As I am sure you are aware, the new NHS chief executive,
Simon Stevens, has recently marked a “change in policy”, favouring a form of
micro management of the country’s elderly population in regards to health. A
new system of decentralised healthcare. The advantages of this approach will be
discussed later in this post, however this change in policy is more significant
regarding the confidence crisis within the NHS, particularly as community hospitals such as the ones below close.
Confident about Confidence
If we consider this context (the
NHS’s growing waiting times and significant costs), the issuing a statement has
suggested a more proactive response as opposed to adjustments to the NHS’s recent
bureaucracy. This is significant as it implies that the CEO understands the growing
concern which should, I believe, help to comfort many patients and offer more
effective treatment. This is because, to some extent, the spiral effect that
has occurred within the NHS has occurred due to a sudden realisation of the
system’s backlog. This caused increased probing which has continued due to the
lack of confidence. By addressing this through a more patient based focus, I
think Simon Stevens will encourage more people to use the NHS which will lead
to immediate treatment as opposed to dealing with the consequences in the
long-term.
For Better or for Worse
However, the change itself is less clear. A localised
hospital system would undoubtedly cost more if we consider the growing rate of
research specifically within specialities (as hospital medicine is now growing
at the fastest rate in healthcare). This, in the long term, is likely to cause
a growing investment in medical specialities and so this requires a large
hospital structure to apply this investment most effectively. Therefore, I
think that investment into local hospitals will create an opportunity cost by
preventing investment into these specialities. This would create long-term
issues due to a shortage of medical specialities and GPs (indeed the family
doctor service within Northern Wales needs GPs urgently according to a senior
medical figure). Thus the advantage of a more widespread hospital system may be
ineffective due to the lack of ability for these hospitals to specialise.
Clearly, this would lead to a minority of patients having to be continually
sent elsewhere hence leading to increased paper work issues which inflicts a
hidden cost.
Nevertheless, this would only be a small section of patients
and it is unlikely that the growing investment into local hospitals would
undermine investment in larger hospitals, since this would reduce the burden on
larger hospitals to provide basic care. Thus, larger hospitals may instead
respond by increasing specialisation. In contrast, as outlined by Stevens, the UK
has an ageing demographic so this localised system of care would be beneficial
for the elderly which would allow them to feel more at ease. This would mean that
they would be encouraged to discuss their health which would allow for the rise
of a more considerate system where patients and their physician can learn
together. This would lead to improving quality of care.
Even so, the care needs of the elderly are complex and are
at risk of being forgotten. For example, surgeons may be reluctant to refer an
85 year old to have a coronary bypass operation. Thus this move towards a local
system may have short-term implications such as reduced transparency, hence
making it difficult to evaluate the effectiveness of care which is important
considering the growing scepticism towards the ability of the NHS to reach
targets.
Even so, Stevens suggests that this is not an issue and
instead argues that waiting time targets promote a greater threat to patients
being forgotten. I disagree. I do not believe that there is a conflict between efficiently
managing waiting times and patient care. Instead, Stevens should instead target
the growing cause for the inability to meet waiting times: paper work. This
does not, necessarily, include cutting back on paper work as this is essential
for fluency in care and the ability of physicians to understand the background
of patients both physically and psychologically. On the other hand, waiting
times could best be met by introducing efficiency tests for doctors that
calculate their ability to work well and work fast. These two aspects should
not be in conflict.
Therefore, the localisation of hospitals has the potential
to cause growing waiting times as patients requiring A&E care are typically
admitted to specialist hospitals; hence a reduction in investment is likely to
place more pressure on targets specifically within A&E as studies have
shown that “66 percent of patients are admitted to inpatient wards from A&E
in the last ten minutes before the four-hour deadline”. This means that the
situation may get worse.
However, there is a clear advantage of small scale care in
that it can include the community. This is specifically seen within the growing
need for palliative care and rehabilitation in the primary care sector. This
has also been shown by research to have the same monetary cost as large
centralised systems so decentralised care could have the benefit of being quick
and easy to access as well as being cost effective.
My Verdict
Nevertheless, in summary, it is dangerous to believe that
localisation will solve the issues associated within the NHS due to the
variations between patients and the occasional need for intensive care in
speciality units. However, with obesity predicted to rise to 50% by 2050 as
well as our ageing demographic, traditional hospitals are not suitably adapted
to dealing with small scale issues. However, significant investment into this
community care scheme is unlikely to have a long-term impact on the success of
healthcare due to the lack certainty. A lack of certainty over how it is to be
funded. A lack of certainty over the role and limits these hospitals will cater
for. At best this could relieve the pressure on speciality units yet at worse
it could delay other reforms and be accused of diverting attention from other
failures of the NHS. My verdict: it is too soon to tell.
Sources:
(NB: This analysis of Simon Steven's comments, to involve local hospitals in the NHS more, are my interpretation and I would like to hear other views on this preposition)
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