NHS Budget Scrutiny: Right, Until it’s Not

Anyone working in healthcare will be painfullyaware the NHS is operating in a 'challenging financial environment'.

Like all public services at present, scrutiny is being placed on every poundspent (and sometimes it feels like every penny).

This approach is right - until it's not.

Done right, scrutiny leads to positive change. It means carefully evaluatingnew products and services and commissioning only those that are safe, thatwork, and are cost-effective. Crucially, it means reducing usage of and/ordecommissioning products and services that no longer meet those criteria - i.e.are they safe, do they work, are they cost-effective. Wes Streeting has beenclear about the need for reform rather than pouring more money into aninefficient system.

Done wrong, scrutiny leads to inertia. It means aversion to change, no appetitefor innovation, blanket spending freezes. ‘No spend' becomes preferable to'better spend'. New, proven products and services do not reach the hands ofpatients. Ultimately this maintains the status quo, even where that is nolonger good enough - which the Darzi investigation has made abundantly clear.

Take the example of prescribing in primary care & the community.

It's been over 3 years since the Government published its NationalOverprescribing Review report.

The report found that "at least 10% of the current volume of medicines maybe overprescribed (though this will be less than 10% by value)." That's10% of prescribing that isn't right for patients and isn't right for NHSbudgets.

Here's the primary care & community picture in 2019, from NHSBSA Prescription Cost Analysis:
Total prescribing = c. 1.1 billion items
Total cost = c. £9.1 billion

After the National Overprescribing Review report's publication, you mightexpect big changes - particularly in a challenging financial environment.

But here's the picture in 2023/24:
Total prescribing = c. 1.2 billion items
Total cost = c. £10.9 billion

Whatever detail and nuance sits behind the numbers (and there's a lot), onething is clear: the required scale of change has not happened. Despite pocketsof best practice, some of which Big Health is fortunate enough to support, weare still seeing more prescriptions for greater cost.

So what? Why am I saying any of this?

In a challenging financial environment, I want to see scrutiny done right. Hereis a golden opportunity - identified by the Government's own report - toscrutinise what the NHS already spends and use that money more effectively.

Wes Streeting promised to "ask some hard questions about where moneyalready goes in the system".

Tackling overprescribing is a perfect place to start. Because what's more, asthe title of the report emphasises, it's good for everybody: patients,clinicians, and the NHS alike.