Sunday, 1 November 2009

The Doctor Can See You Now

Bunnco your man on the spot is recovering from a boozy dinner party hosted by some hospital medics last night. Andy Burnham, the Health Secretary, tells us that patients must now be seen within 18 weeks. It's going to be one of those 'dividing lines' between Labour and Tories at the election, he says. But as bunnco discovers, Burnham might want to be careful what he wishes for because the election headlines he's hoping for might backfire on him,

One of the nice things about being able to read newspapers online is that late-on in the day you get to have a sneaky peek at tomorrow’s headlines before you go out in the evening. And so it was yesterday as the following story from today's Sunday Telegraph caught my eye.

Andy Burnham makes NHS private care pledge 'key election battleground'
In an interview with The Sunday Telegraph, Andy Burnham, the Health Secretary, declared that a "key battleground" for the next election will be a Labour pledge to offer patients the legal right to free private care if they do not get the treatment they need from the NHS within 18 weeks.

If the Health Secretary thinks it’s going to be an important battleground topic, you’ll excuse me from writing a little about it. Because last night my wife and I were invited to dinner by a prominent medical family and all the other guests were medics too apart from some bloke who reads the news on local TV.

And in between interruptions from trick-or-treaters, I just happened to mention that ha-ha they were all going to have to sharpen-up their act because Labour was going to legislate to get their patients seen within 18 weeks. By Law. Or Else.

And this is what the medics told me.

At our local hospital there’s a beds crisis. It’s full. Which is a bit awkward because it’s one of the nearly brand-new PFI ones that we’re going to be paying off for the next 30 years. Routine operations are being postponed with consultants sitting around as ‘lists’ are cancelled. And what’s happening is that a back-log is building up.

But thanks to Mr Burnham, the 18-week limit has already been introduced by the Primary Care Trust [PCT] as a target. And as the PCT is paying the hospital to perform the operations within 18-weeks, everything has to stop so that the 'breachers' can been sorted out.

What normally happens is that the hospital, a ‘secondary PCT’ in the jargon, schedules a few Saturday morning sessions to catch up so as not to miss the target. Nothing wrong about that. In fact, it all sounds quite reasonable. But the snag is that on Saturday mornings theatre staff are paid on overtime. And the pay-rate is £40 per hour. And get this. Even the porter gets forty quid an hour to wheel the patients to and from the wards. In fact, everyone’s on an extra forty quid an hour apart from the receptionist, which everyone seemed to think was a little unfair.

Not surprisingly it’s very expensive to carry on like this so oftentimes the backlog cases get referred to the private hospital down the road where all this £40/hour nonsense isn’t tolerated. So the surgeons and various hangers-on just decamp to the private hospital and do what they would have done in the NHS one. Same people. Same Operations. Different hospital. Better Value. But because the Private Hospital charges a mark-up it’s more expensive than doing it in-house.

So they're going to start Saturdays again in the NHS hospital in the run-up to Christmas, which is handy because the presents under the tree never seem to get cheaper.

So I ask what would happen if the 18 week target is missed? It seems that for every ‘breach’ [I suppose you or I would call them patients!] the hospital gets fined ten thousand pounds by the ‘Primary PCT’. That’s right. Ten Grand. Each. The PCT just knocks ten grand off the hospital’s invoice when it comes to pay at the end of the month. No ifs. No buts. And around just one dinner table last night were “tens" of breaches. Oh dear. That’s quite a lot of money. No wonder that the hospital managers are now laying-on extra Saturday sessions to catch-up.

So let’s just review this. The unintended consequence of the 18-week target and ten-grand fine is that hospital porters and nurses are paid £40 per hour to come in on Saturday mornings. And operations are scheduled to hit a timeline regardless of clinical need. It just doesn’t seem like good value to me.

And when Labour makes it made a statutory requirement to hit the target regardless of clinical need in Andy Burnham’s Alice-in-Wonderland world, presumably missing the target is going to be a criminal offence. And with all the surgeons and anaesthetists banged-up at Her Majesty’s Pleasure, it just makes you wonder how anyone is going to get seen by anyone!

And of course, this is without the pressure of Swine Flu, where the Australian experience shows that intensive and critical care can collapse under the weight of new cases and targets go out of the window.

“The NHS is in a complete mess” says my genial host “But it’s not a complete disaster. Do you know what the best thing about 18 weeks is? As we get close to the deadline, all I need to do is see the patient and prescribe an aspirin and then the clock starts running all over again. Brilliant isn’t it.”

As the Telegraph reports today Burnham says "This will be a key battleground for the next election.”

I’ve a feeling he’s going to be right but not for the reasons he might hope.

Bunnco - Your Man On The Spot

1 comment:

wirch said...

I know this hospital well (really, I do know exactly where you're referring to) and what you say is all true.
I do wonder how vulnerable this money is to the 20% cuts apparently on the way; not very is my inclination as each £ buys clinical activity, directly and unquestionably. Fundamental resource expansion is costly - each consultant costs £100k/year or so and only operates two or three times a week. Cheaper to buy extra capacity from your existing staff.