The calculation shows that only 34% of healthcare delivery produces real value. Nearly 66% is wasted on unnecessary variation. I should emphasise that Brent James believes his figures are conservative! For example, the source of waste he calls “Inappropriate care” relates to care given where none is required. Surely that never happens in the NHS, right? Wrong. Outpatient appointments is a good example. All the evidence shows that nearly half of all outpatient appointments deliver no clinical benefit to patients and are unnecessary. To show the impact of this waste in C&IoS I have added the C&IoS healthcare budget in the last column of the waste calculation. Brent James waste calculation shows that currently only £404 million of the original £1.2 billion budget is delivering real value. Just suppose I had piped up yesterday, “Excuse me, but the STP projected savings are piffling, there is a possible £800 million to save from the budget not just £50 million”. I would have been buried under a hail of abuse. But is it really that unfeasible? Remember Brent James is not some wet behind the ears business consultant, out of touch with the reality of running a large healthcare system. He lives and breathes these issues every day and is cutting waste of the Intermountain system and saving lives every year. He believes that nearly two thirds of healthcare delivery is wasted. I would be intrigued to see the volume of results we would get if we asked every NHS employee to record for a month, examples of variation in delivery they witnessed.