Last Word


The cost of demanding savings mustn’t be patient choice

Source: NHE May/June 15

 Chris Whitehouse, who chairs the Urology Trade Association, discusses the day-to-day impacts on patients of decisions over efficiency, consumables and devices.

The NHS is creaking at the seams. Swamped by demands, the NHS has to perform near miracles on a daily basis – treating patients with resources barely sufficient for the task. 

It’s evident that greater investment coupled to better use of resources in the health service will be required as need builds to predicted levels by 2020. The oft-quoted figure from the Five Year Forward View is that an extra £8bn a year is needed. But £22bn in savings is also needed – additional to the ‘Nicholson Challenge’ of £20bn in savings during the last Parliament. 

The NHS doesn’t just need more money. It needs to use what it has more efficiently. 

But, while simply writing the NHS a blank cheque would be impossible for any government, the challenge for the health service is how it can make efficiencies without sacrificing patient choice. This could happen if, in a scramble to save money, patients are left without access to the products that will have the greatest positive impact upon their quality of life. 

Such a situation would have a profound impact on patients, particularly those with chronic and degenerative conditions, such MS, or congenital conditions such as spina bifida. It would fundamentally affect their quality of life by potentially meaning they would no longer have access to the treatments, medication and devices that best meet their individual needs, when their daily reality involves catheterisation to manage continence problems. 

There is an ongoing debate amongst experts as to the benefits and flaws of both multi-catheterisation – requiring patients to re-use the same catheter – and single-use catheters. Single-use catheters are used by patients with chronic conditions, with these not requiring repeated cleaning. The rationale has been to improve the patient’s quality of life while minimising the risk of urinary tract infection. 

Much work has and is being undertaken to determine whether multi-use catheters could be used without additional risk of UTIs (urinary tract infections), and whether such products can be used without requiring changes to a patient’s lifestyle or quality of life. This work is welcome, provided it gives patients more rather than fewer treatment and management options. 

This is the critical point. No-one is suggesting patients have carte-blanche to call upon NHS resources, but even at a time when the NHS is having to make unprecedented savings, there is a need to reconcile this with patients’ needs. There is a danger that, to take catheters as an example, decisions on what is or is not available to patients is made primarily based on cost. Whilst this must be a factor, it cannot be the overriding one. 

Taking decisions on the availability of medical devices like catheters based on cost would not only be against patients’ best interests, but also those of the health service itself in the longer term. Catheters, as an example, are by their nature intimate products. The needs of those using them vary greatly – ranging from dexterity issues to a need to be discreet or allow catheterisation while out and about. In short, they allow patients to live more normal lives. In prioritising short-term savings, the NHS would push patients to products delivering worse clinical outcomes, which affect patients’ dignity and their opportunity for economic and social participation. Long term, they might need additional health support, negating short-term savings. 

The financial state of the NHS is a perilous one. It requires a firmer footing, based on the best available care, if it is to meet the needs of our populations by 2020. Addressing the problem requires additional funding, but also a more informed population taking responsibility for its health and supporting better value for money through efficient use of resources. 

Whether this involves a degree of rationing or not is something we will see over the longer term. But it would be a betrayal of NHS’s principles if the push for financial savings placed treatments and devices out of the reach of patients with chronic conditions. Such a development would be ineffective and short sighted. 

Quite simply, for all the funding drama, the NHS must find a way to reconcile balancing the books with continuing to support patient choice, and allowing patients to manage their condition with dignity and independence.

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