nhs – The Daily Opinion

Great Expectations: The Cost of Misunderstanding the NHS

The NHS has a big problem. I’m not talking about questionable financial management, the dangers of excessive entanglement with the private sector, or even superbugs on the wards. The biggest problem I see in the NHS today is a chronic lack of understanding on the part of the public. The very group of people it was set up to assist is contributing to its downfall.

Sitting in a waiting-room in a hospital department recently, I couldn’t help but overhear some of the comments made by other patients. One gentleman, perusing the reading material set out by the water cooler, complained that the magazines available were old issues. Another voiced the opinion that the department’s nurses didn’t ‘look professional enough’. Yet another, upon hearing that she would be seen by a locum doctor as her usual clinician had been called away on an emergency, demanded to know why she should bother turning up for her appointment if her doctor didn’t.

Expensive uniforms. Robotic medical professionals. Magazine subscriptions. Such are the expectations of a service set up first and foremost to provide decent and affordable healthcare for all who need it. Of what possible relevance would the latest issue of Heat be to your health? How could the last-minute substitution of one doctor for another equally well-qualified one be less convenient than having your appointment cancelled? And why on earth would you think that spitefully missing your appointment would be hurting anyone but yourself?

It’s on this last point that I would like to concentrate – because, actually, you aren’t only hurting yourself. Each missed appointment has a knock-on effect on patients, doctors, and hospital services. Allow me to take you through the process.

Imagine you have an ongoing health problem of some kind. Let’s say it’s a skin condition. It flares up like eczema, but the usual creams and ointments don’t seem to have any effect. You’re scratching your elbows down to the bone and climbing the walls in frustration, so your GP refers you to Dermatology. You are sent an appointment letter from your chosen hospital, asking you to attend on a certain date.

At this point, the following people are already involved in your care:

Your GP, who referred you
A Consultant Dermatologist, who checked over your referral letter to assess whether you had been referred to the correct department
A secretary, who scheduled your appointment, created the letter and sent it to you

These people are paid to work in the NHS. The NHS is paid for through taxes. Taxes are paid by you.

Let’s continue.

So now the wheels have been set in motion. You have your appointment date, but – glory be! – your inflamed skin has miraculously cleared, and you see no need to attend your appointment. Fair enough. It’s your health, it’s your decision. At this point, according to the information detailed in your hospital appointment letter, you contact the Dermatology department to let them know that you no longer need the appointment. They now have an empty slot in that day’s schedule, which they fill by offering it to another patient who needs it, which helps to cut down their waiting-list.

Only… you don’t contact Dermatology. It’s only the NHS, after all – it isn’t like a private medical clinic, or even the dentist, who would charge you if you didn’t give at least twenty-four hours’ notice of cancellation. The NHS doesn’t charge anyone, because it doesn’t actually cost anything.

Before we debate the ridiculousness of that viewpoint, let’s return to our scenario.

We now have two conflicting realities: one, in which you have decided you won’t be attending your appointment, but haven’t let the hospital know this; and two, in which the hospital has arranged for a highly-trained specialist in skin complaints to review you and offer their expert medical opinion in order to help you.

The day of your appointment arrives. Over in the Dermatology department, the receptionist has created a file for you in anticipation of it being filled with notes about your condition. Down the hall, a trained medical professional is waiting in his (or her) office to help you, not knowing that you won’t be turning up. He can’t just call in the next patient, because perhaps you’re running a few minutes late. Perhaps he could use the time to answer some of the many written queries that arrive from GPs and patients every day, but again, he can’t really get stuck into anything, because you might be about to walk through that door.

Any minute, now.

Had you attended your appointment as planned, the clinician would have then dictated a letter to your GP, which would then be typed by the departmental secretary and sent out. Your lack of attendance doesn’t mean that this doesn’t happen. The clinician still dictates a letter to let your GP know that you didn’t attend, and the secretary still types it and sends it. This is part of what is called continuity of care. Communication keeps everyone informed.

Let’s just remind ourselves how many people are currently involved because you asked for help:

Your GP
One secretary
One receptionist
One Consultant Dermatologist

And now for some very rough numbers (because I’m no statistician) – please take the following as averages:

A GP earns around £100,000pa (call it £50/hr) – 15 minutes spent seeing a patient and making the referral therefore costs around £12.50
An NHS secretary earns £23,500pa (call it £12/hr) – 20 minutes spent typing a couple of letters, scheduling an appointment, and printing and sending said letters costs £4 (not counting the cost of stationery and postage)
An NHS receptionist earns £16,500pa (call it £8.50/hr) – 10 minutes making up a file costs around £1.50
A consultant earns around £100,000pa – the initial consultation (or, in our scenario, the vacant slot intended for it), plus time to dictate a letter and make any necessary onward referrals within the hospital network, takes about one hour (often longer, in fact) of their time, at a cost of £50.

That’s £68 wasted, according to this rather conservative estimate of time and money spent. That doesn’t include all those little extras like postage, stationery, electricity. I guess if we wanted to include those we could round this figure up to £70. So that’s £70 of public money – your money – down the tubes every single time a patient does not attend an appointment and doesn’t let the hospital know. Taking into account NHS England’s recent estimate that 6.9 million hospital appointments are missed every year in the UK, that’s a sizeable chunk of public money gone for no good reason.

If we, the public, thought of the NHS as a “real” business, rather than a fantasy world where doctors and nurses toil merrily all day and night for free just for the warm fuzzy feeling of knowing that they’re doing good, we’d more easily be able to compare costs and make the right decision – to spend a few minutes and less than 50p cancelling an appointment by phone, or to waste £70 and a good couple of man-hours by not doing so. It’s a financial no-brainer.

And yet the status quo persists, the NHS continues to haemorrhage money, and many people continue to complain about the services. But is it any wonder some of the waiting-lists are so long if patients habitually miss their appointments and fail to give any notice that a slot has become available? And is it any wonder that so many departments are grossly overspending, given the amount of money wasted on empty appointment slots, rescheduling, and extra letters?

I think so many people miss their appointments because they take the NHS for granted. They see it as a free service that they can take or leave. The money that funds it is taken out of our wages straight off – we never see that money so we don’t see it as a loss when it’s inefficiently spent. It isn’t perceived as being the same as missing a private appointment, where you’re charged for it if you don’t cancel in time and the money comes straight from your own pocket. But it is, in a very real, if less direct, sense, money taken out of your pocket and tipped down the drain. And in the case of missed appointments, it’s a very preventable waste of money.

We take the NHS for granted because we don’t think about how it works. We don’t understand it and we only talk about it when it disappoints us. We make demands of it as if it has limitless funds; we complain about the money being wasted, yet we refuse to acknowledge our part in that wastage. This is our own money we’re throwing away! These doctors and admin staff are here to help you, but they can’t help you if you don’t turn up and they certainly don’t deserve your vitriol when the service you receive is inevitably less than perfect. We need to meet the NHS halfway for it to work efficiently and cost-effectively. We have a responsibility for our own health and a responsibility for our public services. It’s time for each and every one of us to recognise our part in it.

Organ Donation: Are You In?

You shouldn’t worry. It’s never going to happen to you, is it? It’s always that thing that you read about in the papers; the statistic on the news; a story that comes up over a coffee about a friend of a friend.

When it comes to organ donation, you could presume that your only connection to it will be in deciding whether or not you might make the noble decision to donate your organs in the event of your unfortunate demise.

But what if your heart starts to fail? It has been beating every minute of every day of every month of every year of your life…what if all along you had a silent fault waiting to strike? Or, what if you ended up developing end-stage lung failure or your diabetes became so bad that you needed a new kidney…

And then you realise that only 31% of the UK population is registered to become organ donors.

Then you are told that, as an adult, the average wait for a kidney is over three years; the median for a lung transplant over one year and the wait for a heart, an average of 253 days.

And what if you aren’t well enough to survive that wait?

An estimated 1,000 people die each year waiting for a life-saving organ, according to the NHS. The very unfortunate truth is that there are always more people needing organs than there are healthy ones available from donation. At present in the UK there are over 10,000 people needing a transplant. Whilst the wait for organs can obviously be different for all patients, the delay is always going to be inevitable while there is such a severe shortage of organs available for transplantation.

And sadly, for many the wait is just far too long.

Waiting time can also be negatively influenced by the disparity in the number of organ donors from certain ethnic backgrounds including those from south-Asian, African and African-Caribbean communities. This is particularly so because, for example, black people have an increased chance of developing kidney failure – three times more so – than the rest of the UK population. Ethnicity is so important because tissue and blood type compatibility are much more likely to prove a match; crucial in the success of transplantation.

The vital element within the UK system has always been consent; people have to actively ‘opt-in’ and give their consent to organ donation by actively adding themselves to the register, having a donor card or by otherwise discussing their wishes with their loved ones. Wales, however, has recently broken away from the system in favour of the ‘opt-out’ system – where consent is presumed for all unless the person has chosen to opt-out. A system which inevitably provokes much debate with the religious and ethical issues that arise. In both systems though, the final decision falls to the next-of-kin.

So let’s face it, ‘opt-in’ or ‘opt-out’, the bottom line is this: In the utterly devastating and tragic event of a loved-one’s death, there could still be the potential of passing on the incredible gift of life – even to several people.

And when that question of organ donation is broached, will you know what they would want the answer to be? Would you have the knowledge, and indeed the strength, to recognise the wishes of the person you love? Will you be certain enough to follow through their request – whether it be in favour of donation or not?

The bottom line is that we need to talk about it. We need to know. And we need to act on it.

For more information and to find instructions on how to join the organ donor register go to: NHS Choices Organ Donation

Why Would Anyone Want to Care for the General Public?

This is a question many people in the National Health Service (NHS) must be asking themselves after a leaked document revealed that staff in the south-west of England will have to work more, get less, whilst still adhering to those strict targets set up for trusts all over the country.

I believe everybody understands that there will be pay cuts/freezes for people in all sectors, but those in the NHS are seemingly being hit over and over and over again. The latest comes from a leaked document which reveals the following. Staff will have to deal with:

Salary reductions across the board.
Even more cuts to their allowances.
Considerably more hours.
The amount of leave they have per year reduced.
Mass changes to their sickness benefits.
And to put the flies on the pile of faeces, they will all be dismissed and will have to reapply for their own jobs.

And this is ignoring absolutely everything to do with NHS pensions. So if they are earning less after these changes whilst still having to pay more then what’s left? Why would anybody want to work for the public healthcare system in this country? Let’s get one thing straight. The health system is one of the toughest to work in as hours are long, targets are strict, and it gets battered by disgruntled members of the public and the media on a consistent basis. It’s like they are trying to destroy the whole thing and turn us into an Americanised copy.

Let’s look at one area of the health system that’s tiny these days. The dentists. Now, have you ever tried getting an appointment with a dentist in this country outside of the private sector? If you haven’t then I assure you that you certainly won’t find it easy as there are so few dentists. Yes, it’s true that all dentists in this country have to go through a few years of training in the public system before going into private practice, but how many of them are going to stay? You get less than private practice and you are under the control of somebody else, what’s the point?

Dental floss

All these changes are going to do is continue to push the brightest and the best out of this country and into the waiting arms of another country. Alternatively, if they decide to stay then they are probably either going to create or join a private practice instead. So tell me one thing, exactly how does the government hope to keep a fresh and competitive health system when they are constantly throwing people out of it with their ludicrous changes? I hope for the future of the NHS that their answer is a pretty damn good one.

Give a shit

Will We Soon be Booking Doctor Appointments and Accessing Medical Records Online?

The Coalition government has today unveiled plans for patients that allow them to book appointments with their GPs online, as well as check test results on the Internet too. Apps for smartphones are to be developed and patients will have access to all their medical records online as well. Health Secretary Andrew Lansley said these plans will give patients more power.

Personally, I welcome this move because I tend to use technology every day. I use a smartphone and actually prefer to have most aspects of my life online, from banking to shopping. This move would really hone in the advances in technology and would allow the NHS to become a more accessible part of people’s lives.

I understand the dilemma a lot of patients face on a Monday morning when they have to book an appointment with their GP, often having to spend a considerable amount of time on the telephone trying to get in to see their doctor. In many cases, when individuals do finally get through they are offered an appointment much later in the week, or in some dire cases the following week. My elderly grandmother faces this dilemma each time she has to book an appointment, and to be honest it really isn’t fair. Much like it isn’t fair for people with children to spend so much time out of their day telephoning their local surgery when they really need to be doing much more important things in their lives. In that respect, you’d think that most people would welcome this plan, wouldn’t you?

There are critics of these new plans for the NHS. As ever, we need to look at the positives and negatives of the changes. We might be keen to see the NHS adapt to the 21^st century advances in technology, but many patients may not be ready to put their phone down and pick up a laptop. A lot of elderly patients will feel left behind, out of the loop and quite frankly angered by the new plans. In the technologically advanced generation we find ourselves in, are our older generations being left out or should they in fact embrace any future advances in technology?

The government needs to tread carefully when these plans are turned into reality so that users who don’t have Internet access or don’t use smartphones are included and can still easily access their local NHS branches.

It’s not only about being able to book appointments online. Patients will eventually have access to their medical records online, as well as test results being made available online too. This will raise questions about the issue of security for the proposed plans. Is allowing patients’ medical records to be accessed online a good thing, or will it be only a matter of time before hackers make their own plans to sabotage this information?

However, the government plan to enhance the system of booking appointments, they obviously need to take into account people’s views on security and sensitivity about their private information online.

But, to the vast majority of Internet users, who use online banking and enter their bank details online on a daily basis, is it any different accessing your medical records online and having test results sent through cyberspace?