Thursday, 26 November 2015

"Efficiency saving" has undermined the NHS

The government has announced extra money up front to avoid a crisis in the NHS. That much is welcome news. But it comes with a further tranche of 'efficiency savings' of £22 billion. This is on top of the savings of £20 bn over the last five years. But what have been the consequences of these 'savings', and where has the money gone? If savings were made, then why are so many Trusts in financial difficulty?

Last year the House of Commons Health Committee warned that the targets of these savings were 'unsustainable' after hearing evidence from NHS finance directors. The committee also criticised the Government's lack of transparency over how the money saved had been used, raising the issue that the Department of Health handed back billions of unused NHS budget back to the Treasury each year.

It certainly begs the question of why so many Trusts are in deficit when they have made such big efficiency savings.  What is the truth behind these savings?

Efficiency savings conjures up images of making 'cuts in the back room' or improvements in  'back office efficiency'. We are supposed to believe such changes would be improvements and won't affect front line staff or front line services. On the contrary we are supposed to believe these will improve patient care.   It is argued that the front line services could be provided more efficiently and effectively.  But what is the reality?

Let's be clear what efficiency savings really mean. It is about meeting rising health care needs from the same resources.  That means  more operations without adding more operating theatres, surgeons, anaesthetists and nursing staff. 

It also means freeing up beds quicker. 

That is the bottom line of 'efficiency' savings - and it is also one reason why the NHS is in crisis, with bed shortages and increased waiting times, and with NHS Trusts in deficit.

Efficiency savings means freeing up beds through earlier discharge. It is also what has led to the charge of 'bed-blocking' levelled at sick patients. This has had appalling consequences.

As I referred in a previous article, a report by Healthwatch England found that premature discharge from hospital creates a costly 'revolving door' with one million patients readmitted to hospital within 30 days of being discharged. Readmission into A&E costs the NHS a staggering £2.4 bn a year.  This is not 'efficiency' - it is carelessness.

What is rarely told is that the 'bed shortage' is a  result of 'efficiency savings'.  

From the outset of the Quality, Innovation, Productivity and Prevention - (QIPP) the overarching efficiency savings process - 'enhanced recovery' was targeted with the potential to save 200,000 bed days.  The idea was to enhance the patient experience by making a quicker recovery to care.  What it often means is transferring the cost of sick people onto the care budget. 

The Daily Mail provided examples of this cruelest kind of 'efficiency' in a report last year. 

"Sharon Mounter felt a wave of rising panic when the nurse told her that she was being discharged from hospital.

The 35-year-old events organiser from South London still had a fever, and felt so weak and dizzy she could barely sit up in bed. But the nurse insisted in a kind but firm manner that she was well enough to leave, adding: 'We need your bed.'

Sharon had been in hospital for almost a week after being admitted with a high temperature and 'unbearable' joint pain.

Doctors attributed it to a flare-up of her lupus, an autoimmune disease that causes the immune system to attack its own tissues and triggers fatigue, pain and skin rashes."

Sadly this is not an isolated case - and nor was Sharon an elderly 'bed-blocker'. 

A survey by Healthwatch England found that more than half of NHS hospitals do not record whether a patient has a safe home to return to before discharging them.

But what is the real outcome? The outcome is added burdens on families and local authorities with care costs.  Families being given two days notice that their relatives must be moved into care to free up a bed. 

This is why we ended up with NHS Trusts threatening legal action on 'bed-blocking' patients. It was a game of shifting the blame.  We are supposed to believe the bed shortage is the result of 'people living longer'.  This is clearly nonsense - a smoke screen to cover what is really causing the problem. We haven't suddenly started living longer! Yet the 'bed-blocking' problem developed over the course of a year or two.  We need only ask why to realise that it isn't because people are 'living longer'. 

No, it was driven from within the NHS itself. It was part of the 'efficiency savings'. The idea was to get patients into care quicker. But 'care' was the loser as cold calculation took over from compassion. The NHS and the Care 'system' play a game of musical chairs, or perhaps I should say beds, and it is patients and families who suffer the consequence. 

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