The NHS has seen its budget grow considerably in recent years. Spending plans for NHS England estimate an outturn of £162.5 billion in 2024-25.[1] Despite this level of funding, concerns continue about the performance of the NHS compared to its peers on key healthcare outcomes, including life expectancy and deaths.[2] The pressures to improve on this are exacerbated by the size of waiting lists, at 7.6 million cases in August 2024,[3] and an aging population, placing further demands on the health system. It is crucial that a concerted drive is made to increase efficiency and productivity in the NHS, particularly by making full use of resources already at its disposal.
Throughout the 2024 general election parties exchanged ideas to improve efficiency in the NHS. In its manifesto, Labour pledged to increase the number of operations, scans and appointments by two million and to “double the number of CT and MRI scanners.”[4] Meanwhile, the Conservatives pledged to fund technology helping staff read MRI and CT scans more quickly, which would boost the efficiency of the service.[5]
Yet in relation to the utilisation of expensive machines, many NHS trusts are not using their available assets optimally. If NHS trusts are to maximise efficiency and improve patient outcomes, the management of the machines must be improved.
This note covers a period including the coronavirus pandemic. The pandemic effected the utilisation of machines as individuals avoided going to hospitals, with trusts seeing significant drops in the average machine uses. By 2022, it is reasonable to expect that machine utilisation would have returned to pre covid levels as pandemic era restrictions had been lifted.
Increasing utilisation by sharing underused machines between trusts that are based in similar geographical locations offers a potential solution to underutilisation. This would allow patients to have their scan sooner if they are willing to go to a trust with underused machines. This would increase usage, cut waiting lists and improve patient outcomes. Alongside this, trusts should increase the hours that machines are in use. According to primary data, machines in the NHS are typically used within working hours but opening this up so patients can receive scans or procedures outside of the traditional working hours could significantly improve utilisation. This would allow patients to move up the waiting list if they are willing to get scans or procedures outside of traditional working hours. However, where necessary and under the right circumstances, investing in machinery alongside staff to use it to cut waiting lists is a warranted investment.
This note explores the utilisation of three different types of machines in NHS trusts in the UK: magnetic resonance imaging (MRI); computerised tomography (CT) scanners; and surgical robots.
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Key findings
- For three out of the four years, Royal Devon trust performed the most scans per MRI machine. Only St George’s in 2021 performed more scans per machine than Royal Devon. The most scans performed per MRI machines in the four respective years were 15,020, 11,483, 13,301 and 15,393 in the respective years.
- Between 2019 to 2022, the trusts with the lowest average MRI scans per machine were Royal Papworth Hospital with 1,624 and 1,441 scans in 2019 and 2020, York and Scarborough Teaching Hospitals with 779 scans in 2021 and NHS Greater Glasgow and Clyde with 135 scans in 2022.
- Worcestershire was the top performing trust for CT scans in 2019 and 2020 with 27,452 and 26,300 scans per machine. Surrey and Sussex trust was the top performer in 2021 and 2022 with 20,209 and 21,998 scans per machine.
- NHS Highland had the fewest number of CT scans per machine in 2019 with 705 scans, while NHS Borders had the fewest in 2020 and 2021 with 585 and 715 scans respectively. Royal Berkshire performed the fewest CT scans per machine in 2022, with 535.
- Hull performed the most procedures with surgical robots in 2019. East Sussex performed the most procedures in the subsequent years. For the four years, the trusts with the most procedures performed with surgical robots saw 411, 318, 357 and 490 procedures completed per machine.
- Belfast Health and Social Care Trust had the fewest number of surgical robot uses per machine in 2019 and 2020 with 51 and 16 uses In 2021, NHS Tayside used their surgical robot the fewest with 25 uses per machine and in 2022 Buckinghamshire Healthcare had the lowest usage per surgical robot machine with 51.
- The outbreak of covid in 2020 saw a drop in median MRI machine use from 2019 of 1,665 or 26 per cent. There was a 1,572, or 16 per cent, fall in median usage of CT scans and a median drop of 73 surgeries conducted by surgical robots, or 34 per cent.
- Across all trusts, the median number of MRI scans completed per machine in 2019, 2020, 2021 and 2022 was 6,456, 4,791, 5,362 and 5,248, respectively.
- The median number of CT scans completed in 2019, 2020, 2021 and 2022 was 10,125, 8,553, 9,095 and 9,249.
- For surgical robots, the median number of uses per machine across trusts was 212 in 2019, 140 in 2020, 124 in 2021 and in 2022 it was 164.
- If trusts that utilised their machines below the trust median in 2022 brought the number of scans or procedures in line with the median, this would be equivalent to having an additional 40 MRI machines or a 13 per cent increase, 59 CT scanners equal to a 14 per cent increase and seven surgical robots or a 25 per cent increase.
- None of the machines analysed in this note have returned to pre-covid utilisation levels.
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[1] HM Treasury, Autumn Statement 2023, November 2023, p.33.
[2] Anandaciva, S., How does the NHS compare to the health care systems of other countries?, The King’s Fund, 26 June 2023, www.kingsfund.org.uk/insight-and-analysis/reports/nhs-compare-health-care-systems-other-countries, (accessed 13 February 2024).
[3] NHS England, Statistical Press Notice NHS referral to treatment (RTT) waiting time data August 2024, 10 October 2024, www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2024/10/Aug24-RTT-SPN-Publication-PDF-388K-v2.pdf, (accessed 26 July 2024).
[4] Labour, Labour Party Manifesto 2024, June 2024, www.labour.org.uk/change/build-an-nhs-fit-for-the-future/, (accessed 19 June 2024).
[5] The Conservative and Unionist Party, The Conservative and Unionist Party Manifesto 2024, June 2024, Page 41.