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Nurses' surgery advice to help save £150m a year


Nurses could save £150m a year by helping patients to make better decisions about elective procedures, according to research seen exclusively by Nursing Times.

Pilot work carried out by the NHS Institute for Innovation and Improvement, working with Cardiff University and NHS Direct, looked at how patients could be supported to consider alternatives to surgery.

A shared decisions tool has been designed, which asks patients about their expectations of surgery, why they are considering the procedure and if they have considered alternatives.

Patients discuss the questions with clinicians such as specialist nurses, health coaches and physiotherapists before their appointment with a medical consultant.

Department of Health national clinical lead for shared decision making Stephen Laitner told Nursing Times: “Nurses are ideally placed because they’re not closely aligned to a particular outcome, like surgeons are.

“They’re particularly good at consulting individuals and making decisions that are right for them. People feel they get a very personalised, patient centred conversation with the nurse.”

A US evaluation of shared decision aids has suggested they reduce take-up of surgery by between 20 and 25 per cent.

The UK analysis assumes NHS surgery rates would be reduced by 10 per cent after using the tool, as surgical rates are not as high as they are in the US.

Reducing the need for knee replacements by this amount would save approximately £40m, with a further £24m saved by reducing cataracts procedures and £13m by reducing hernia operations.

If another 10 other common procedures were added, the amount saved would be £150m a year, the analysis suggested.

The pilots were based in Oldham, Middlesbrough and Stanmore, for patients with osteoarthritis, localised prostate cancer and benign prostatic hyperplasia.

There are now plans to expand the programme into amniocentesis, early stage breast cancer and prostate cancer screening.

Last week, Nursing Times’ sister magazine Health Service Journal revealed figures showing that the NHS is spending tens of millions of pounds each year on operations of questionable benefit to patients’ health.

The figures came from patients’ answers to generic questions asked as part of the new patient reported outcome measures data collection.

The patients answers showed, on average, that nearly one third of those undergoing groin hernia, varicose vein and hip and knee operations reported their health and quality of life had either not changed or had worsened after the surgery.


Readers' comments (3)

  • Has anyone looked into the long term effects in this delay in surgery? What are the costs of later inability to work? How many deteriorate to a point where surgery is no longer an option? This is evident now where delays/cancellations and long waits resulted in deterioration beyind the point of help and permanent disability which has high costs attached.
    How experienced are these nurses?
    Or is this just another way of blaming the ill/disabled for NHS costs rather than looking where money can really be saved in inefficiency, multiple management layers etc?
    I'll stick with the medically qualified thanks.

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  • And yet another story on how Nurses are increasing care standards yet saving the NHS money, and the cheeky ***** at the top are STILL blackmailing us into accepting an effective pay cut or lose our jobs!!!! It is time to strike! Now!

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  • I support Mike’s sentiments but consider this. If such a plan were to be implemented you’d have to employ nurses to do the job. As the nurses currently employed are busy. Essentially a doctor would then refer patients to a nurse to have a discussion about whether or not the patient should have the operation they’ve just recommended. Something doesn’t add up. Lots of things don’t add up. Essentially we’re saying the doctor hasn’t done their job properly (ie having a proper consultation with the patient about whether they want the operation in the first place). Now this may be the case, but is the best way to solve the problem by adding another step in the process? If 10% of consultations would find alternatives, 90% wouldn’t and would be a waste of the nurse’s time. It doesn’t seem like a very sensible step to add. It’s using nurses to solve a doctors’ problem inefficiently. Any money thrown at implementing this idea would probably better be thrown at providing physios and OTs to provide their alternative services. As doctors would be more likely to recommend these alternative services to surgery if they thought their patients would ever get the service instead of lingering on a physio’s waiting list.

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