I took my kids to the café we often go to on a Saturday morning after their swimming lessons for a bacon roll and a coffee this weekend (the kids didn’t have coffee)
I read the front page of The Times for the first time in a long time and it described how the head of the NHS has now decided to come clean on the fact that we either choose good emergency and cancer care or reduce waiting times but we can’t have both. This is a political bombshell obviously and one that’s not supported by the main political parties because they want to promise us everything.
The want to promise us good routine care where people don’t have to wait for anything and exceptional emergency and cancer care but unfortunately nobody wants to pay for it and certainly nobody wants to promise to pay for it.
And so I recounted the conversation with my great friend Carl Dunstan, who will almost certainly read this (Hi Carl! Remember the chat at the Colts?), where he had met some really powerful people along the way in his job in the quest to provide exceptional physiotherapy for everybody in the UK through a different model, less expensive than the NHS currently provides but to a wider audience. It will work in the private sector too and there are companies coming in from outside the UK hell bent on changing the system for the better of the patients and for the better of the country’s wallet.
But i’m sorry to sound like a cynic; I don’t think it will work.
The reason is this… I tried it already. On two separate occasions I have been responsible for taking minor oral surgery out of district general hospitals into primary care. On both occasions we managed to reduce the hospital cost by over 66% and were able to provide metrics how good the quality of care we were providing was.
In the second site, which was Refine Specialist Dental Care in Alfreton when I was involved in that practice, we (I) created a set of key performance indicators for the Primary Care Trust, the like of which they’d never seen before. These were presented as a Keynote presentation on a monthly basis to show our referrals, procedures carried out, complications, prescriptions given etc. The service was great- it saved a fortune and allowed the Primary Care Trust (CCG) or whatever they’re now called to provide 3 x the care for the same amount of money or a third of the care for the same amount of money, depending on how you looked at it.
Due to political pressures the commissioners decided to go for the latter and the same amount of care was provided for a third of the money with the rest of the money presumably recycled into somewhere else or, in fact, totally not available. But here is the rub… the service was so successful that on renegotiation of the contract they wanted another 50% cut in the cost from the new agreed level! This is a political imperative – we’re in a situation where we have to save money and money has to be saved absolutely everywhere and the removal of third molars is clearly not as important as children’s cancer.
The new models of innovative healthcare will only work in a system where there is money or where people are prepared to pay and in the UK it simply is not the case, not in the same way it is accepted in other cultures around Europe. I know this from conversations I’ve had while learning various skills in Europe and speaking to other healthcare providers.
In the UK we are fat and we are rich and we have plenty of money as a society, we just choose to spend it on other things apart from healthcare. There is a culture that expects the NHS to fix us when we’re broken regardless of the cost and regardless of the evidence. People are outraged when a patient is not given the chance for a hugely expensive, experimental drug, which may not work or is poorly proven to be effective because they have a disease. We cannot provide healthcare like this. We must learn to pay for evidence-based healthcare.
At the moment one of my major tasks is working up a case to present at the digital symposium in London, surgery which is videoed and the whole diagnostic process outlined to demonstrate to hundreds of people at a symposium. In an ideal world every single case would be done like this, it would be worked up to this detail with every consideration looked at, every box ticked, every ‘t’ crossed and ‘i’ dotted but somewhere along the line we reduced down the quality to make it less expensive and somewhere in the middle we have to strike a balance. The problem is, whose version of balance do we strike?
For me it’s become hard to say “I’m happy to do that badly because it’s cheap” but if truth be told all across healthcare that decision is being made on a daily basis.
I’ve said it here before and I’ll no doubt say it again - and I’m not right wing regardless what anybody says – I really feel that people are going to have to decide between £100 per month worth of Sky TV and excellent healthcare.
Blog Post Number - 1243