Skip to main content

"Efficiency saving" has undermined the NHS

The government has announced extra money upfront 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 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 backroom' 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 think 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 cruellest 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 the 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 smokescreen to cover what is really causing the problem. We haven't suddenly started living longer! Yet the 'bed-blocking' problem developed over 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. 

Comments

Popular posts from this blog

Ian Duncan-Smith says he wants to make those on benefits 'better people'!

By any account, the government's austerity strategy is utilitarian. It justifies its approach by the presumed potential ends. It's objective is to cut the deficit, but it has also adopted another objective which is specifically targeted. It seeks to drive people off benefits and 'back to work'.  The two together are toxic to the poorest in society. Those least able to cope are the most affected by the cuts in benefits and the loss of services. It is the coupling of these two strategic aims that make their policies ethically questionable. For, by combining the two, slashing the value of benefits to make budget savings while also changing the benefits system, the highest burden falls on a specific group, those dependent on benefits. For the greater good of the majority, a minority group, those on benefits, are being sacrificed; sacrificed on the altar of austerity. And they are being sacrificed in part so that others may be spared. Utilitarian ethics considers the ba...

Ethical considerations of a National DNA database.

Plans for a national DNA database   will be revealed by the Prime Minister this week. This is the same proposal the Tories and Liberal Democrats opposed when presented by the Blair government because they argued it posed  a threat to civil liberties. This time it is expected to offer an 'opt-out' clause for those who do not wish their data to be stored; exactly how this would operate isn't yet clear. But does it matter and does it really pose a threat to civil liberties? When it comes to biology and ethics we tend to have a distorted view of DNA and genetics. This is for two reasons. The first is that it is thought that our genome somehow represents the individual as a code that then gets translated. This is biologically speaking wrong. DNA is a template and part of the machinery for making proteins. It isn't a code in anything like the sense of being a 'blueprint' or 'book of life'.  Although these metaphors are used often they are just that, metapho...

The unethical language of 'welfare dependency'

It is unethical to stigmatise people without foundation. Creating a stereotype, a generalised brand, in order to  demonize a group regardless of the individual and without regard for the potential harm it may do is unfair and prejudicial. It is one reason, and a major one, why racism is unethical; it fails to give a fair consideration of interest to a group of people simply because they are branded in this way. They are not worthy of equal consideration because they are different.  It seeks also to influence the attitudes of others to those stereotyped. If I said 'the Irish are lazy'; you would rightly respond that this is a ridiculous and unfounded stereotype. It brands all Irish on the basis of a prejudice. It is harmful certainly; but it is worse if I intend it to be harmful. If I intend to influence the attitude of others. And so it is with 'the unemployed'. All I need do is substitute 'work-shy' and use it in an injudicious way; to imply that it applies to...