The Taxpayers' Alliance has continued its assault on what it sees as profligate public spending, this time with a report arguing that many NHS Trusts are underusing expensive equipment.
The alliance comments that: 'There is great potential to increase the efficiency of many NHS trusts to improve service to patience and value for taxpayers."
I have no doubt that the NHS is going to come increasingly under fire as the pressure to cut public expenditure becomes even more intense.
The NHS has been the most generously funded of all our public services for more than a decade, but there is little evidence that productivity has improved during that period. Those who work in the service, both clinicians and managers, know that there is scope to provide services more efficiently. But they also know how difficult it is to effect change.
The NHS is not a single organisation, rather a network of institutions whose interests, both financial and otherwise, tend to conflict as often as they coincide.
Market mechanisms might provide the answer in the medium-to-long term: effective commissioning by primary care trusts and strong competition between providers should drive up quality and drive down price.
The problem is that the market-based approach is still in its infancy : commissioners are not yet fully equipped to do the job, and the government has been reluctant to stimulate competition by opening the door to voluntary and private sector providers, or by allowing public sector providers to fail.
The answer in the short term has to lie in collaboration between NHS organisations – not just efficiency drives within trusts, as advocated by the Taxpayers' Alliance, but genuine co-operation across a whole health economy, by which I mean all the commissioners and providers of services within a defined locality.
It has been accepted wisdom for some time that too many people receive expensive hospital treatment and that better value would be obtained if care moved 'upstream', with greater emphasis on prevention, early diagnosis and care in a community setting rather than in hospital.
This shift will only be achieved in the short term if primary care trusts, GPs, community service providers and acute hospitals work together to define the optimal care 'pathway' for patients – particularly those with chronic long-term conditions – and then agree among themselves who should provide the care.
Crucially, they will have to accept the consequence – that capacity (and that means wards, hospitals and jobs) will have to be taken out of the acute sector.
It might be possible to redeploy some of those resources into primary and community care, but there is an overriding imperative to save money. That means extracting savings in cash terms, not just moving staff and equipment.
Brokering agreements to make this happen will not be easy – it will take determination on the part of the government and a new spirit of collaboration across organisational boundaries within the NHS.
However, the alternative is that the NHS will continue to run inefficiently while its funding is reduced, resulting in a marked deterioration in care to patients and financial crisis for a significant number of trusts.
Alan Downey is head of public sector at KPMG
