Improve NHS efficiency and cut waste
Reform UK · what the evidence says
An independent, source-checked look at Reform UK’s policy “Improve NHS efficiency and cut waste” — what it would actually do across the things that affect your life. Every claim below quotes the source behind it. How this works.
Public finances & the next generation — Genuinely contested
n/a · low confidence
This package of NHS efficiency measures could save some public money on procurement and missed appointments, but the net fiscal effect is genuinely unclear: weekend theatre expansion requires costly extra staffing, and the IFS says Reform UK's NHS cost-saving measures would likely save less than estimated. Without independent costings of the whole package, the bill to or saving for the public finances cannot be pinned down.
The evidence
- The policy proposes negotiating better procurement prices, reviewing PFI contracts, charging missed-appointment non-attenders, and abolishing the NHS Race and Health Observatory as efficiency measures. — reformparty.uk (manifesto) — “negotiating better procurement prices, reviewing Private Finance Contracts, charging those who fail to attend appointments without notice, and abolishing the NHS Race and Health Observatory”
- NHS trusts spent over £3 billion outside NHS Supply Chain in 2022-23, suggesting real procurement savings are available. — nao.org.uk (institutional) — “Trusts spent over £3 billion outside NHS Supply Chain, the dedicated procurement route, in 2022-23”
- There is significant price variation: individual trusts paid up to £490 for a hip replacement stem versus £258 through NHS Supply Chain. — nao.org.uk (institutional) — “for a hip replacement stem, individual trusts paid up to £490, with a median price of £333, while NHS Supply Chain's price for the same product was £258”
- PFI financing costs added substantially to capital costs for NHS schemes, according to some studies. — vertexaisearch.cloud.google.com (media) — “some studies finding these costs added an average of 39% to total capital costs for NHS PFI schemes”
- Missed hospital appointments are estimated to cost the NHS £165 each, amounting to around £1.2 billion annually. — deep-medical.ai (media) — “Missed hospital appointments are estimated to cost the NHS £165 each, amounting to around £1.2 billion annually”
- Expanding weekend theatre capacity requires additional staffing costs; experts say motivated staff need appropriate remuneration and the involvement of entire teams including theatre practitioners and porters. — bmj.com (media) — “expanding weekend operating capacity requires motivated staff with appropriate remuneration and incentives, and the involvement of the entire team, including theatre practitioners, radiographers, and porters”
- Charging for missed appointments may shift costs to emergency services rather than eliminate waste. — vertexaisearch.cloud.google.com (media) — “Charging could also lead to patients delaying seeking care until conditions become more serious and costly, or diverting costs to other parts of the system, such as emergency care”
- The IFS has noted that Reform UK's NHS cost-saving measures would likely save less than estimated. — ifs.org.uk (institutional) — “some proposed cost-saving measures would likely save less than estimated”
Biggest unknown: Whether the staffing and implementation costs of weekend theatre expansion and rota reform exceed the savings from procurement, missed-appointment charges, and PFI reviews — no independent costing of the package as a whole is available.
Our reading: Several components of this policy point toward fiscal savings: the NAO has documented real procurement inefficiencies (trusts paying up to 90% more than NHS Supply Chain prices), PFI contracts impose costly obligations that a review could reduce, and missed hospital appointments represent around £1.2 billion in annual waste. These are genuine fiscal levers. However, the counterweights are also significant. Weekend theatre expansion requires higher-paid weekend staffing across entire clinical teams — not just surgeons — and BMJ evidence is clear that remuneration and whole-team involvement are prerequisites. Without a costed staffing model, this component could be a net fiscal cost rather than a saving. The missed-appointment charging proposal faces administrative overhead costs and, on international evidence, may shift costs to more expensive emergency pathways rather than eliminate them. The IFS — the most relevant independent fiscal monitor in the evidence set — explicitly judged that Reform UK's NHS savings measures would deliver less than claimed. No independent end-to-end costing of the package exists in the evidence provided. The procurement and PFI components have credible savings potential, but whether they outweigh the costs of the operational changes cannot be established from the evidence available. This is a genuine crux: the answer turns on a parameter (net staffing cost of weekend expansion) that is unquantified in any provided source.
Healthcare — Mixed picture
moderate · moderate confidence
This policy bundles several efficiency measures — some with genuine potential to cut waiting times — alongside others that could harm access for vulnerable people or carry safety risks. The net effect on patients depends heavily on implementation detail and whether funding follows the reforms.
The evidence
- The policy proposes opening operating theatres on weekends to reduce waiting times. — reformparty.uk (manifesto) — “opening operating theatres on weekends”
- One Shropshire trust improved Saturday theatre efficiency and saw income increase up to 20% by performing extra cases that couldn't be done during weekdays. — hsj.co.uk (media) — “saw an income increase of up to 20% by performing extra cases that couldn't be done during weekdays due to full capacity”
- Research on over 4 million elective procedures found the risk of death was 82% higher if operated on over the weekend. — hsj.co.uk (media) — “the risk of death was 44% higher if a patient was operated on a Friday and 82% higher if operated on over the weekend”
- This higher risk was observed even when weekend patients were healthier and had less complex procedures. — hsj.co.uk (media) — “This higher risk was observed despite patients often having better preoperative health and less complex procedures”
- Expanding weekend operating capacity requires motivated staff with appropriate remuneration and incentives, and the involvement of the entire team. — bmj.com (media) — “expanding weekend operating capacity requires motivated staff with appropriate remuneration and incentives, and the involvement of the entire team, including theatre practitioners, radiographers, and porters”
- Without considering all staff groups' requirements, planned elective weekend theatre work might not proceed. — bmj.com (media) — “Without considering the requirements of all staff groups, planned elective theatre work might not proceed”
- Sharing already scarce resources at weekends could adversely affect emergency patient outcomes. — publishing.rcseng.ac.uk (academic) — “sharing already scarce resources at weekends could adversely affect emergency patient outcomes”
- The policy proposes planning rotas further in advance to improve efficiency. — reformparty.uk (manifesto) — “planning rotas further in advance”
- NHS organisations often struggle with staffing challenges due to outdated rota systems, leading to wasted hours, last-minute changes, and high agency spending. — jms-one.uk (media) — “Current NHS organisations often struggle with staffing challenges due to outdated rota systems, including reliance on spreadsheets, leading to wasted hours on manual planning, last-minute changes, and high agency spendin…”
- Advanced digital scheduling has shown benefits in reducing administrative workload and supporting staff wellbeing, retention, and performance. — hartree.stfc.ac.uk (academic) — “have shown benefits in reducing administrative workload for clinicians and providing more predictable patterns, supporting staff wellbeing, retention, and performance”
- The policy proposes negotiating better procurement prices. — reformparty.uk (manifesto) — “negotiating better procurement prices”
- The NAO reported the NHS is not fully utilising its spending power to save money on medical equipment and consumables. — nao.org.uk (institutional) — “the NHS is not fully utilising its spending power to save money on medical equipment and consumables”
- Trusts spent over £3 billion outside NHS Supply Chain in 2022-23, missing potential savings. — nao.org.uk (institutional) — “Trusts spent over £3 billion outside NHS Supply Chain, the dedicated procurement route, in 2022-23”
- For a hip replacement stem, individual trusts paid up to £490 versus NHS Supply Chain's price of £258, illustrating significant variation. — nao.org.uk (institutional) — “for a hip replacement stem, individual trusts paid up to £490, with a median price of £333, while NHS Supply Chain's price for the same product was £258”
- The policy proposes reviewing Private Finance Contracts. — reformparty.uk (manifesto) — “reviewing Private Finance Contracts”
- PFI companies recorded £1.9 billion in pre-tax profits between 2004 and 2021, paying out £1.07 billion in dividends. — chpi.org.uk (media) — “99 NHS PFI companies recording £1.9 billion in pre-tax profits between 2004 and 2021, and paying out £1.07 billion in dividends to shareholders”
- PFI financing costs added an average of 39% to total capital costs for NHS PFI schemes. — vertexaisearch.cloud.google.com (media) — “these costs added an average of 39% to total capital costs for NHS PFI schemes”
- The policy proposes charging patients who fail to attend appointments without notice. — reformparty.uk (manifesto) — “charging those who fail to attend appointments without notice”
- Missed hospital appointments are estimated to cost the NHS £165 each, around £1.2 billion annually. — deep-medical.ai (media) — “Missed hospital appointments are estimated to cost the NHS £165 each, amounting to around £1.2 billion annually”
- Flat-rate user fees could create a financial barrier for low-income groups, potentially increasing health inequalities. — vertexaisearch.cloud.google.com (media) — “flat-rate user fees could create a financial barrier for low-income groups, potentially increasing health inequalities”
- In Ireland, primary care user fees made low and middle-income individuals five times more likely to forgo appointments than wealthier patients. — vertexaisearch.cloud.google.com (media) — “after implementing primary care user fees, low and middle-income individuals were five times more likely to forgo appointments than wealthier patients”
- Charging could lead to patients delaying care until conditions become more serious, diverting costs to emergency care. — vertexaisearch.cloud.google.com (media) — “Charging could also lead to patients delaying seeking care until conditions become more serious and costly, or diverting costs to other parts of the system, such as emergency care”
- Missed appointments often stem from social, economic and communication barriers rather than deliberate intent. — patientclaimline.com (media) — “missed appointments often stem from social, economic, and communication barriers, rather than deliberate intent, and penalising vulnerable groups could be problematic”
- The policy proposes abolishing the NHS Race and Health Observatory. — reformparty.uk (manifesto) — “abolishing the NHS Race and Health Observatory”
- The Observatory was established to identify and tackle ethnic inequities in health and care, facilitate research, and make policy recommendations. — nhsrho.org (media) — “The Observatory was established by NHS England in April 2021 to identify and tackle ethnic inequities in health and care, facilitate research, make policy recommendations, and drive transformational change”
- Abolishing the Observatory could be seen as a step back in addressing institutional racism, which experts acknowledge negatively impacts health outcomes for ethnic minority people. — committees.parliament.uk (government) — “This could be seen as a step back in addressing institutional racism within the health and care system, which experts acknowledge exists and negatively impacts health outcomes for ethnic minority people”
- NHS productivity is 5-11% lower than it was in 2019/20, underscoring the challenge of achieving significant efficiency gains. — commonslibrary.parliament.uk (government) — “NHS productivity is 5-11% lower now than it was in 2019/20, underscoring the challenge of achieving significant efficiency gains”
- The IFS suggests Reform UK's healthcare spending pledges would not be nearly enough to meet ambitious commitments like eliminating waiting lists within two years. — youtube.com (media) — “the IFS suggests this would not be nearly enough to meet ambitious commitments like eliminating waiting lists within two years, a feat not achieved in NHS history”
Biggest unknown: Whether weekend theatre expansion can be staffed safely and affordably, and whether missed-appointment charges deter necessary care from low-income patients more than they recover costs.
Our reading: This policy bundles six distinct interventions with genuinely varied evidence bases. On the positive side: procurement reform has clear, measurable headroom — the NAO confirms the NHS is leaving significant savings on the table, with price variation on single items like hip stems showing gaps of hundreds of pounds. Better rotas have good evidence for improving staff morale and retention, which feeds into capacity. PFI review addresses contracts that demonstrably divert clinical resource to financial obligations. Weekend theatre expansion has at least one positive real-world case. On the negative side: weekend surgery carries a documented and substantial mortality risk signal (82% higher weekend risk), and experts are clear that safe expansion requires whole-team staffing and pay incentives not mentioned in the policy. Missed-appointment charging is the most contested element — the international evidence (Ireland) suggests it reduces access among lower-income groups more than it deters casual no-shows, and experts link no-shows to structural barriers, not personal choice; this risks worsening access inequalities without meaningfully reducing demand. Abolishing the NHS Race and Health Observatory removes a body whose work targets documented disparities in maternity, mental health and COVID outcomes — its closure would likely worsen health equity without saving substantial sums. The IFS cautions that the broader spending envelope behind these plans is insufficient to achieve stated goals. On balance, the procurement, rota and PFI elements are plausible efficiency gains; the weekend theatre and no-show charging elements carry real access and safety risks; and the Observatory abolition worsens equity. The net effect is mixed — meaningful potential upside on efficiency, real downside risk on access and equity.
Equal treatment & democratic rights — Hurts
minor · moderate confidence
Abolishing the NHS Race and Health Observatory removes a dedicated body tackling ethnic health inequalities, and charging for missed appointments risks creating new barriers that fall hardest on disadvantaged groups. Neither effect is enormous, but both point in the same direction for equal treatment.
The evidence
- The policy would abolish the NHS Race and Health Observatory. — reformparty.uk (manifesto) — “abolishing the NHS Race and Health Observatory”
- The Observatory was established to identify and tackle ethnic inequities in health and care, facilitate research, make policy recommendations, and drive transformational change. — nhsrho.org (media) — “The Observatory was established by NHS England in April 2021 to identify and tackle ethnic inequities in health and care, facilitate research, make policy recommendations, and drive transformational change”
- The Observatory's work focuses on providing evidence-based recommendations to improve health outcomes and combat discriminatory practices. — pmc.ncbi.nlm.nih.gov (government) — “Its work focuses on providing evidence-based recommendations to improve health outcomes and combat discriminatory practices”
- Abolishing the Observatory could be seen as a step back in addressing institutional racism within health and care, which experts acknowledge exists and negatively impacts ethnic minority health outcomes. — committees.parliament.uk (government) — “This could be seen as a step back in addressing institutional racism within the health and care system, which experts acknowledge exists and negatively impacts health outcomes for ethnic minority people”
- The policy would charge patients who fail to attend appointments without notice. — reformparty.uk (manifesto) — “charging those who fail to attend appointments without notice”
- Flat-rate user fees for missed appointments could create financial barriers for low-income groups, potentially increasing health inequalities. — vertexaisearch.cloud.google.com (media) — “flat-rate user fees could create a financial barrier for low-income groups, potentially increasing health inequalities”
- Evidence from Ireland shows that after implementing primary care user fees, low and middle-income individuals were five times more likely to forgo appointments than wealthier patients. — vertexaisearch.cloud.google.com (media) — “In Ireland, after implementing primary care user fees, low and middle-income individuals were five times more likely to forgo appointments than wealthier patients”
- Missed appointments often stem from social, economic, and communication barriers rather than deliberate intent, meaning charges could penalise vulnerable groups. — patientclaimline.com (media) — “missed appointments often stem from social, economic, and communication barriers, rather than deliberate intent, and penalising vulnerable groups could be problematic”
Biggest unknown: Whether alternative NHS structures would absorb the Observatory's anti-discrimination and policy-recommendation work, and whether missed-appointment charges would include meaningful exemptions for vulnerable groups.
Our reading: Two elements of this policy touch O9 directly. First, and most significantly, abolishing the NHS Race and Health Observatory removes a body whose explicit mandate is to identify and address ethnic health inequities and combat discriminatory practices within health and care. The Observatory has contributed to government policy on maternity, mental health, sickle cell disease, and the COVID-19 inquiry — all areas where ethnic minority groups face documented disparate outcomes. Removing this institutional mechanism does not eliminate ethnic health inequities; it removes dedicated scrutiny and policy pressure to address them. Experts characterise this as a step backward on institutional racism. Second, charging for missed appointments introduces a financial penalty that the evidence suggests will fall disproportionately on lower-income and more vulnerable patients. The Irish experience — where low-and middle-income patients were five times more likely to forgo care after user fees were introduced — is the strongest available comparator and points clearly toward regressive differential treatment. The missed-appointment charges do not in themselves constitute a formal anti-discrimination violation, but they predictably worsen equal access by income group, which is an O9 concern. The other elements of the policy (theatre hours, rotas, procurement, PFI review) are efficiency levers with no plausible O9 effect and are excluded from this verdict. The combined direction is a modest worsening: real but not catastrophic, because the Observatory was advisory rather than regulatory, and because the charging proposal's final design (exemptions, thresholds) is unstated. Confidence is moderate because the Observatory's counterfactual impact is hard to quantify and the charging policy lacks implementation detail.