Sir John Bourn, head of the National Audit Office, reported to Parliament today that NHS Acute Trusts in England held medical equipment with an estimated replacement value of some £3 billion. In 1996-97 they spent some £220 million on acquiring medical equipment annually and a further £120 million on maintenance. Figures for 1997-98 are similar.
Medical equipment includes all medical devices connected to patients as part of their treatment and care in hospital, and medical devices used for diagnostic and laboratory purposes. It represents a substantial asset for the NHS that needs to be managed efficiently to provide good quality care of patients at least cost.
Sir John identifies many examples of good practice in the management of medical equipment, from strategic overview, to day to day activities such as maintenance, and in the field of medical equipment safety. But he concludes that overall more needs to be done by trusts to manage their equipment assets effectively. Important measures include the needs:
- to allocate clear responsibility for medical equipment at board level;
- to ensure that inventory information is comprehensive and used fully in decision-making;
- to better co-ordinate the procurement of medical equipment across trusts, with more involvement of technical personnel who can also usefully contribute to non-clinical aspects of user training; and
- to take action that should help to improve standards of reporting of adverse safety incidents and to reduce their occurrence.
Sir John recommends that the NHS Executive and NHS Trusts should investigate unexplained variations in the value of medical equipment holdings to see whether some trusts are under-provided with medical equipment compared to similar trusts. There may be good reasons why some trusts appear to have higher than expected amounts of medical equipment and maintenance costs, but there is scope for investigating holdings of medical equipment to see whether economies of up to a maximum of £400 million are possible.
Sir John considers that the benchmarking of costs and management practices could yield benefits in lower costs, quality improvements and reduced safety risks. For example:
- medical equipment maintenance costs vary widely across trusts, and there may be scope for keeping equipment in good order and achieving savings up to a maximum of £18 million a year. This money would then be available for the enhancement of patient care;
- while clinical requirements dictate that a minimum number of makes and models of the same item of medical equipment is needed in a hospital, where appropriate, standardisation can save on costs, improve flexibility in the use of medical equipment for patient care, and reduce the potential for serious incidents; and
- it is essential that all users of medical equipment are properly trained.
Sir John notes that the Accounts Commission for Scotland have adapted some of the methodology used by the National Audit Office to review the management of medical equipment by trusts in Scotland. The scope for local audits of NHS trusts in England and Wales, drawing on National Audit Office findings, has been discussed with the Audit Commission.