Imagine a company that keeps asking its shareholders for more money to modernise its business in order to make it competitive, yet at the same time did not change its working practices, its marketing or how it competed in the economic environment. Eventually the shareholders would say enough is enough and would invest their money in an alternative venture.
Can we use this as an analogy to what is happening with the NHS? I would say yes, except for the fact that we cannot stop funding the NHS as it provides healthcare to our nation, and there is no alternative. However, should we be giving it the extra £20 billion by 2023 as a 70th ‘birthday present’, announced by Prime Minister Theresa May without demanding widespread change.
Although it seems universally accepted that the NHS requires more money, is this actually the case, or is it throwing more money into an inefficient system? Does the NHS actually need more money or does it need to firstly sort itself out?
To see if this is a reasonable viewpoint, we can firstly look at our own sector. Eye health is around 10% of hospital outpatients appointments and yet there is relatively little effort given to moving this work to the community, where much of it can be done more conveniently to the patient, but also more economically. If this is the case in the one small sector we know about, then there will be examples in other clinical areas.
Within the wider NHS, as frequently mentioned in this column, there are around 200 clinical commissioning groups (CCGs) and that means 200 head offices, 200 chief executives and all other functions duplicated 200 times. While one CCG would not be right, 200 is clearly too many and means there are too many individuals repeating the same roles across small areas.
Within the hospital sector we know that an inpatient bed is an expensive commodity, while a bed in the community is cheaper. And yet we continually hear stories that there are patients who are ‘bed blocking’, that is, medically fit to be discharged from hospital, but a community bed is not available. Why are we not moving monies towards public health and social care to reduce demand on the more expensive hospital resources?
Currently relatively little money goes towards prevention of illness and educating members of the public to take better care of themselves, despite the fact that helping people to take responsibility is at the top of most NHS priority lists. This is a consequence of an inefficient system always having to deal with the here and now. Give the funds to public health and social care and we’ll see less demand and fewer issues in the treatment areas of the NHS.
There should be radical reform of the NHS, but there are also hundreds of small ideas that together would eliminate waste. In the primary sector, lost appointments through patients not attending can be as much as 40% in some areas and clearly is a complete waste of resources. Would it be too far to charge patients for failed attendance?
We hear that each part of the NHS has its own procurement function and will buy commodities at hugely varying prices. Can you imagine any national company that would have hundreds of local variations to purchase anything from staplers to thermometers and not exert the advantage of scale. These type of ideas will be icing on the cake but it is radical change that has to happen.
Four billion pounds a year sounds a huge amount of money and yet it is only around 3.5% of the annual NHS £114 billion spend. Would it be possible to make a similar percentage savings through changes as illustrated above and then be able to spend new monies on new innovative treatment, rather than keeping an inefficient system going?
Some of the issues above are being addressed in some fashion, for instance rumour has it that the number of CCGs is expected to reduce in the future, and the Carter review addresses consumables, however, my worry is that none of this will be quick enough and will be in isolated pockets, rather than nationwide.
Rather than throw good money after bad, we should focus on a more efficient system and I am confident this would mean that we have enough to provide an adequate level of care. Increase in monies can then be used to enhance the service provided.