£32 billion going to the NHS may be what the BMJ wants, but it is certainly not what the people of England need. As a matter of urgency, the people of England need the BMJ to work with the Department of Health and the NHS to identify and disinvest from areas where vast amounts of finite tax payer money is being wasted on unnecessary, and often times harmful, prescriptions, tests and treatments. In 2017, the OECD published a document which estimated that at least 20% of activity in healthcare services added no value, which is consistent with the DHSC publication Good for You, Good for Us, Good for Everybody: A plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions, which emphasised that at least 10% of prescribing was pointless.[1, 2]
It is also interesting to note that 20% of the current NHS budget is about £32 billion. To support this, the BMJ ought to revive the Too Much Medicine initiative which was last updated in 2018. Since this last update, the BMJ has publshed a number of articles about waste in healthcare [3, 4, 5, 6, 7] but more needs to be done to also actively work with all healthcare professionals to identify and disinvest from the wasteful activities and to reinvest the liberated resources to support higher value activities that can help to reduce the backlog, improve health and prevent disease. Linked to this, the people of England need the BMJ to advocate strongly for initiatives that will promote health and deliver primary prevention of disease like creating more spaces for the evidence-based and efffective diabetes prevention programme as well as providing healthy, delicious, sustainable school meals for all children in England.[8, 9]
The BMJ needs to look again inside the box of the NHS to reveal and reduce interventions of low or zero or negative value and recommend more high value options to promote population health. Even £1 billion can be used to improve health and prevent disease in a sustainable way for the people of England; for example, an additional £1 billion would be enough to provide all primary state school pupils in England with a free school meal and extending this to all secondary school pupils would be a additional £1.5 billion.
Funnelling ever more finite tax payer money into the NHS is not the best way to deliver population health given the state of the country right now.
Competing interests:
The Oxford value and Stewardship Programme promotes and provide professional and organisational development to help clinicians and healthcare organisations identify waste and shift resources to higher value healthcare www.ovsp.net
Rapid Response:
Re: NHS funding for a secure future
Dear Editor
£32 billion going to the NHS may be what the BMJ wants, but it is certainly not what the people of England need. As a matter of urgency, the people of England need the BMJ to work with the Department of Health and the NHS to identify and disinvest from areas where vast amounts of finite tax payer money is being wasted on unnecessary, and often times harmful, prescriptions, tests and treatments. In 2017, the OECD published a document which estimated that at least 20% of activity in healthcare services added no value, which is consistent with the DHSC publication Good for You, Good for Us, Good for Everybody: A plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions, which emphasised that at least 10% of prescribing was pointless.[1, 2]
It is also interesting to note that 20% of the current NHS budget is about £32 billion. To support this, the BMJ ought to revive the Too Much Medicine initiative which was last updated in 2018. Since this last update, the BMJ has publshed a number of articles about waste in healthcare [3, 4, 5, 6, 7] but more needs to be done to also actively work with all healthcare professionals to identify and disinvest from the wasteful activities and to reinvest the liberated resources to support higher value activities that can help to reduce the backlog, improve health and prevent disease. Linked to this, the people of England need the BMJ to advocate strongly for initiatives that will promote health and deliver primary prevention of disease like creating more spaces for the evidence-based and efffective diabetes prevention programme as well as providing healthy, delicious, sustainable school meals for all children in England.[8, 9]
The BMJ needs to look again inside the box of the NHS to reveal and reduce interventions of low or zero or negative value and recommend more high value options to promote population health. Even £1 billion can be used to improve health and prevent disease in a sustainable way for the people of England; for example, an additional £1 billion would be enough to provide all primary state school pupils in England with a free school meal and extending this to all secondary school pupils would be a additional £1.5 billion.
Funnelling ever more finite tax payer money into the NHS is not the best way to deliver population health given the state of the country right now.
Muir Gray, Anant Jani and Alf Collins
1. OECD (2017), Tackling Wasteful Spending on Health, OECD Publishing, Paris, https://doi.org/10.1787/9789264266414-en.
2. https://assets.publishing.service.gov.uk/media/614a10fed3bf7f05ab786551/...
3. BMJ 2022;379:o2614.
4. BMJ 2022;379:e069211
5. BMJ 2022;379:e070698
6. BMJ 2022;378:o2052
7. BMJ 2022;379:e070118
8. Nature. 2023 Dec;624(7990):138-144.
9. https://www.iser.essex.ac.uk/wp-content/uploads/files/misoc/reports/Impa...
10. https://ifs.org.uk/publications/policy-menu-school-lunches-options-and-t...
Competing interests: The Oxford value and Stewardship Programme promotes and provide professional and organisational development to help clinicians and healthcare organisations identify waste and shift resources to higher value healthcare www.ovsp.net