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Compounding existing fractures: sticking plasters only make a bad situation worse

The NHS is always good for a headline on a slow news day.  But even with war, terror, Brexit, US regime change, the death of many much-loved celebrities and more vying for prominence, the NHS can still punch through and make the front pages on a big news day.  And not just once over the past week, but twice – and counting.

Red Cross chief Mike Adamson was first, describing the NHS as engulfed by a humanitarian crisis.  Running an organisation that works out of 20 A&E departments across the country, he took a broad view and based his claim on what he had seen first-hand:  hospitals and ambulance services are in a constant struggle to keep up with demand;  and patients are dying after waits on trolleys in hospital corridors.  Elsewhere, official government data from the Office for National Statistics is unearthed and shows that at least two patients die of starvation or thirst each day while in NHS care.

Health Secretary Jeremy Hunt was moved to respond by way of an emergency statement in the House of Commons, stating that 30% of patients should not be in A&E at all.  This gave us the second wave of headlines, including the Daily Mail’s ‘Broken NHS is YOUR [the patients’] fault’.

The MTG agrees that around 30% of patients should not be using A&E services.  A&E should focus on urgent and emergency care cases.

But we certainly do not agree that it is the patients who are at fault.  The Daily Mirror described Mr Hunt’s statement as ‘an admission of failure’ – the very title of our November 2015 report on unplanned admissions, where we analysed the data, which showed that unplanned (or emergency) hospital admissions account for more than one third (5.4 million) of all hospital admissions and two thirds of all hospital bed days.

Critically, from an organisational standpoint, these patients use a disproportionate amount of resource and money.  Direct costs to the NHS were £11 billion in 2010/11 alone (most recent figures at time of the report).

The truth about unplanned admissions in the NHS back then still holds true today, and the numbers – around one third of patient cases – are consistent.  So what can be done?

The MTG believes that the best way to reduce unplanned admissions down from crisis levels is to fix patients’ underlying health issues.  Medical technologies improve lives, and improve patient compliance with their ongoing treatment regime by increasing their knowledge on their condition and putting them at the centre of their own care plan.  So if the best way to treat a patient is to use medical technology, it has the added bonus of removing them from the A&E equation.  Fewer trips to casualty, less strain on a maxed out service.

For example, peripheral vascular disease is a common condition, which develops slowly over time.  Scheduling a minimally invasive angioplasty to insert a stent under local anaesthetic will use substantially less bed time and other resource than the alternative: recurring trips to A&E because GP surgeries do not have the facility for out-of-hours emergencies, and – especially among the elderly – possible eventual lower limb amputation under full surgical conditions, with subsequent costly physical and mental therapies.  So failure to stent can result in extreme consequences for the patient, as well as NHS budgets.  This cause and effect of medical technology is fundamentally sound.  And the long-term gains far outweigh the short-term investment.

Of course, from a business perspective although the general principle holds true, it is more complex than this.  Up-front investment in medical technology is not always recouped by the people carrying the initial cost.  Investment in acute care settings, such as using innovative new treatments that improve recuperation or require less follow up, will often lead to savings in other parts of the NHS, such as less time in hospital and a reduced requirement for social care services post treatment. Those making the investment in improved technology will not see the budget savings that come further down the line.

So we are long over-due for prescribers and payers to take a broader view and to look beyond their own monthly spend submissions and assess the budgetary impact of a technology against ALL anticipated benefits.

As the 12-week NICE and NHS England consultation on changes to the arrangements for evaluating and funding drugs and other health technologies draws to its conclusion, the MTG is calling for a removal of the current structural disincentive to investment and the introduction of reporting changes that support NHS managers to look beyond the pounds, shillings and pence of acquisition costs and develop a true budget impact model that takes the returned value of investment into account.

Sometimes you have to break something in order to properly fix it.

18.01.17

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