Does the NHS sometimes waste money reassuring patients unnecessarily?
The NHS can learn much from its senior doctors, but only if they have their authority returned in respect of patient treatment. This is something that has been lost within the public service since the introduction of various changes in consultants’ working practices over the past 15 years or so.
We are failing to use the knowledge and expertise of some of our country’s most senior clinicians. These senior doctors have demonstrated that they are key to reducing unnecessary referrals to secondary care, and to bringing some order to the increase in unnecessary investigation and treatment of our population and subsequent costs to the taxpayer.
I have been told that a doctor’s career has three phases: knowing what to do, knowing when to do it and, most importantly, when NOT to do it. The latter phase only comes with expertise and experience which is normally found in the very doctors who are now retiring early.
Within the NHS many patients are being unnecessarily ‘over investigated’ and ‘over-treated’ – they are called VOMITs – Victims of Medical Investigation and Treatment. All of this is at a cost to those patients who really need to be treated – they must wait longer as a result. In addition, there is the cost to the public purse and to areas of healthcare that desperately need the money that is being poured into inefficient hospitals that constantly tie their clinical teams in red tape and administration. (Although I accept that this may partly be because of the over-regulation of health by the CQC (Care Quality Commission) and NHS England.)
Nearly all commissioning groups in the UK have exceeded their budgets, and much of that additional expenditure is on investigations or treatments within hospitals, – when the outcome is not always good value for the patient or for the taxpayer. In fact, I understand most hospitals have no idea what their clinical outcomes are. We are paying for this and we have no idea if we are getting value for money. Something has to change.
Many patients are being referred to hospital because of the fear of a doctor ‘missing’ something which then results in patient harm and can damage the doctor’s reputation and career. Once referred to a hospital the patients are often seen by fully trained but relatively inexperienced doctors who will tend to admit and investigate a patient rather than reassure them and allow them home. Once patients, particularly the elderly, are in hospital it is difficult to get them home. This is bad for patients, doctors, nurses and bad for the NHS as a whole.
In my view, what is needed is a system to allow our most experienced doctors to knowledgeably control referrals and patient demand. Doing so will reduce hospitals’ workloads and allow them to better care for the patients who do need to be in a hospital bed. Whilst GPs have done a great job in reducing some referrals, if we continue to allow people to go to hospital without any input from senior experts before they enter the hospital, then nothing will change.
The problem is the senior consultants are employed by the hospitals. They are therefore conflicted. If they advise someone not to come to hospital, the hospital loses income and the consultant could have their income reduced. Hospitals are expensive places, filled with ambitious people who want to make a name for themselves or their departments. They will not want to promote a system that reduces their income.
We know from the Get It Right First Time projects ( GIRFT) run by the NHS that the key is to get the senior doctors involved BEFORE the patient reaches hospital, but how do we do it when the consultants are employed by the very organisations that will lose out by the advice they give?
Well it is simple: our commissioners need to get advice from organisations that have good governance systems, to keep patients safe, but also ones that understand the need to reduce expenditure for the benefit of the whole NHS. This cannot be done by traditional management consultants, who are frequently asked for advice by NHS managers. It has to be done by independent medical and surgical consultants with years of front-line experience and an understanding of when NOT to do things.
It is time we asked the professionals for help, not their royal colleges, not their unions (BMA) or their specialty associations, but organisations that have experience of the commercial world, as well as the clinical understanding of healthcare. With their help, perhaps we can help our NHS cope with the ever-rising demands from our population, and rebalance healthcare more towards outcomes.
The key is getting the frontline, senior expert consultants to help, not to disenfranchise them as we are currently doing.