New Research: NHS Trusts under-using vital equipment

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.