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Using a calculator to deliver patient care just doesn’t add up

In June we wrote about the widespread recognition that medical technology offers genuine potential to provide value for money to the NHS and taxpayers, and offer improved healthcare to patients.

The basic steps in our virtuous cycle go:

  • Budgets are becoming ever-increasingly tight
  • Healthcare providers must cut their cloth accordingly – and must identify and make major efficiency improvements
  • Front-ended investment can minimise medium-to-long-term costs to the NHS, allowing for a change in approach from short-term cost reduction to sustainable cost-effectiveness over the longer-term
  • Better information about medical technologies and the appropriate use of these technologies will deliver better patient outcomes – reducing recovery rates and the need for subsequent costly medical interventions

As we noted in our report Innovation, Health & Wealth – A Scorecard, tackling key issues is patchy and inconsistent across 90 per cent of CCGs(1). As for the other 10 per cent – it can be presumed from their silence that they too were patchy in what they were delivering.

And now the Patients’ Association is reporting that this ‘postcode lottery’ means that patients for seven key elective surgical procedures such as hip replacements and cataracts(2), will have to face an average waiting time of over 90 days, more often than not breaching the NHS Constitution’s 18 week wait limit between referral and receiving surgery.

This does seem to suggest that the situation has worsened since Medical Technology Group reported in November 2013 that there was at that time a dramatic variation in waiting times across England for hip and knee treatments, with financial calendars for Trusts driving outcomes for patients. So as the financial year ends on 31st March, March is the busiest month for operations as managers ‘use or lose’ unspent money. April, by contrast, has 11 per cent fewer operations as new budgets are applied and managers project (and protect) their spend over the coming 12 months.

For true and lasting change to happen to the NHS, this short-termism has to be addressed. Yes, budgets exist for a reason, and are a good and necessary thing. But this management by spreadsheet is like a culturally endemic virus, tainting everything it touches.

We agree with the Patients’ Association that delayed operations seriously impact a patient’s independence, mobility, ability to work and socialise, and protracts pain or suffering. Timely surgical interventions, conversely, remove pain and restore mobility and the ability to work – a large minority of women (31 per cent) and men (42 per cent) undergoing hip or knee replacements are of working age.

Timely surgical intervention produces better outcomes for patients, the NHS and consequent spend on welfare and benefits – reducing patients’ cost demands on the NHS as services are used for a shorter period, as well as reducing the cost to welfare as patients are likely to return to work more quickly. Delays in surgery, on the other hand, produce worse economic outcomes and can have an additional negative impact on family life and psychological wellbeing. These add further strains on the public purse.

And so we can see that the virtuous cycle applies here too. Any delay in intervention leads to worse patient outcomes, and the knock-on, negative ripple effect of that. In unison with the Patients’ Association, we are calling on commissioners, policy makers and politicians to take radical steps to improve the speed of NHS provision as a matter of urgency. This may be a real challenge, but that is neither a reason to not try nor an excuse to fail. Patients invest up-front through their taxes for this service; it is not unreasonable of them to want their medical needs come first.

  • A Freedom of Information request was sent to 211 CCGs across England in October 2014; 189 responded.
  • The seven key elective surgeries are: hip replacement, knee replacement, operations on hernias, adenoids, gallstones, cataracts and tonsillectomies.
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