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November 16, 2014

Private Eye Issue 1378
Filed under: Private Eye — Dr. Phil @ 5:39 pm

What a Waste

It’s a shame that the Academy of Medical Royal Colleges report on protecting NHS resources is subtitled: ‘a doctor’s guide to cutting waste in clinical care.’ NHS waste is everyone’s responsibility, from patients to politicians. The report claims 20% of mainstream clinical practice brings no benefit to patients and there is widespread overuse of tests and interventions. The cost of prescribed medicines wasted is around £300 million each year. The average NHS cost of admission to general hospital is £1713, a consultant outpatient £135, an outpatient psychiatric assessment £145, one bed day for adult mental health inpatient £430, 11.7 minutes with a GP £45, prescription cost per GP consultation £41, cost of an MRI scan £187, cost of ambulance call out £235, cost of a hip replacement £5485. The carbon footprint of most of these interventions is listed, and a scenario where one patient ends up having many of these when they could have been avoided.

Interventions towards the end of life are often futile, costly and unkind and yet staff may feel pressured into doing something by patients and relatives. No mention is made of the waste of political reform. The current ideological absurdity – to believe a market system will reduce waste and inefficiency – is a huge delusion that fragments services and diverts precious resources to the pockets of lawyers, management consultants and shareholders. The NHS desperately needs good managers with the stability of secure jobs, not a merry go round of firing, compensating and then rehiring the same staff in new organizations that have lost the organizational memory of their predecessors.

The report repeatedly emphasizes that climate change is the largest threat to human health in the 21st century, and yet mental illness is a far bigger immediate threat. A culture of fear and bullying still persists in parts of the NHS. Threatening GPs with public outing for failing to spot cancer won’t improve their stress levels or reduce the number of investigations ordered. The human and financial waste of NHS staff trained but unable to find a job is not mentioned. After the MMC medical training fiasco (Eyes passim), a nurse contacted the Eye about her husband – a surgical trainee whose NHS job prospects were destroyed. ‘I ended up with a husband at the end of his tether. Indeed I took a day off work as I thought I would come home to see him hanging.’ He went off to train and work abroad, as many newly qualified doctors are doing at huge cost to the NHS.

The wasted lives of NHS whislteblowers who try to do as the report suggests, and speak up about unsafe and unnecessary care also gets no mention. On October 27, BBC1 broadcast ‘Baby P-the untold story’ which repeated the allegations made in the Eye in 2011 (Shoot the Messenger) about how Dr Kim Holt was not listened to by Great Ormond Street Hospital management when she repeatedly raised concerns about patient safety in Haringey clinic where Baby Peter was seen. She also made a disclosure to the lead inspector of the Healthcare Commission in November 2008 and was not even interviewed. The Joint Area Review of Haringey, ordered by children’s secretary Ed Balls in November 2008, made no mention of Dr Holt’s detailed evidence of clinically risky system failures but she was suddenly invited, by GOSH’s lawyers, to retract her concerns and offered a £120,000 gagging payment signed off by both the Treasury and the DoH. It took four years for her to be reinstated to her job in Haringey, a huge waste given that last week her team won a clinical excellence award as team of the month for Whittington Health, and she has been listed as one of the top 100 NHS clinical leaders by the Health Service Journal and one of top 50 women in the NHS.

Hopefully, the same happy ending may yet become Professor Ed Jesudason and Mr Shiban Ahmed, two extremely gifted surgeons who blew the whistle on what they believe are unnecessary, harmful and wasteful operations on some children with acid reflux at Alder Hey hospital in Liverpool. NICE agrees there is no evidence for cutting the vagus nerves and the stomach sphincter, and the Chief Inspector of Hospitals, Mike Richards, has been asked by NHS England Clinical Director Sir Bruce Keogh to investigate. However, the punishment for Jesudason and Ahmed for raising concerns is that they are unable to get another job in the NHS which, given their undoubted talent and the millions it has cost to train them, is a phenomenal waste. What are the Royal Colleges doing about that?