Can the NHS Save Money Without Hurting Patients?

I was intrigued a while ago to hear about the success achieved by Essex police in funding an extra 239 jobs largely through cost-saving measures. The force apparently took simple steps like cutting out biscuits with their morning cuppa and stopping the purchase of designer sunglasses, channelling the money instead into front-line posts which make a real difference to the service they can provide to people in the county.

Apart from thinking that's an awful lot of snacks and fancy eyewear, I was cheered by the idea of a large public body taking the sort of homely steps that families all over the country have been pushed to, in our efforts to reduce debts and manage our finances better. My other half being a great advocate of costing things over the year, I have never been in any doubt about just how much can be wasted on a daily cappuccino, Mars bar, packet of fags, (fill in your own favourite treat) - but if you haven't ever tried it, doing the sums can be salutary.

And now politicians are eyeing up the NHS, and asserting that serious cuts are going to have to be made. We all know that this is the case, but how is it going to be achieved? I would love to think that some of that expensive management time is being dedicated right now to identifying commonsense, waste-cutting measures that would save money without harming patients, but I fear that it's not happening.

I have heard recently a couple of anecdotes about life in the NHS which underscore my scepticism. First, a tale of sterile supplies - gloves in this particular case - supplied to the hospital in question in packs of six, from which the staff were accustomed to take the single pair needed at the time, and throw away the other five, since they were no longer sterile. It did not apparently occur to anybody to question this practice: it was a fact of life that sterile gloves arrived in multipacks, and therefore most had to be discarded. I wonder how many similar rituals are being enacted up and down the country?

And earlier this week, an outpatient attending hospital for an MRI scan took refuge in a changing room, in a clearly distressed condition, because he was obliged to put on one of those humiliating back-opening gowns, and there were no dressing gowns available to preserve his modesty because "we're saving money". This must be a fairly widespread experience; I know people who have been through it over many years and in various hospitals, with differing degrees of upset according to personality and mental state at the time.

So it's probably safe to say that whatever steps are taken to save money, challenging the status quo and respecting the dignity of patients won't be at the top of the list.

It is always tempting when faced with the challenge of cutting costs to go for politically sensitive targets, in the hope that public outrage will be so great that the government will back down from their demands. If you say "cutting X pounds from our budget will mean sacking nurses, or closing intensive care beds", you are far more likely to marshal opinion behind you than if you admit that you could achieve the savings by buying the office supplies from Viking and reducing the proliferation of highly paid managers.

What will probably happen in reality is that cuts will be made in those areas that are least glamorous and most in need of support, such as mental health and geriatric care. But wouldn't it be wonderful to be proved wrong, and see the NHS following the lead of Essex police; saving money in ways that hurt no-one, and actually improving the service they can give to patients?

What do you think? Share your ideas on how money could be saved, or your opinions about the way the NHS uses the funds it has - just click the "comment" link at the top of this piece, and you're away!

Care and Dishonesty - where have our morals gone?

I wonder whether you were as shocked as I was to hear about the latest research findings on the subject of dishonesty.

Our legal system - and indeed the functioning of our society in general - is based on the idea that reasonable and honest people share an understanding of what constitutes a dishonest act. So it is rather dispiriting to find that less than half of women, and even fewer men, think it is dishonest for a care home nurse to put pressure on an elderly patient to change their will in their favour. In fact, it was regarded as only marginally more dishonest than snapping the stalks off broccoli in the supermarket before weighing/paying. More than 80% of these same people think that
it IS dishonest to lie about your age on an internet dating site...

The fear of being frail and dependent is one that haunts many of us as we get older: thinking that a majority of the people you may be relying on for your day-to-day care believe that it's OK to manipulate you in this way is really scary.

Whatever happened to the caring and compassionate society that was supposed to come out of the global economic meltdown? It sounds more like "I'm all right, Jack, devil take the hindmost" - if I can mix my metaphors! Perhaps the people who responded to the survey will change their opinion when they are faced with choosing residential care for their own frail elderly parent (after all, it will then be their putative inheritance that is being redirected) or better yet, themselves.

Certainly, there is an increasing interest in services offering to vet or monitor carers on behalf of the client's family, reflecting the widespread suspicion that not all carers are as compassionate or as altruistic as we would like them to be.

What do you think? It feels as if every time you pick up a paper or turn on the radio there is another story about vulnerable people being let down or exploited in some way, yet at the same time we seem to be enmeshed in more and more legislation designed to prevent these things happening. While inspections involve being able to tick lots of boxes on a sheet, and most of us have such a shaky grasp of basic morality, it is perhaps not surprising that there is such a gap between the standards we allegedly aspire to and what is actually delivered.