A parliamentary report slammed the British government's program for buying high-priced MRI and CT scanners and linear accelerators, noting that the state-run health system possibly lost millions of pounds by forgoing bulk-buying strategies.

A politician who prepared the report also said she was "shocked" by how capital equipment was used within the public health system, pointing out wide variations in efficiency and "unacceptable" wait times: for instance, nearly half of stroke patients don't receive a head scan within 24 hours, and almost one out of 8 cancer patients doesn't undergo potentially life-saving radiation therapy.

"[T]he way this equipment is bought and used is not providing value for money for the taxpayer," Margaret Hodge, a Labour member of parliament and chair of the public accounts committee, which prepared the report, told parliament last month.

Buying problems

Since 2007, the NHS has bought almost 50 million pounds worth of CT, MRIs and linear accelerators. All told, it has about 1 billion pounds worth of equipment, or nearly 1,000 of these devices. But the machines are aging.

The report estimates more than half of the high-tech devices need to be replaced in the next three years, likely to the cost of 460 million pounds.

However, at the same time, the NHS is under pressure to cut 20 billion pounds from its budget, so the report authors said facilities have to do a better job managing how they buy and provide access to their machines.

As it stands, each "trust," or group responsible for delivering health care in an area, mostly buys equipment on its own, and doesn't coordinate with other trusts, the report said. Plus, nearly 20 percent of orders for MRI, CT or linear accelerators don't come through "framework agreements" hashed out by the NHS Supply Chain, and generally held to be cheaper than individual deals reached separately by trusts with suppliers.

The NHS Supply Chain has also yet to place bulk orders for MRI, CT or linear accelerators, aggregating orders across different trusts, even though it's achieved "volume discounts" for digital mammography and ultrasound units, the report said. The committee also claimed an earlier review found the system could save tens of millions of pounds on aggregate purchasing of advanced imaging equipment.

"[M]oney is being wasted because trusts don't join together to buy equipment and get the best deals by exploiting their bulk buying power," Hodge told parliament.

Access issues

Buying the equipment wasn't the only concern. How it was used also came up for a lashing.

Hodge said they found "unacceptable" variations in access to equipment, with average CT scan rates at different facilities varying from 7,800 to 22,000 per year. Opening hours also ranged from 40 to 100 hours per week.

Plus, stroke victims aren't receiving timely head scans, and 13 percent of cancer patients who could benefit from radiation therapy don't get it, according to a March National Audit Office survey cited by Hodge in the report.

"A modern NHS should not allow 50 percent of people who have a stroke to wait more than 24 hours for a scan," Hodge said.

Still, very long waits, of six weeks or more, have been mostly eliminated, according to the National Audit Office. As of July 2011, median wait times were 1.4 weeks for CT scans and 1.8 weeks for MRI scans, according to evidence supplied by the NHS.

Fixing the system

Hodge and colleagues recommended a half dozen fixes, including getting trusts to share purchasing plans with NHS bosses to better collaborate on buys, and as well as putting more pressure on trusts to purchase through so-called framework agreements.

The investigators also hope a new national data set on MRI and CT use, expected in April, will allow the NHS to benchmark providers' performances and make them work better. A similar data set, for radiotherapy, was launched in 2009.

"From 2012-13 onwards, the NHS Commissioning Board should ensure that this data set enables local clinical commissioning groups to hold trusts to account for their performance, and to drive improvements in efficiency," the report said.

Health department's response

In response to the committee's report, health minister Simon Burns said the government was doing "everything it can to root out waste and inefficiency," and that it would consider the recommendations.

"Already the NHS has saved up to 15 per cent on scanners by working with NHS Supply Chain to coordinate large orders over time with other trusts," Burns said in a statement. "This is the NHS working smarter, but full savings will not be seen until all trusts make use of this system."

He also said the NHS was planning on expanding radiotherapy capacity by 150 million pounds.