Thursday, May 30

Surgical masks and robotic operations are a needless waste of NHS money



Useless surgical masks and robots could be scrapped to help save NHS £150 million a year, Imperial College has said, after identifying changes the health service can make to save more than £150 million each year.

Researchers from the Department of Surgery and Cancer, found 71 commonly performed procedures or practices that are of high cost but low value to patients, which could be stopped.

They include hernia repair operations for people with few symptoms, which currently cost the NHS £28 million a year, but do little to make people feel better.

Likewise using CT scans to diagnose appendicitis was found to have little benefit above and beyond the traditional blood tests and hands-on pressure checks by doctors. Scrapping them could save the health service four million pounds, the report found.

The team also discovered that robotic surgery has ‘little or no advantage’ when compared with traditional keyhole operations and said it must be ‘considered a candidate for disinvestment.’ There is also no evidence to show that infections can be prevented by surgical masks, even though they cost the health service £150,000 a year.

Writing in the British Journal of Surgery, surgeon Humza Malik, of Imperial College London, said: An expected £30 billion funding gap is expected by 2020 in the NHS.

This provides motivation to identify and reduce the use of healthcare interventions that deliver little benefit and which could be substituted with less costly alternatives without affecting safety, and quality of care.

The intention was to identify general surgical procedures or interventions that are currently employed as a result of established practice, or previously published guidance, that more recently published research has found to be ineffective.

Stopping low-value services represents a significantly greater opportunity for efficiency savings than thought previously.

The researchers, who studied 1,500 paper into the benefits of procedures, found that surgeons were overusing endoscopes – tiny cameras which can fit into small areas of the body. Doctors regularly use the cameras to check in the stomach, bowel or throat for evidence of cancer even when a diagnosis is unlikely.

They estimated that unnecessary endoscopic procedures are currently costing the NHS nearly £42 million a year.

Switching to a better method of gallstone removal called an index cholecystectomy, which prevents complications, could also save £72 million a year, including £13 million in readmissions. Ditching enemas before colorectal surgery could also save almost £100,000 a year.

The NHS is currently attempting to identify which services it should no longer be offering, and recently released a list of over-the-counter drugs it would stop funding, including paracetamol and ibuprofen.

However patients groups said they were concerned that stripping out some procedures could take away treatments that some found to work.

Rachel Power, Chief Executive of the Patients Association, said: “The NHS is currently in a phase of reducing what it offers as a consequence of underfunding by central government – while this paper is only an academic exercise so far, it is very possible that NHS England might find the idea of limiting ‘low value’ surgery attractive.

If it goes down that road, we would offer the same caution as we have for its current initiative on low value medicines: in principle this could be a sensible matter of good housekeeping, but any changes must be undertaken with the full involvement of patients, and without accidentally limiting access to effective treatments that meet patients’ needs.

A Royal College of Surgeons spokesperson added:“NHS finances are currently stretched to their absolute limits, so it is important that surgeons look carefully at how they can improve efficiency and scale back surgical interventions that deliver little benefit to patients.

While the authors of this study have focused on general surgery, the principles could probably apply to every surgical specialty.