Saturday, September 5, 2015

Invest wisely

Its all very weird. Debate about 7 day NHS has started to walk into Pythonesque territory now. To start with, a 7 day NHS is absolutely what is needed...but somehow we need to get past the belief that the NHS exists only within a hospital. Talk about Safe staffing, talk about 7 day working..the debate is mostly centred around hospitals...which is a bit odd- given that the bulk of NHS is based in the community!
Look at it...Health economists are saying it; Think tanks are saying it...let's forget for a moment what the BMA is saying..(as that provokes various debates about vested interests)...but the message is loud and an era of cash strapped environment, the more cost effective way of doing things is to invest in the community.

Everyone, or at least most importantly, Mr Hunt, seems to have at least agreed that implementing a 7 day service will need significant amount of investment- but as a diabetes specialist, I am baffled. To begin with, I was told there was no money...fair we walked down the road of discussing tough choices, thinking of I am being told, there is money but for ...what is it...elective work? Do you want me to do type 1 clinics on a Saturday? No problem..but unless you uplift my salary or give me another colleague etc, someone else will have to do the weekend rounds I already do. I have yet to have had any patient ask me for that- as they have adhoc slots, emails and phones to use regards their care anyway.

But let's not rehash all the old debates about other stuff appears that we have lost all sense of understanding as to what is actually emergency work. Evidently, me doing clinic on a Saturday will stop a diabetes specialist, let me say this, if you have money to burn..rather than increasing my salary further, how about you use that money to fund education for patients with diabetes, set up a help line, fund education of practice nurses...heck..even do something to prevent type 2 I can assure you THAT would certainly help save admissions, future cardiovascular know..the sort that we all are doing this job for.

Let's be crystal clear- we are struggling for money- and for trusts strapped for cash, more money to do more elective work in present times will be like manna - will it help patients- the health economists say No. Should we use any available money in community care? Mental Health? Think tanks say Yes. Can't really accuse them of vested interests. Let's be serious- there is no extra money- its shifting lines on balance sheets...recently Public Health lost money, remind me how much did the Vanguards get to kickstart the brave new world? To get the money needed for 7/7 working, something else will have to give...will it be mental health? Community services? GP funding? Who knows

However,if this is all about making sure election promises are kept, little else, then please- do carry on. I will happily do some extra clinics on weekends- will it help anyone bar a bit of convenience for a few? No- it won't. We have made a savings of 1.8 million £ over 4 years based on outcomes saved in diabetes patients- NOT by doing more clinics but by providing support for primary care- but heck, are we doing evidence based anything anymore?

We must, absolutely must, think beyond our own silos- and consider we work for the NHS-as a whole- take a step back and see where the money is best used. In a climate of no restrictions, we can and must aspire for everything...otherwise we put resources where it makes the biggest difference for the population. It can't be that difficult..can it?


  1. I agree with Dr Partha Kar that the NHS faces very difficult choices in the next few years. The HSJ is reporting that the share of the total health budget spent on GP services fell again in 2014-15. It's unsurprising therefore that an increasing number of GPs and patients are complaining about the difficulties in accessing NHS primary care services. We are now seeing several newly-established companies offering private online GP services. It does seem that we will be heading for a system where those who can afford to do so will have access to both NHS and private GP services.

  2. Very good point about about reducing the demand with proactive public health.
    I'm not a fan of the 'nanny state' but if the state is paying to pick up the pieces then it deserves to have a say in reducing the cause of its spending.
    After that, if you were commissioning services and you really cared for patient quality but you were told that there was a fixed amount of money you could spend then the only solution would be to ration some services (the public rightly don't want this), consolidate on fewer sites (not popular with the public either but probably the right thing to do) or reduce your cost base(not popular with the doctors and the cause of a lot of this Twitter outrage about the future of the NHS.)
    If your costs are 80% wages then it would be foolish for a government not to look at that area first.
    Medics feel their interests are threatened by the current government (in many respects this is understandable) A negotiation is taking place and we've had many years of money being thrown at us whenever we've shouted 'patient safety'. This money hasn't led to a proportionate increase in productivity, it has mostly 'fed the NHS beast' and led to over-medicalisation of birth,death and everything in-between with everyone's wages inflating.
    In the same period most doctors have willingly abdicated their responsibility for medical leadership and given it to middle tier administrators (mostly ex nurses). We then complain that we have no control anymore over our patients.
    I don't think any large political party wants to dismantle the idea of a taxpayer funded NHS, free at the point of use.
    The difference with this government is that they are trying to run the NHS for the benefit of the patient and the taxpayer rather than the patient and the staff.
    It's not going to be pleasant for the staff but it's arguably the only sustainable direction if we want to keep the NHS.