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Giving staff a share of savings, enabling patients, and streamlining governance and capital processes, will help reduce the NHS’s endemic waste problem, writes Sir John Oldham.

Waste is endemic in our health and care system. Notwithstanding the serious waste represented by inappropriate care and errors, 30 per cent of healthcare does not add patient value (1). Productivity is also a problem and has been declining.

Macro-causes such as estate and slow technology are often, correctly, cited as sources of inefficiency, but there are many others.

There is widespread agreement that the capital allocation system in the NHS is broken. There is little if any access to resources for medium sized schemes (£60-80m) that are often the critical enabler of delivering better services more locally for patients. The investment in primary and community care estate is shameful as a proportion of the whole.

NHS Property Services is too distant from understanding the needs on the ground and, in the world of integrated care systems, arguably redundant. In 2023 it had 66 empty properties and some nine plots of land undeveloped.

Numerous buildings are underutilised (Imperial College Healthcare Trust has 20 per cent void space, and Queen Mary’s in Roehampton has several empty wards but pays estate charges for the unused space). Yet primary and community care development is constrained by lack of space.

Implementing a “one estate” policy locally in Places, as proposed in the Fuller Stocktake, will improve the use of spare capacity. But an urgent review of capital allocation should be undertaken too, with ICS CEOs.

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DatE: 31 March

Posted in News on Mar 30, 2025

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