The Crisis in Costs
'Chronic disease costs the NHS about £7 for every £10 it spends on patient care.'
The system we have is no longer financially sustainable. We all understand the reasons.
NHS inflation is invariably well above the national average rate. We have to care for an ageing and more needy population. Ever more costly drugs and technologies put a huge strain on a budget that now has to pay for a massive NHS reorganisation as well as responding to the financial crisis.
Adverse effects, resistant infections and compensation payments following medical accidents are all contributing to a downwards spiral that is now out of control.
Failing budgets, drastic measures
At least one Foundation Trust has admitted its financial problems are so grave it needs a bail-out. Heatherwood and Wexham Park NHS Foundation Trust in Berkshire is to receive a loan of £18 million from the Department of Health – money it will have to pay back in time. It has announced it is shedding 450 jobs: about 12% of its workforce.
The NHS has been told it must save £20 billion – a fifth of its budget – over the next couple of years. That is bound to impact on patient care. Several primary care trusts have banned procedures they regard as unnecessary – surgery for varicose veins, pain relief procedures, IVF, for instance – regardless of the clinical needs of patients and the professional judgement of doctors. GPs are being told to cut their prescribing bill and refer fewer patients for hospital treatment.
There is growing concern about the closure or downgrading of maternity units, with the General Secretary of the Royal College of Midwives, saying: ‘We would be very worried if reconfigurations were being driven through because of the economic circumstances.’
A handful of NHS Trusts have already announced they are reducing staff numbers while some are ‘re-structuring’: code for cutting the salary bill. That handful is about to become a flood.
Chronic overspending on chronic disease
Isn’t it time we asked ourselves just what it is we have been paying for? And how that has sent costs sky high? Is there another way of doing things, of delivering good medicine, of keeping people as fit and healthy as possible?
Expensive, high tech biomedicine is absolutely the answer to serious, acute disease. But industrialised medicine is not. And biomedicine is not the only answer to long term, chronic conditions. It is not the dramatic triple bypass or cutting edge brain surgery − not even cancer care − that takes up most of the NHS budget. It is chronic disease: costing the NHS about £7 for every £10 it spends on patient care.
Worryingly, recent studies published by the British Medical Journal suggest that the evidence base for some costly pharmaceutical treatments is not as solid as it should be because some drug companies do not publish the negative results from trial. That means evidence is skewed and we may be wasting money by prescribing ineffective – even potentially harmful – drugs.
Long term patients
The point about long-term disease is that it is just that. Long term. These illnesses are a continuing financial burden on the NHS. There is cardiopulmonary disease, arthritis and much more; degenerative conditions such as multiple sclerosis; illness associated with life style – respiratory disease and Type 2 diabetes. These are diseases that progress.
The best that conventional evidence based medicine has so far been able to offer is some degree of management of the disease or control of symptoms – sometimes not even that. The management of long term illness is under-valued in a system that focuses on throughput and permanent solutions, is rarely patient-centred and often fragmented. Yet chronic disease represents a vital healthcare need.
Quality of Life
These patients are with us for many years, even decades. And it is a huge problem. Around 1.5 million people in the UK are diagnosed with Type 2 diabetes. Many develop heart disease, kidney disease and vascular disease leading to lower limb amputation. Some lose their sight. Then, almost 10 million live with arthritis. Around 3.5 million have chronic obstructive pulmonary disease − the third most common cause of death worldwide.
These are just three examples. In terms of pain and quality of life, the cost to patients is immeasurable. The cost to the NHS is only too easy to measure. This crisis of costs is telling us we need a new way of looking at medicine and a new way of doing it.
Thankfully, science has shown us the answer. Not this time the hard, laboratory-based science that has given us both the miracles of modern medicine and the downside of industrialised healthcare, but psychosocial science. Far from sidelining the traditional art of medicine and healing, evidence-based healthcare shows that communication and kindness improve most healthcare outcomes.
Which is why modern medicine needs the therapeutic relationship, mind-body medicine and holistic care to balance out the impact of the de-personalised, de-humanised and deteriorating approach to healthcare that has led us into the Mid-Staffordshires and others like them.
Ethics and efficiency
It is also why we need to focus more on ways of encouraging all people, but especially those with long term conditions, to look after their own health, to stay as fit and healthy as possible, to slow down the progression of disease and the effects of aging.
The pioneering work at Bromley-by-Bow GP practice and College Surgery in Devon is showing us the way. They have shown us that money really can saved by imaginative, compassionate professionals who are allowed to deliver the standard of care they believe is right. That involved and engaged patients can help each other as well as themselves. That self-care brings benefits to the NHS as well as to patients.
Ethics combined with efficiency. That is the only way forward.