Better use must be made of medicine in hospitals

The NHS in Scotland could improve the management of medicines in hospitals to make sure patients are getting the most benefit from the money spent in this area. These are the conclusions of a new study, A Scottish prescription: managing the use of medicines in hospitals, published today by the Auditor General.

‘New medicines are continually being developed to treat more conditions and achieve better results for patients,’ said Deputy Auditor General Caroline Gardner. ‘However, spending on medicines is rising faster than NHS spending overall. NHS boards need to manage this by improving planning and budget setting and promoting cost effective prescribing.

‘In addition, all staff prescribing medicines must have access to current, reliable information and expert advice to make the best use of medicines. This is particularly important as increasing numbers of new medicines and increasingly complex medicines become available.’

Recent years have seen an increase in the number and complexity of medicines available to treat patients and in the types of staff who can prescribe them. While overall hospital running costs increased by 32% in the four years to 2003/2004, expenditure on drugs increased by 56% over the same period. The average spend on medicines per patient in an acute hospital has risen by 65% since 2001/02.

The report identified several areas where improvements could be made, including:

• Improved data on the anticipated costs and benefits of new medicines and of recommended changes in the use of medicines. This would help planning and budget setting at management level. Evaluations of new medicines and recommended changes in how medicines are used should include an analysis of the total budget impact.
• Better information on how medicines are used in hospitals to help them monitor whether patients are getting the most appropriate medicines. A national hospital electronic prescribing and medicines system (HEPMA) would help to address this. The Scottish Executive Health Department (SEHD) should develop a clear project plan with targets and dates for setting up a HEPMA system.
• Developing guidance for staff on the use of medicines and monitoring how well this guidance is followed. Not all hospitals have a broad range of guidance that staff need. Many do not have education and training programmes to raise awareness or promote the use of their guidance.
• Ensuring there is sufficiently qualified pharmacy staff to meet future needs. While the role of the pharmacist is developing and two-thirds of hospitals currently have clinical pharmacists working on wards, there is a shortage of qualified staff. SEHD should improve workforce planning for pharmacists and pharmacy technicians.

‘Good progress has already been made by a number of NHS boards, particularly in providing staff with guidance and advice on prescribing the most appropriate medicines,’ said Ms Gardner. ‘Our recommendations are aimed at helping all the organisations involved in health service planning and patient care to make best use of medicines and maximise their benefits.’