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Managing high value capital equipment in the NHS in England

Value for money is not being achieved across all trusts in the planning, procurement and use of ‘high value equipment’, such as CT, MRI scanners and Linear Accelerator Machines (linacs). There are significant variations across England in levels of activity and a lack of comparable information about performance and cost of machine use.

Trusts are not collaborating to purchase machines and they are not getting the best prices. According to the National Audit Office, around half of all CT and MRI scanners and linac machines are due for replacement within three years. Were trusts to replace existing machines, they would collectively need to find £460 million within three years.

The number of diagnostic scans carried out on NHS patients using CT and MRI machines has increased almost threefold in the last ten years. For radiotherapy, the number of treatment sessions has increased two and a half fold over the same period. The workforce supporting delivery of scanning and radiotherapy has increased but shortfalls remain in capability to deliver services. Many trusts face resource constraints in meeting increasing demand, with vacancy rates for consultant radiologists of around seven per cent and high rates of attrition for people training to become therapeutic radiographers delivering radiotherapy treatment.

There is wide variation in utilisation rates of MRI and CT scanning machines. However, because there is no central collection of data, individual trusts cannot compare their utilisation rates and costs with other trusts in order to improve efficiency. Trusts report their average costs per scan, but they do so differently. In 2008-09, the average cost per CT scan ranged from £54 to £268; and, for MRI, it was between £84 and £472 per scan. However, for radiotherapy, the Department of Health has developed a dataset which will enable comparisons to be made about efficiency and utilisation between radiotherapy treatment centres.

Today’s report points out that trusts are not collaborating to get the keenest prices on purchasing or maintenance of machines. One quarter of purchases in 2009–10 were made outside existing framework agreements and opportunities were missed to secure lower prices by grouping together requirements for new machines.

"Half of this high value medical equipment is due to be replaced within the next three years. This is a challenge requiring planning by individual trusts since there is no longer a centrally funded programme. Turning to efficient management of this equipment, 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."

Amyas Morse, head of the National Audit Office

Notes for Editors

  • Press notices and reports are available from the date of publication on the NAO website, which is at Hard copies can be obtained from The Stationery Office on 0845 702 3474
  • The Comptroller and Auditor General, Amyas Morse, is the head of the National Audit Office which employs some 900 staff. He and the NAO are totally independent of Government. He certifies the accounts of all Government departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which departments and other bodies have used their resources.

PN: 20/11