Underuse happens when effective care isn’t delivered when it’s needed. It can lead to people needing more complex care as their conditions get worse – for example, if they end up in hospital because their condition isn’t managed properly at home. This means that tackling underuse can sometimes save money for the NHS, by keeping people well and reducing use of costly services. In other cases, reversing the problem of underuse is more likely to increase costs – particularly in the short term – as a result of investment in new services or improved access. In either case, tackling underuse is fundamentally about improving care for people who need it.
So, where might the NHS not be delivering enough of the right things?
One example is diabetes care. While the National Institute for Health and Care Excellence (NICE) sets out clear guidelines for what good diabetes care looks like, data from 2012/13 tells us that only around 60 per cent of people with diabetes treated by the NHS receive eight of the nine recommended care processes that could improve their health. Even fewer – only 36 per cent – achieve all three of NICE’s recommended treatment targets. Failure to provide people with the right care can make their health worse – and around 24,000 people die from avoidable causes related to their diabetes every year. It also costs money: estimates suggest that around £170 million a year could be saved through better management of diabetes in primary care, reducing the need for people to go into hospital.
Another example is when people become ill but their conditions aren’t diagnosed, leading to missed opportunities to intervene early and stop them getting worse. Take chronic obstructive pulmonary disease (COPD), where Department of Health guidance suggests that around one in eight people over the age of 35 has COPD but doesn’t know about it – and more than 15 per cent are only diagnosed after turning up to hospital in an emergency. It’s thought that many opportunities to diagnose COPD are missed, and that better diagnosis and treatment could improve people’s health while saving the NHS money.
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