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NHS care can be improved while also saving costs

Published: 23 February 2023

The NHS could simultaneously save millions of pounds and improve care, a new report from the NIHR shows.

The NIHR’s new evidence Collection, “7 findings that could save the NHS money and improve care”, brings together seven NIHR-funded studies. It identifies findings that could help improve the quality of healthcare while also delivering significant savings.

The seven research findings the NIHR identified are:

1. Hospital at home is a good option for many older people

A model of home-based care “hospital at home” did not lead to higher deaths after six months or one year in comparison to being cared for in hospital. People were also less likely to then be admitted to a care home. They and their carers also preferred hospital at home over hospital care. A study estimated that this service could save £3,071 per patient in NHS, personal social care and informal care costs.

2. Online CBT for PTSD is as effective as face-to-face therapy

Researchers assessed a type of cognitive behavioural therapy (CBT) designed to treat trauma but delivered online. This CBT was as effective as, and cheaper than, the same therapy given face-to-face. The online course cost £277 per person, compared to £729 per person for face-to-face therapy. Online therapy may be available to people sooner.

3. Pills that reduce stomach acid do not improve persistent throat symptoms

New research has found drugs called proton pump inhibitors (PPIs), increasingly used to treat persistent throat symptoms, offer no benefit over dummy pills and should not be prescribed to treat these symptoms. This could save the NHS up to £4 million a year. People who reduce their intake of unnecessary medications would also benefit from reduced side effects.

4. Most people undergoing planned surgery do not need compression stockings

A trial found that taking anti-clotting medicine alone was just as effective as combining it with compression stockings. This could save the NHS in England around £63 million per year as well as easing discomfort for patients.

5. A plaster cast can safely and cost-effectively treat a broken wrist

A moulded plaster cast is a safe and cost-effective alternative to surgery for a distal radius fracture. Researchers found that casts were as effective as surgery using wire for most patients. Wrist pain and function were similar, regardless of which approach was taken. Using casts instead of surgery could save hundreds of thousands of pounds, and free up surgical time and theatre capacity.

6. No benefit from the switch to more expensive anticoagulation in intensive care

Using cheaper anticoagulation proved just as effective in treating kidney patients. A large study compared intensive care units that continued using heparin anticoagulation, to those that switched to the newer citrate anticoagulation. It found no clear benefit to patients from the switch. Using heparin instead of citrate anticoagulation could save the NHS £2,376 per patient.

7. Many people having joint replacements can safely stop routine follow up in the 1-10 year period after surgery

The NHS spends roughly £100 million per year on follow-ups after surgery. Research found that most people who had straightforward hip and knee replacements using UK-recommended joints can safely stop routine follow-up in the 1 to 10-year period after surgery. Reducing follow-ups and unnecessary clinical tests could save money and free up time for specialists to treat more patients.

Professor Lucy Chappell, Chief Executive of the NIHR, said:

“The NHS provides an extremely broad range of important services, and NHS staff provide high quality care and support in so many different ways and settings. Our research often helps to find new treatments, but it can also tell us when we can provide better care that also saves costs, allowing us to focus on reaching more patients.

“The recommendations in today’s report can help our NHS colleagues work to provide the best care possible, underpinned by research. Patients can use this information to understand more about the choices that they are offered; for example, some older people might prefer to be cared for at home if they become unwell, rather than being admitted to hospital, and others may prefer to avoid an operation for a wrist fracture, rather than have surgery. This report shows how we can understand the benefits of doing so, for patients, service users and NHS staff.”

Dr Jemma Kwint, NIHR Senior Research Fellow and author of the report, said:

“We want to help the NHS make the best use of research to provide value for money and better care for patients. These findings demonstrate that it is possible to make cost savings without compromising the high quality of care that the NHS delivers.”

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