21 April 2000
In Getting it right first time, the auditors said that hospitals could save between a sixth and a third of their budget for hip replacements by reducing purchasing costs and cutting the length of time patients stay in hospital after their operations.
The health service spends £140m a year carrying out 30,000 total hip replacements, £53m of this on the artificial joints used in the operations. The NAO believes trusts could save £7m through better procurement of these prostheses.
The report describes a chaotic situation where those who complained most were likely to be treated first, at the expense of the old and the timid.
It also found that trusts and the orthopaedic surgeons who perform the replacements believe patients could spend less than the current average of 11 days in hospital, but few had plans to reduce the length of stay. The NAO believes cutting stays by two to six days could save between £15.5m and £46.5m a year.
However, this does not take into account the extra costs earlier discharge would place on other parts of the NHS and social services departments.
David Davis, chairman of the Commons Public Accounts Committee, said more could be achieved with the money available. 'The report provides clear evidence that resources could be used much better. Some hospitals have made progress in reducing the length of stay,' he said.
The NAO said that some consultants are not performing enough operations to ensure their work is of the best quality. Some 8% of orthopaedic surgeons do fewer than ten hip replacements a year, while 71% perform fewer than ten revisions of replacements each year.
Concern over standards was one of the first issues the NAO addressed, according to Tim Fry, the author of the report. Standards were not questioned in the past, because most patients who received artificial hips were over 60 and would often die before any serious problem arose. 'This does not fully answer the question now, as younger people are having hip replacements, but it does have an impact on it,' he added.
PFapr2000
