Intended for healthcare professionals

Feature Disinvestment

Experts’ guide to saving money in health

BMJ 2010; 340 doi: (Published 17 March 2010) Cite this as: BMJ 2010;340:c1281
  1. Sophie Cook, editorial registrar
  1. 1BMJ, London WC1H 9JR
  1. scook{at}

    Academics and politicians have recently argued that NICE should pay more attention to disinvestment to help the NHS to save money. But what can be done at an individual specialty level? Sophie Cook asks some experts

    NHS funding has done well under Labour with real NHS spending almost doubling since 1999-2000.1 However, changes in the economy mean that growth will not be sustainable. A report by the King’s Fund and the Institute of Fiscal Studies predicts that at best the NHS will see low growth over the next spending period (2011-17), and even this scenario requires substantial cuts and increased productivity.1 When making cuts it is important to maintain high standards of care and patient safety.

    Last year, Tony Delamothe, deputy editor of the BMJ, proposed his top nine ways in which the NHS could save money (the tenth was for readers to contribute),2 garnering some interesting responses. So we asked front line professionals for their views on how their specialties could save money while maintaining high standards of care.


    Adam Timmis, consultant interventional cardiologist and professor of clinical cardiology, Barts and The London NHS Trust

    Revascularisation of patients with stable angina before they have been given optimal drug treatment,3 extensive coronary stenting in diabetic patients with multivessel disease (in whom bypass surgery is the preferred method of revascularisation4), and Holter monitoring of young patients presenting with palpitations and a history indicating ectopic beats (who require only reassurance)5 should all be stopped, according to Professor Timmis. Non-invasive diagnostic tests for patients with a pre-test probability of coronary disease that is above 90% or below 10% should also be discontinued as “this adds little or nothing to diagnostic precision.”

    Cardiology patients tend to be elderly, and Professor Timmis says for patients who were coping …

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