important priorities for reduction in waiting times. The research does not advocate cutting machines in any Trust in the UK. It simply says that if currently available machines were used to the national average, which in itself is far below the government own targets, more scans could be available to patients, and that this kind of attempt to provide better value will be vital with resources in the NHS likely to become scarcer in the years to come. The majority of the population know someone, or have themselves, had to wait unreasonable amounts of time to have diagnostic imaging or treatment by these machines. The report was undertaken with advice from very senior health professionals, who themselves have seen inefficiencies in machine usage at first hand.

  • Steve Robson

    I wonder if they need people to operate the machines. You’d probably accuse them of employing people in non-jobs if they did. Why dont the TPA staff retrain and run the machines instead of writing crap reports. OK, you’d have to work in the public sector which you hate, but you would be doing something socially useful and could learn why others work in public service.

  • Phil Hammond

    I think that Katherine Andrew should clearly see from these comments that the weight of educated/NHS experienced opinion is against her on this one! Just hope they didn’t spend too much time writing this!!

  • Steve Robson

    No, one thing you can’t accuse the TPA of is spending too much time and effort on their research.
    They have a superfast method. They start with the answer, which is always some variation of the public sector is rubbish, the private sector is great, well paid people in the public sector (over £50K pa)are rubbish, extraordinarily rich people in the private sector (over £10million pa) are fantastic, worth every penny and shouldn’t have to pay any tax. From that they draw some findings and report them as facts.
    About an hour per Report I would think. I do find their productivity a bit low in that context, but then they are not themselves in the private sector, which possibly explains it.