As GPs across the country grapple with how best to commission care for their users, the King's Fund raised serious concern last week about how groups of GP consortia can be expected to understand the complexities of our nationwide hospital provision.
In a report out earlier this month called Reconfiguring Hospital Services, the King's Fund says that sorting out how to improve the quality of hospital care may well result in closing some hospitals or consolidating what services each hospital offers. They are concerned that the impending abolishment of strategic health authorities, along with Primary Care Trusts, means that there will be no umbrella view of hospital services and stress that, in their opinion, "Market forces alone are unlikely to result in improvements in quality of care for patients in many hospitals, and could result in deterioration in some cases".
A classic case of such complexities is the current Government review of Specialist services which is currently looking into which hospitals in the UK will provide congenital heart surgery for children. It is recommending that such procedures are carried out in just six or seven hospitals in the future which means that of the four current London providers only two will remain.
The reasons for consolidating care aren't just concerned with funding. There is evidence to suggest that the more surgery a surgeon performs the better he becomes at it and, in addition, the larger the hospital the better the survival rates. This isn't rocket science: one of my first ever posts discussed a surgeon's success in terms of Malcolm Gladwell's theory that it takes 10,000 hours of practice to become great at something.
But while there may be a case for reducing such nationwide congenital surgery centres from 11 to 6 or 7, there are unexpected consequences for those patients who don't have congenital heart conditions but also receive treatment at the hospitals under scrutiny.
The Government's review currently favours maintaining congenital heart surgery at Great Ormond Street Hospital and Evelina Children's hospital, which means Brompton Hospital in London would lose its ability to offer this treatment. I was surprised to hear that the Cystic Fibrosis Trust is campaigning against the Brompton hospital losing its congenital heart care. I'm a CF patient at Brompton and I didn't see the connection.
But the CF Trust is worried that if Brompton loses its ability to provide congenital heart care then it will not have the patient base to justify it having a children's intensive care unit and anaesthesia service. Which means that the care available for paedeatric CF patients will be inadequate. This in turn places additional stress on the other three London hospitals that look after CF patients as they would need to find clinic space and bed space for over 300 additional patients that are currently looked after by Brompton.
And for me, an adult CF patient, it makes me worry that there will be a knock-on effect on the care I receive at Brompton as there would no longer be a future patient base of CF children that would grow up to need an adult CF service. Brompton provides world-class care for Cystic Fibrosis patients so surely it can't be intentional that this service is now under threat?
This does all sound complicated, but it is this detailed understanding of the demands on individual hospitals and the ability to foresee the effects of curtailing certain patient services that the Government must retain. The concern is whether GP consortia will be able to get to grips with the reforms that hospitals will require without the quality of care being affected for all the many patient types that use each hospital.
The King's Fund believes that GP consortia will not have the experience or size to implement major service improvements in hospitals and is urging that the Government's new NHS Commissioning Board be given greater powers to strategically plan hospital services. It argues that without these powers the system will gravitate to a 'market forces' model and this will not provide any improvement in the quality of care patients receive. And remember, the Government promises that a key aim behind its proposed overhaul of the NHS is to improve care - it is clear to me that to do this the Government must start looking at the limitations of GP commissioning as well at the advantages.
Tuesday, 8 March 2011
Wednesday, 23 February 2011
NHS reforms: Patient choice may have positive side-effects
Patient choice is a key element behind Lansley's reforms. The idea is that choice will help health services will improve without the need for central management. Patients will "vote with their feet" and only use good services, leaving those NHS providers who aren't good at what they do to either improve or close down.
I'm not too sure what I'd feel if I was one of the poor patients who had to suffer bad treatment before the rest of us all cottoned on and ran screaming from the hospital, but that aside, this idea of patient choice may actual have the knock-on effect of being beneficial for our health.
To help manage my Cystic Fibrosis, I constantly self-monitor my health. Off by heart I know my hospital number, weight to 0.1 of a kg, height, average pulse rate, average oxygen saturation in my blood, and all my lung function stats. I actually know when I'm more ill than my lung function stats would suggest and I get to have a big say in what treatment I have. For example, my hospital constantly tell me to put on weight so I've just asked them to send me a clinical study of the long-term health benefits for CF patients if they are over a BMI of 19.
It may seem weird that I like to know the medical facts and figures behind everything, but the more I understand the importance of my medicine the more likely I am to make the extra effort to take it all - and believe me, there is a lot to take.
So it made me realise that the idea of informed choice behind the NHS reforms might actually improve our individual health as well as the performance of health providers. If we feel actively involved in our own treatment we may be more likely to take our drugs and take note of all the other bits and pieces we can all do to help our treatment work more quickly: eat better, exercise more and sleep regularly.
Moreover, if we feel like we are in control of our treatment it might make us feel more positive about coping while ill and motivate us to get better as soon as possible.
Working out how to get us to self-manage our health better is definitely a shift that the whole of society needs to make. With obesity levels and alcohol abuse on the rise, the whole country needs to recognise that good health starts with us. Any NHS system that advocates public health awareness but simultaneously fails to provide a choice in treatment of specific health-problems is sending out mixed messages to us all.
Patient choice may not prove effective at deciding which companies should provide our NHS care but the drive to provide greater information and choice to patients could be an interesting way to get us to think again about our own responsibility towards our individual health.
I'm not too sure what I'd feel if I was one of the poor patients who had to suffer bad treatment before the rest of us all cottoned on and ran screaming from the hospital, but that aside, this idea of patient choice may actual have the knock-on effect of being beneficial for our health.
To help manage my Cystic Fibrosis, I constantly self-monitor my health. Off by heart I know my hospital number, weight to 0.1 of a kg, height, average pulse rate, average oxygen saturation in my blood, and all my lung function stats. I actually know when I'm more ill than my lung function stats would suggest and I get to have a big say in what treatment I have. For example, my hospital constantly tell me to put on weight so I've just asked them to send me a clinical study of the long-term health benefits for CF patients if they are over a BMI of 19.
It may seem weird that I like to know the medical facts and figures behind everything, but the more I understand the importance of my medicine the more likely I am to make the extra effort to take it all - and believe me, there is a lot to take.
So it made me realise that the idea of informed choice behind the NHS reforms might actually improve our individual health as well as the performance of health providers. If we feel actively involved in our own treatment we may be more likely to take our drugs and take note of all the other bits and pieces we can all do to help our treatment work more quickly: eat better, exercise more and sleep regularly.
Moreover, if we feel like we are in control of our treatment it might make us feel more positive about coping while ill and motivate us to get better as soon as possible.
Working out how to get us to self-manage our health better is definitely a shift that the whole of society needs to make. With obesity levels and alcohol abuse on the rise, the whole country needs to recognise that good health starts with us. Any NHS system that advocates public health awareness but simultaneously fails to provide a choice in treatment of specific health-problems is sending out mixed messages to us all.
Patient choice may not prove effective at deciding which companies should provide our NHS care but the drive to provide greater information and choice to patients could be an interesting way to get us to think again about our own responsibility towards our individual health.
Wednesday, 2 February 2011
Time to rethink the approach to NHS reforms
The first debate of the NHS reforms took place on Monday, and the second reading of the bill was passed with 321 MPs voting for and 235 voting against. It followed six hours of debating.
But while MPs are battling each other in the House of Commons, they are also trying to win over the public to their plans. So wide-reaching are the reforms, it has taken a while for health journalists to fully realise the implications, let alone the general public who have very little understanding of the NHS machinations at work behind their GP surgery.
This week has been full of statistics and surveys aimed at influencing the direction of the debate. While the reforms are focused on giving power to the GPs over the way NHS money is spent, it is the MPs who will decide whether the reforms are happening. So GPs, powerless in the face of empowerment, are using the media to bang on the doors of the Commons. A snapshot survey of the Royal College of General Practitioners, found that of 1,800 responses, 70% disagreed or strongly disagreed that patient outcomes would improve by opening up the NHS to private companies. 50% also felt GP commissioning would not give more power to patients.
And the MPs themselves have resorted to throwing statistics at the press in the hope of making their opinion the dominant story in the papers. Shadow health secretary John Healey claimed that 3 out of every 4 GPs disagreed that NHS reforms would improve patient changes. (The excellent blog Factcheck questioned the veracity of this stat though).
The Tories have hit back at Labour claiming these reforms were begun in part by Blair's Government. I'm currently reading Andrew Rawnsley's brilliant book 'End of the Party' about the last two terms of the Labour Government. He continually highlights Blair's frustration at being unable to make great public service reforms. In a 2002 interview with Rawnsley, Blair said: "We will not maintain public services and the welfare state unless we radically recast them" (pg76). He wanted to introduce choice to the users of the NHS and diversity of providers, hoping the third sector and private companies would tender for contracts. His reforms were watered down due to party opposition, but it is clear that parts of New Labour were of the same mind as the Tories now are.
So the questions is, why can't we all have a sensible conversation about it?
If the parties are both thinking the same thing - that the NHS must change before it starts to fall-apart - then perhaps an honest conversation with the British public is required. In which the case for change is explained and a realistic time-frame is established for such measures. Perhaps the first step is to start on the path to GP commissioning, but in a more balanced, state-managed way rather then the piecemeal free-for-all that is currently being considered. Once commissioning is up and running then the next step might be to consider what benefit, if any, private companies can bring to the NHS.
In contrast, it is clear to me that the current state of affairs in which GPs are fighting to be heard and the public haven't even been asked their opinion will just result in chaos. The BMA today even said a strike over NHS reforms is a possibility.
As plans currently stand reforms could result in a wildly variant health-service - with some GPs succeeding with commissioning while others fail, and private companies taking advantage of the mess to take over services that undermine the viability of NHS hospitals.
The first step of reforms must be to accept that the NHS, which has been developing for 60 years, cannot be recast in just 60 months. And if reforms cannot be implemented before a general election, and a possible change-over of power, perhaps the fate of much-loved British institution is deserving of the parties to come together and work towards strong, effective and safe reforms for the NHS, which override party politics.
MPs that spend less time fighting each other could then spend more time listening to the opinion of those affected: medics, nurses and us, the service user.
But while MPs are battling each other in the House of Commons, they are also trying to win over the public to their plans. So wide-reaching are the reforms, it has taken a while for health journalists to fully realise the implications, let alone the general public who have very little understanding of the NHS machinations at work behind their GP surgery.
This week has been full of statistics and surveys aimed at influencing the direction of the debate. While the reforms are focused on giving power to the GPs over the way NHS money is spent, it is the MPs who will decide whether the reforms are happening. So GPs, powerless in the face of empowerment, are using the media to bang on the doors of the Commons. A snapshot survey of the Royal College of General Practitioners, found that of 1,800 responses, 70% disagreed or strongly disagreed that patient outcomes would improve by opening up the NHS to private companies. 50% also felt GP commissioning would not give more power to patients.
And the MPs themselves have resorted to throwing statistics at the press in the hope of making their opinion the dominant story in the papers. Shadow health secretary John Healey claimed that 3 out of every 4 GPs disagreed that NHS reforms would improve patient changes. (The excellent blog Factcheck questioned the veracity of this stat though).
The Tories have hit back at Labour claiming these reforms were begun in part by Blair's Government. I'm currently reading Andrew Rawnsley's brilliant book 'End of the Party' about the last two terms of the Labour Government. He continually highlights Blair's frustration at being unable to make great public service reforms. In a 2002 interview with Rawnsley, Blair said: "We will not maintain public services and the welfare state unless we radically recast them" (pg76). He wanted to introduce choice to the users of the NHS and diversity of providers, hoping the third sector and private companies would tender for contracts. His reforms were watered down due to party opposition, but it is clear that parts of New Labour were of the same mind as the Tories now are.
So the questions is, why can't we all have a sensible conversation about it?
If the parties are both thinking the same thing - that the NHS must change before it starts to fall-apart - then perhaps an honest conversation with the British public is required. In which the case for change is explained and a realistic time-frame is established for such measures. Perhaps the first step is to start on the path to GP commissioning, but in a more balanced, state-managed way rather then the piecemeal free-for-all that is currently being considered. Once commissioning is up and running then the next step might be to consider what benefit, if any, private companies can bring to the NHS.
In contrast, it is clear to me that the current state of affairs in which GPs are fighting to be heard and the public haven't even been asked their opinion will just result in chaos. The BMA today even said a strike over NHS reforms is a possibility.
As plans currently stand reforms could result in a wildly variant health-service - with some GPs succeeding with commissioning while others fail, and private companies taking advantage of the mess to take over services that undermine the viability of NHS hospitals.
The first step of reforms must be to accept that the NHS, which has been developing for 60 years, cannot be recast in just 60 months. And if reforms cannot be implemented before a general election, and a possible change-over of power, perhaps the fate of much-loved British institution is deserving of the parties to come together and work towards strong, effective and safe reforms for the NHS, which override party politics.
MPs that spend less time fighting each other could then spend more time listening to the opinion of those affected: medics, nurses and us, the service user.
Wednesday, 26 January 2011
Waiting-list Watch - part 1
In June 2010 health secretary Andrew Lansley scrapped NHS waiting list targets. He argued they created too much paper work and he wanted the NHS measured on "patient outcomes' instead of arbitrary targets. Unsurprisingly with the targets gone, waiting lists are now creeping up. Lansley is wrong to think patients will only judge the NHS on outcomes, they will judge it on the whole process from start to finish. How long you wait to see a doctor, receive a diagnosis and start treatment are intrinsic to what patients think about the NHS.
Trade magazine, Pulse, announced today that waiting lists have increased, on average, by a quarter already.
For example:
All statistics are based on the Department of Health data. I'll continue to blog on waiting time targets, as it is my guess they will continue to rise and rise as the NHS struggles to make £20 billion of efficiency savings by 2014 with just a 0.1% annual increase to their budget in the same period.
Lansley may want to remember that NHS patients are also voters. His decision to scrap targets, which at the time received little coverage, may well come back to haunt him in four years time.
Trade magazine, Pulse, announced today that waiting lists have increased, on average, by a quarter already.
For example:
- The proportion of admitted patients who did not receive treatment within 18 weeks has risen by a fifth – from 6.7% to 8% – with 23,826 missing out.
The number of people waiting more than the previous target of six weeks for diagnostic tests rose by more than 90% compared with the same period last year.
All statistics are based on the Department of Health data. I'll continue to blog on waiting time targets, as it is my guess they will continue to rise and rise as the NHS struggles to make £20 billion of efficiency savings by 2014 with just a 0.1% annual increase to their budget in the same period.
Lansley may want to remember that NHS patients are also voters. His decision to scrap targets, which at the time received little coverage, may well come back to haunt him in four years time.
Tuesday, 25 January 2011
Introducing 'Where's the Benefit?' blog
I've just started contributing to a blog which is focused on highlighting cuts and changes to disabled benefits. Here is a link to my first post.
Going forward, I'll post most of my benefit related blogs on Where's the Benefit? and refocus this blog on all issues to do with the NHS, whether that be treatment, funding, reforms of personal experiences.
Going forward, I'll post most of my benefit related blogs on Where's the Benefit? and refocus this blog on all issues to do with the NHS, whether that be treatment, funding, reforms of personal experiences.
Wednesday, 19 January 2011
NHS reform - there is another way
Slowly the public is beginning to understand the massive implications of the NHS white paper the Government released in July last year. With the Health and Social bill published today even the right-wing press, more in tune with the Government's thinking, are nervous about endorsing the plans whole-heartedly. This is a clear indication of how risky the plans are - no one is quite sure the outcome of this massive shake-up, although everyone is agreed that it will be the biggest change faced by the NHS since its creation in 1948.
During their election campaign the Tories promised no more top-down NHS reorganising, and in a bid to justify this policy u-turn David Cameron claimed this week that "we can't afford not to modernise". However, I believe that considerable reforms can still be made without jeopardising the entire structure of the NHS, especially when it is undergoing a period of austerity on a previously unheard scale.
Last year I spoke to Cumbrian GPs for a piece for the Guardian. Cumbria has been slowly devolving commissioning power from Primary Care Trusts to GPs, with GPs responsible for the vast majority of the money since April 2010. And I found that in Cumbria it is working well. GPs have focused on providing local care for their patients. They now treat more patients in their home by developing a network of mobile nurses; they have allowed routine blood tests and minor operations to be done in GP surgeries; they have worked on improving how patients manage long-term illnesses to help cut hospital emergency admissions.
I didn't expect to be so impressed by 'clinician-led' commissioning but I was. It improved patient treatment and it made best use of the budget that was available. The Cumbrian GPs were strong advocates for their patients and when this fervour was combined with budget management it naturally resulted in GPs thinking more wisely about how best to spend their money.
But Cumbria's experience has not yet involved private companies. They are effectively running their businesses as not-for-profit community interest companies. As such the spending decisions were genuinely managed by GPs and not enforced upon them by private companies such as United Health, which a Houslow GP consortium has brought in to manage its patient referrals. In response to concerns raised during the NHS white paper consultation phase, it is very telling that health secretary Andrew Lansley amended his proposals so that the person with overall responsibility for a GP consortium's budget need not be a GP. In fact, a cynic might say that the reason GPs are being forced to take on commissioning so quickly, (in less than half the time Cumbria has spent introducing the change) is so that they will be forced to turn to private companies for help, allowing the Government to make such companies the 'enemy' if its proposals don't work out so well.
Perhaps most crucially Cumbria has not begun to tackle the issue of competition that the Government is so keen to impose on the NHS - it wishes to open up patient care to 'any willing provider'. In fact, from what I saw, there was even less competition in Cumbria because it placed a large focus on improving the care pathways between primary care (GPs) and secondary care (hospitals). For example, GPs are helping to man A&E wards and they are using new computer software to gain an overall view of patient care. This helps them ensure hospital patients are admitted for as long as they need before having their care transferred to their home in the local community. As such, GPs are forging closer relationships with local hospitals, which in my mind precludes competition from private providers. It is working for patients (I spoke to one man who avoided a three month hospital stay by receiving daily intravenous antibiotics in his home from visiting nurses) and it is saving money - the budget for hospital emergency admissions has been cut by 6% in 2009 to reflect its 6% fall in caseloads.
But when I specifically asked one doctor about introducing competition, a doctor who describes himself as "evangelical" about clinician-led commissioning, he agreed it was the aspect of the proposed reforms that he'd be most likely to challenge the Government on. He also commented that now waiting lists have been brought down to 18 weeks or less there is not such need for competition. It is interesting, then, that the Government started talking about introducing competition into the NHS around the same time that it scrapped waiting list targets for hospitals.
Perhaps media confusion surrounds the Coalition's proposals because one half of the reforms that focuses on GP commissioning and seems innovative, and if allowed to evolve over a longer period of time than currently demanded by Lansley (which will allow GPs the time and space to consider options other than enlisting private management companies), may well provide the best bang for the buck in the NHS. But the other half of reforms that focuses on competition is incredibly worrying. The Mirror today highlighted how many Tory donors have direct links with the private healthcare market. The Guardian yesterday spoke about the key clause in the reforms that allows private healthcare companies to undercut market-rate tariffs. This is sheer folly. A giant healthcare company can afford to write off huge losses while waiting for NHS hospitals to go under through lack of funding, before raising its prices once it has won itself a dominant position in the market.
The Health and Social care Bill is released today. Spend some time reading newspaper reports about its content and ask yourself if this is what you want for your NHS. In my opinion, the best way forward is to follow Cumbria's lead. Involve GPs in commissioning, but at a pace that works for them; improve care pathways between primary and secondary care, devolving more treatment to local areas if possible; phase out PCTs, replacing them with GP consortia that have a better understanding of patients and treatment options; maintain Strategic Health Authorities so that GPs are still guided by the state and not private companies who have their shareholders interest at heart.
The NHS white paper released last year was called 'Liberating the NHS' - I can't help but think that what this really means is that the proposals liberate the Government from having to manage the NHS at all.
During their election campaign the Tories promised no more top-down NHS reorganising, and in a bid to justify this policy u-turn David Cameron claimed this week that "we can't afford not to modernise". However, I believe that considerable reforms can still be made without jeopardising the entire structure of the NHS, especially when it is undergoing a period of austerity on a previously unheard scale.
Last year I spoke to Cumbrian GPs for a piece for the Guardian. Cumbria has been slowly devolving commissioning power from Primary Care Trusts to GPs, with GPs responsible for the vast majority of the money since April 2010. And I found that in Cumbria it is working well. GPs have focused on providing local care for their patients. They now treat more patients in their home by developing a network of mobile nurses; they have allowed routine blood tests and minor operations to be done in GP surgeries; they have worked on improving how patients manage long-term illnesses to help cut hospital emergency admissions.
I didn't expect to be so impressed by 'clinician-led' commissioning but I was. It improved patient treatment and it made best use of the budget that was available. The Cumbrian GPs were strong advocates for their patients and when this fervour was combined with budget management it naturally resulted in GPs thinking more wisely about how best to spend their money.
But Cumbria's experience has not yet involved private companies. They are effectively running their businesses as not-for-profit community interest companies. As such the spending decisions were genuinely managed by GPs and not enforced upon them by private companies such as United Health, which a Houslow GP consortium has brought in to manage its patient referrals. In response to concerns raised during the NHS white paper consultation phase, it is very telling that health secretary Andrew Lansley amended his proposals so that the person with overall responsibility for a GP consortium's budget need not be a GP. In fact, a cynic might say that the reason GPs are being forced to take on commissioning so quickly, (in less than half the time Cumbria has spent introducing the change) is so that they will be forced to turn to private companies for help, allowing the Government to make such companies the 'enemy' if its proposals don't work out so well.
Perhaps most crucially Cumbria has not begun to tackle the issue of competition that the Government is so keen to impose on the NHS - it wishes to open up patient care to 'any willing provider'. In fact, from what I saw, there was even less competition in Cumbria because it placed a large focus on improving the care pathways between primary care (GPs) and secondary care (hospitals). For example, GPs are helping to man A&E wards and they are using new computer software to gain an overall view of patient care. This helps them ensure hospital patients are admitted for as long as they need before having their care transferred to their home in the local community. As such, GPs are forging closer relationships with local hospitals, which in my mind precludes competition from private providers. It is working for patients (I spoke to one man who avoided a three month hospital stay by receiving daily intravenous antibiotics in his home from visiting nurses) and it is saving money - the budget for hospital emergency admissions has been cut by 6% in 2009 to reflect its 6% fall in caseloads.
But when I specifically asked one doctor about introducing competition, a doctor who describes himself as "evangelical" about clinician-led commissioning, he agreed it was the aspect of the proposed reforms that he'd be most likely to challenge the Government on. He also commented that now waiting lists have been brought down to 18 weeks or less there is not such need for competition. It is interesting, then, that the Government started talking about introducing competition into the NHS around the same time that it scrapped waiting list targets for hospitals.
Perhaps media confusion surrounds the Coalition's proposals because one half of the reforms that focuses on GP commissioning and seems innovative, and if allowed to evolve over a longer period of time than currently demanded by Lansley (which will allow GPs the time and space to consider options other than enlisting private management companies), may well provide the best bang for the buck in the NHS. But the other half of reforms that focuses on competition is incredibly worrying. The Mirror today highlighted how many Tory donors have direct links with the private healthcare market. The Guardian yesterday spoke about the key clause in the reforms that allows private healthcare companies to undercut market-rate tariffs. This is sheer folly. A giant healthcare company can afford to write off huge losses while waiting for NHS hospitals to go under through lack of funding, before raising its prices once it has won itself a dominant position in the market.
The Health and Social care Bill is released today. Spend some time reading newspaper reports about its content and ask yourself if this is what you want for your NHS. In my opinion, the best way forward is to follow Cumbria's lead. Involve GPs in commissioning, but at a pace that works for them; improve care pathways between primary and secondary care, devolving more treatment to local areas if possible; phase out PCTs, replacing them with GP consortia that have a better understanding of patients and treatment options; maintain Strategic Health Authorities so that GPs are still guided by the state and not private companies who have their shareholders interest at heart.
The NHS white paper released last year was called 'Liberating the NHS' - I can't help but think that what this really means is that the proposals liberate the Government from having to manage the NHS at all.
Thursday, 6 January 2011
Innovative community care can be marvellous - but instead we're going backwards
I'm rather appalled that it's been a month since I last posted. I guess having Cystic Fibrosis, planning for Christmas, New Year, my Mum's birthday and my 30th birthday have all taken their toll. Truth be told I'm shattered and writing this while wrapped in a duvet eating the remains of a Christmas cake.
As interesting as my tiredness is, it does have a point to this blog. I have a small device under my skin through which I can administer intravenous antibiotics when I need them. The device needs flushing every six weeks and I've just got off the phone from the outreach team at Brompton hospital to book in a nurse to come to my home next week to flush it. This means I don't have to trek to hospital and expose myself to bugs on the ward. Instead I can rest, stay in the warmth and try to get myself stronger while still getting the treatment I need.
Outreach nurses are fantastically important to the way ill and disabled people can maintain their independence and cope with their illness without filling up hospital beds unnecessarily.
During research for a Guardian article, I recently spoke to a patient in Cumbria who was over the moon about the treatment he'd received from a team of outreach nurses. 78-year-old Mr Clancy needed a lengthy treatment of intravenous antibiotics that he could not administer himself, to cure a severe, but one-off, infection. The infection was so advanced that he was very weak and felt unable to commute to hospital every day. His local GP arranged for him to have a nurse visit him every morning in his own home for three months. He firmly believes that if it wasn't for this service he would have spent 90 days in hospital. In 2002, the cost of a hospital bed was estimated to be €228 per day. Clearly this figure is out of date and would no doubt be higher almost a decade on, but even using this figure Mr Clancy's three month stay would have cost €20,520, or £17,444. And that figure excludes his actual treatment.
It makes economic sense to improve care in the community as hospital admission is one of the most expensive aspects of the NHS. Local care reduces the risk to patients from costly hospital-based infections, it improves their spirits by ensuring they can get better in their environment surrounded by loved ones and it means that hospitals can focus on treating acutely ill patients.
It is therefore really disappointing to me, as someone who has really benefited from community nurse care, that community care, far from being used to help innovate and improve services, appears to be going backward.
Yesterday's Guardian headline story revealed that, in a survey of over 500 doctors, 50% now feel 'bed-blocking' is worse than this time last year, while 40% feel it hasn't improved. Bed-blocking is a term used for patients who are well enough to leave hospital but can't be discharged as there is not sufficient community support to continue their care at home. Often this isn't even innovative support, such as having traditionally hospital-based treatment administered at home, but is basic adult social services support, such as help with personal hygiene and cooking. Just two stories around this week show that Hull council is looking to scrap its adult residential care entirely and Kingston in Surrey is planning to put up the cost to recipients of its adult social care.
The Government has given the NHS a budget rise of 0.1% a year in order to honour its commitment to the electorate of protecting the NHS budget. But simultaneously local councils are facing cuts of up to 8.9% to their budgets. Consequently many, as the examples above show, are looking to their care bill to see where savings can be made. Cutting local social care will directly impact how much the NHS has to spend on each hospital patient. On top of this the NHS is being forced to find £20 billion of efficiency savings by 2014. I can't see how it can even begin to achieve this if hospitals find it increasingly difficult to discharge patients into local care because of cuts to council budgets.
I've first hand experience of the great things that can be achieved if there is greater care in the community, so it's such a disappointment to see that even the basics of community care are now under threat. The Government will not make any NHS efficiency savings whatsoever if it doesn't start to hear the alarm bells ringing up and down the country around the issue of local social services.
As interesting as my tiredness is, it does have a point to this blog. I have a small device under my skin through which I can administer intravenous antibiotics when I need them. The device needs flushing every six weeks and I've just got off the phone from the outreach team at Brompton hospital to book in a nurse to come to my home next week to flush it. This means I don't have to trek to hospital and expose myself to bugs on the ward. Instead I can rest, stay in the warmth and try to get myself stronger while still getting the treatment I need.
Outreach nurses are fantastically important to the way ill and disabled people can maintain their independence and cope with their illness without filling up hospital beds unnecessarily.
During research for a Guardian article, I recently spoke to a patient in Cumbria who was over the moon about the treatment he'd received from a team of outreach nurses. 78-year-old Mr Clancy needed a lengthy treatment of intravenous antibiotics that he could not administer himself, to cure a severe, but one-off, infection. The infection was so advanced that he was very weak and felt unable to commute to hospital every day. His local GP arranged for him to have a nurse visit him every morning in his own home for three months. He firmly believes that if it wasn't for this service he would have spent 90 days in hospital. In 2002, the cost of a hospital bed was estimated to be €228 per day. Clearly this figure is out of date and would no doubt be higher almost a decade on, but even using this figure Mr Clancy's three month stay would have cost €20,520, or £17,444. And that figure excludes his actual treatment.
It makes economic sense to improve care in the community as hospital admission is one of the most expensive aspects of the NHS. Local care reduces the risk to patients from costly hospital-based infections, it improves their spirits by ensuring they can get better in their environment surrounded by loved ones and it means that hospitals can focus on treating acutely ill patients.
It is therefore really disappointing to me, as someone who has really benefited from community nurse care, that community care, far from being used to help innovate and improve services, appears to be going backward.
Yesterday's Guardian headline story revealed that, in a survey of over 500 doctors, 50% now feel 'bed-blocking' is worse than this time last year, while 40% feel it hasn't improved. Bed-blocking is a term used for patients who are well enough to leave hospital but can't be discharged as there is not sufficient community support to continue their care at home. Often this isn't even innovative support, such as having traditionally hospital-based treatment administered at home, but is basic adult social services support, such as help with personal hygiene and cooking. Just two stories around this week show that Hull council is looking to scrap its adult residential care entirely and Kingston in Surrey is planning to put up the cost to recipients of its adult social care.
The Government has given the NHS a budget rise of 0.1% a year in order to honour its commitment to the electorate of protecting the NHS budget. But simultaneously local councils are facing cuts of up to 8.9% to their budgets. Consequently many, as the examples above show, are looking to their care bill to see where savings can be made. Cutting local social care will directly impact how much the NHS has to spend on each hospital patient. On top of this the NHS is being forced to find £20 billion of efficiency savings by 2014. I can't see how it can even begin to achieve this if hospitals find it increasingly difficult to discharge patients into local care because of cuts to council budgets.
I've first hand experience of the great things that can be achieved if there is greater care in the community, so it's such a disappointment to see that even the basics of community care are now under threat. The Government will not make any NHS efficiency savings whatsoever if it doesn't start to hear the alarm bells ringing up and down the country around the issue of local social services.
Subscribe to:
Posts (Atom)