Sunday, 13 May 2012

Lack of hospital beds in UK

It is sad that I feel duty bound to use my blog as an author to raise the problems I see with the UK's National Health Service, but where else can one get one's views in the public view? The bloated administration of the NHS is sucking the lifeblood out of the service where administrators with no clinical experience are on six figure salaries. At the same time skilled clinical staff are losing their jobs.

Take for example the reported shortage of hospital beds (BBC article - Nick Triggle). The Government deny there is a shortage, but if you talk to any A& E Matron and you will hear a very different story. Patients are regularly kept waiting because of bed shortages. The hospitals employ "Bed Managers" whose sole job is to chase the clinicians in the hospital wards to discharge patients early.

The problem with hospital beds is that a "bed" has become a unit of accounting in hospitals. The bean counters find it very convenient to work out the "cost of a bed" by taking the total running costs of a hospital ward/unit and dividing it by the number of beds. Don't forget they also impose the "management overhead + PFI costs" into those running costs. It is not just the medicines, doctors, nurses and ward staff. The bean counters then have an easy to use spreadsheet figure called "bed cost". The cost figure gets absorbed into the management mythology and the people using it forget the original components of the cost.

When senior hospital management realise there have/are going to run out of money they'll introduce cost cutting measures. Some bright bean counting spark will say "if we cut 20 beds from the service we'll save a lot of money over five years". As a consequence patients lose access to those beds, but the overhead hospital costs never go away.  Let's be plain about this: A hospital bed only costs about £5,000 When a hospital "closes" a bed, they don't sell the bed to reclaim the money. The hospital still has to pay infrastructure costs, floor rent, the administrators costs are still there, the PFI costs remain.  The action doesn't reduce the number of patients, people still get sick.

The hospital planners/administrators need to get away from the concept of a "bed cost" and use more realistic accounting methods. 

Here's another view of the problems by a Doctor.

Tuesday, 8 May 2012

Absolute stupidity of NHS Reorganisation

Before the last general election in the UK the leader of the Conservative Party declared that he wouldn't impose yet another re-organisation on the NHS if he was elected as the new Prime Minister. Promptly on arrival as the new PM he handed control to a dubious politician called Andrew Lansley. This silly man promptly set about reorganising the National Health Service. He has this "bee in his bonnet" that is he removes layers of management from the NHS and hands control to General Practitioners (Doctors) they will magically reduce the public costs of the NHS. This man Lansley has the stubbornness of a dead donkey and the listening ability of a beach pebble when it comes to listening to the views of the massive majority of the health care professionals. Just about everyone says scrap the new new re-organisation.

Here's some of the problems:
  • The GPs are independent contractors (I have a letter from the Dept of Health confirming that); their own profit comes first. Giving them control of the purse strings give them the opportunity to avoid any measure that would reduce their profit.
  • The GPs won't have spare time to run the national organisation or even local ones. They'll just re-employ the bureaucrats who used to run the defunct Primary Care Trusts. It won't save money.
Here's a real life example of the changes in progress right now. A friend of mine is a Nurse Practitioner. She's a highly skilled medical practitioner who has a cluster of medical degrees, over 30 years experience who works without the need for clinical supervision at the level of GP/Registrar. Her costs are about half that of a highly paid GP. As a direct consequence of the re-organisation she is being made redundant. Well not exactly redundant, the patients she used to see are being redirected to the local A&E department. The cost the public purse per patient has increased by a factor of three and queues will lengthen in the A&E. 

This senior nurse's redundancy settlement has yet to be agreed, but by the Departmental rules the additional cost to the public purse will be close to £500,000 if an unfair dismissal claim is to be avoided. Meanwhile the same group of GPs who pushed for the closure of the Nurse Practitioner's department are looking to employ her on a freelance basis at a Doctor's rate of pay. The nurse didn't ask for the re-organisation and she doesn't want to be made redundant. She is a strong proponent of the NHS. How many times is this type of situation going to be repeated throughout the NHS?