NHS ‘not getting full value from its costly kit’

The National Audit Office (NAO) says half of all machines in England will need to be replaced in the next three years at a cost of nearly £500m.

But it found NHS trusts had no means of comparing how much they spend on, or use, equipment, while restricted opening hours means the technology can lie idle.

Demand for the equipment is increasing as the population ages and new uses are found for machines, leading to a three-fold increase in numbers of patients scanned using CT and MRI equipment in the past decade.

But the study found NHS organisations were failing to collaborate to get the best deals for the equipment. There was no central information to enable hospitals to compare costs and utilisation rates with other units.

The average cost per scan reported by trusts also varied widely, with MRI scans said to cost as little as £84 per patient in some hospitals rising to £472 in others. CT scans ranged from £54 to £268 per scan.

Around half of all CT and MRI scanners and radiotherapy machines are due for replacement in the next three years at a cost of £460m, with 80 per cent due for replacement within six years, at a further cost of £330m.

The study said: “NHS trusts do not have the means to know if they are making best use or getting best value out of their high value equipment.

“Equally, they do not have the means to determine if they are getting value for money from purchasing or maintenance.

“There are significant variations in levels of activity between trusts, and a lack of comparable information about performance and costs.

“In these circumstances the planning, procurement and use of high value equipment is not achieving value for money across all NHS trusts.”

The NAO said that owing to a lack of clear data it was unable to put a figure on how much was being wasted in the NHS.

The report also pointed out that the UK’s provision of such equipment per head was still significantly lower than many other European countries.

Analysis by the Organisation for Economic Co-operation and Development for 2008 showed the UK ranked 14th out of 20 in the number of MRI scanners per million people in the country.

Since then, the UK’s position has not changed, at six MRI scanners per million of the population, compared with at least 40 machines per million people in Japan and almost 20 per million people in Greece.

MRI and CT unit opening hours also vary widely around the UK, ranging from 40 to around 100 hours a week for MRI units and from 40 to 90 hours a week for CT units.

The study found that “scanning services restricted to 9am-5pm five days a week are not always sufficient to cope with demand, and expensive equipment can lie idle for much of the week”.

It also pointed to “wide variations in the time taken for scans to be performed”. Numbers of people waiting under two weeks from referral for an MRI scan in 2009-10 varied between trusts from below 20 per cent to 93 per cent. For CT scans, it varied from 33 per cent to 98 per cent.

Margaret Hodge, chairman of the Committee of Public Accounts, said: “At a time when the NHS is undergoing radical reform and has the additional challenge of making billions in savings, it is even more important that it focuses on getting the best value for money from all of its assets.

“Trusts are not working together to buy equipment and therefore don’t get the best prices. It is not getting best value from this vital, but expensive, equipment.”

Amyas Morse, head of the NAO, said there was now no centrally-funded programme for buying equipment, presenting a challenge to trusts which had become responsible for purchasing.

He said “trusts across the NHS lack the information and benchmarking data required to secure cost efficient procurement and sustainable maintenance of these key elements in modern diagnosis and treatment”.