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I read the article ‘SoR welcomes Labour budget’ by Richard Evans with interest. He welcomed the announced funding of £22.6bn for day-to-day NHS spending but expressed concern at the fundamental cause of waiting lists. You would expect, or at least hope, that such a considerable amount would have a positive impact on waiting times in the short term at least. For many in the NHS the funding will be welcome, but it does beg the question as to the difference it will make in the longer term, particularly in relation to recruitment and retention.

The SoR has always been consistent in fighting for radiographer investment, training and role development. Working alongside our radiology managers, the changes we have seen to the role of the radiographer in recent decades has been quite astonishing. We know role development makes a positive contribution towards service provision. This is not only true for radiographers – there have been professional developments in other AHP professions and nursing, too – but still the NHS lurches from crisis to crisis.

Shortages across the board

So while role development has been positive it appears that, despite numerous NHS workforce plans, workforce shortages persist. The SoR has consistently argued that more radiographers are needed, but we should also be aware that every other professional group is saying the same thing. According to various professional body reports, the NHS is 50,000 doctors short, 12,000 physiotherapists short, there are severe shortages in nursing – the list goes on.

In the next fiscal year the NHS budget will be in excess of £200bn per annum. In order to satisfy the recruitment and retention goals of every professional body, many more billions will be required and it will take time to train people. With the UK economy in its current parlous state this will be impossible to achieve through taxation alone. The great hope is the UK government’s plans to grow the economy will work and more money for the public sector will become available. However, the economic reality would suggest otherwise. A recent report by the Office for Budget Responsibility expects GDP (gross domestic product) to be largely unchanged in five years. It’s worth remembering that the UK is the sixth largest economy in the world, but:

National debt is above 100 per cent of GDP.
The UK’s monthly interest payments on its national debt are approximately £5.6bn. This figure represents a significant portion of the government’s expenditure, reflecting the high level of national debt.
UK growth is between 0 and 1 per cent and is struggling to grow, and the UK share of the global economy is expected to continue falling in the coming years.

For many years it has been said that if the UK spent the OECD (Organisation for Economic Co-operation and Development) average on healthcare there would be fewer challenges for the NHS. Data from the ONS (Office for National Statistics) shows that the UK spent more (in GDP terms) than the OECD average on healthcare in 2022, although per capita spend was lower, and we spend less on health-related long-term care.

New technology, new costs

Not many will expect the NHS to rectify all of its problems following the increase. Every year we see new treatments, new technologies, population demand increasing and all costs rising. As things currently stand, many health consumers realise the NHS cannot deliver everything it’s asked to do and there has been a significant growth in the number of people in the UK taking private medical cover. With the additional funding we will undoubtedly see a short-term improvement in NHS performance but many commentators believe there will be minimal long-term impact.

Arguably the NHS has stretched itself too far; it is unsustainable and it is time for a radical rethink. It’s not just about funding, of course, and reform of NHS structure may well be required. As a first step, perhaps now is the time for the SoR to be brave enough to lead the debate within the AHP and trade union movements on alternative funding models for the NHS, such as those in place across Europe.

I feel a motion coming on for ADC 2025.

As one of the oldest and most admired healthcare systems in the world, the National Health Service stands as a testament to the principle of healthcare as a universal right. The NHS is an institution that has championed the cause of health equity and patient care, but it is imperative to recognise and address the issue of waste within its workings.

Addressing this issue is not just about financial savings; it reflects on the efficiency, sustainability and future viability of healthcare in the UK. By acknowledging the scale of the problem and implementing innovative solutions, the NHS can not only save money but also sustain its ability to provide high-quality care in an increasingly resource-conscious world.

Healthcare waste is multi-factorial and occurs in various forms, including unused medications, administrative errors, equipment and supply overstocking and inefficient processes. Moreover, a lack of cohesive integration across services can lead to duplicated efforts, further exacerbating the issue.

Patient care at the heart

The ramifications of waste in the NHS extend far beyond budgetary concerns. It threatens the quality of patient care, eroding the foundational values upon which the NHS was built. Funding and resources that could be allocated to frontline services are being squandered on inefficiencies. This not only hampers the ability to provide timely care, it also diminishes the overall patient experience.

Furthermore, the environmental impact of waste cannot be ignored. The NHS in England produces 156,000 tonnes of clinical waste per year and is responsible for a significant carbon footprint, largely because of overproduction, excess packaging and inefficient disposal of unused medical supplies. As the NHS aims to reach net-zero carbon emissions by 2045, reducing waste becomes a pivotal part of its broader environmental strategy, benefiting both the economy and the planet.

To combat waste, the NHS must embrace innovative solutions and leverage technology. In a move they have called a “major crackdown on NHS waste” the government has published an ambitious plan to improve efficiencies of medical technology, grow the economy and create thousands of jobs, entitled Design for Life Roadmap: Building a circular economy for medical technology – a strategic initiative aimed at reshaping health and social care systems to better meet the needs of the public, which is believed will save millions of pounds and divert resources to frontline care.

This roadmap is particularly timely as it echoes the evolving expectations of society concerning public health, emphasising a proactive and preventive approach rather than a reactive one. In a world facing unprecedented health challenges, the Department of Health and Social Care (DHSC) initiative is being met with both optimism and a realist’s caution.

The DHSC roadmap represents a bold vision for the future of health and social care in the UK. The plan aims to maximise reuse, remanufacture and recycling and move away from reliance on imported technology by transitioning from a linear economy towards a circular economy. Linear supply relies on the extraction of virgin materials to create products that are intended to be permanently disposed of after use, including high-value composite devices that contain economically valuable and increasingly scarce materials such as titanium, palladium and platinum, which could be recovered for sale and repurposing.

A new approach

Circular supply takes a multi-layered approach and aims to maintain products at their highest value for as long as possible. This is achieved by delaying materials from becoming waste until the circularity process is exhausted by reusing, repairing, refurbishing, repurposing and recycling materials. Such an approach could generate significant economic and environmental gains.

In her ministerial foreword, Baroness Merron states that the NHS needs to build resilience and sustainable growth that maximises resources, skills and investment by ending reliance on vulnerable supply chains and wasteful practices.

In the vision statement the government promises that, by 2045, the UK will have transitioned away from all avoidable single-use MedTech. Beyond strategic vision, the plan lays out systems for increasing the value of MedTech throughout its lifespan by prioritising decontamination and materials recovery for reuse within UK systems. The Waste and Resources Action Programme (WRAP) estimates that an economy-wide shift to the model of circularity will bring £75bn to the UK economy and create 500,000 jobs by 2030.

Global shock

The roadmap also addresses the vulnerabilities of the NHS’s reliance on global supply chains, which were exposed during the Covid-19 pandemic. Evidence has shown that reducing reliance on volatile supply chains from conflict-struck areas and growing local capacity can protect health systems from global supply shocks, with countries already operating as such experiencing significantly less disruption during the pandemic.

UK health systems have seen disruptions caused by factors such as the volatility in the supply of raw materials, turbulence in energy supply and price, trade embargoes and tariffs, transport constraints and sudden spikes in global demand. The hope behind Design for Life is to transition away from reliance on foreign imports and to ameliorate UK production within the healthcare sector and safeguard clinical provision in the future.

While the intent behind the roadmap is clear, the execution will inevitably face challenges. NHS leadership must take a proactive stance in addressing waste, promoting a culture that prioritises efficiency and sustainability. Policy changes at higher levels can enhance funding for technologies aimed at waste reduction and support best practices across healthcare facilities. Collaborative efforts with private sector partnerships can also introduce new methodologies for waste management and resource optimisation.

The roadmap proposes a UK-wide position on healthcare waste and the vision is shared by all four nations. However, because of the devolved nature of operational healthcare delivery, each nation may adopt its own methods to meet shared objectives.

The key to the success of the roadmap will be collaboration with stakeholders, including health technology manufacturers, professional and regulatory bodies and, most importantly, clinicians and patients, to optimise the use and extend the lifespan of all equipment. There is a clear commitment to incentivise the commercial sector to embed circularity in future production.

Fostering a culture of accountability and transparency among staff is also essential. Regular audits and open discussions about waste can lead to behaviour changes and a greater sense of ownership over available resources. Engaging frontline staff in identifying wasteful practices can lead to grassroots innovations that enhance efficiency.

A long-term approach

The physical and digital infrastructure requirements for these undertakings cannot be underestimated and there are provisions within the plan to model future demand and commit to the long-term requirements of implementation, including a digital enablement strategy and global data-sharing initiatives.

Additionally, a lack of streamlined integration across NHS services often leads to redundant efforts, further aggravating waste. While the ambitions of the roadmap are admirable, it misses opportunities to address the concept of ‘care waste’ related to clinical system inefficiencies and outdated referral pathways creating bottlenecks and duplication by further integrating health and social care as proposed in the 2022 publication of the Johnson administration.

Ultimately, combating waste isn’t merely about reducing costs, it is about preserving the integrity and the mission of the NHS for future generations. The aspiration remains clear: to build a more efficient, sustainable healthcare system that truly reflects the values of a nation that holds health as its highest priority.

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