I first learned about the value of equipment in my early years at A&E. A woman had a laceration to her hand and I was happily stitching away and moving on to the second pack of kit. A male nurse from Nigeria obligingly brought me what I needed but he politely commented on my liberal use. “Back home we have to make it last – we don’t have enough to waste.” That has stayed with me ever since.
Just because I can reach for whatever I need and in vast quantities does not mean I must plunder. Free at the point of care does not mean that it’s actually free, coming from the magic NHS treasure chest that just keeps on giving.
A report compiled by health and wellbeing provider Benenden concluded that on the issue of costs related to the NHS, the UK public is “grossly ignorant” and “holds a flagrantly selfish sense of entitlement when it comes to their own treatment.” Questioning 4,000 people across the UK about the costs of common procedures and treatments, the respondents put the cost of a liver transplant at £12,279 whereas it actually costs £70,000. They believed the number of annual NHS bariatric related surgeries to be about 25,000 when it is actually double that; last year it cost the NHS in excess of £25m. The average cost of a natural birth was estimated to be £1,288, when it is instead £1,824 – and that’s without any complications.
There is a resounding lack of insight from a patient perspective into how much the services they receive cost. But should they know? I think yes. Maybe it’s time to hold a national social experiment where people attending hospital are presented with a bill at the end. Not one to be paid, but certainly to be reflected on.
The system itself too needs to be held to account too. I can recall one incident when emergency social services input was required for an otherwise independent elderly woman who had broken an arm. She didn’t require an acute medical bed, just some support in her home. I applied for the care on the Friday morning and by 5pm I was told that her application had failed. I was offered the opportunity to appeal – but that would not be until the following Tuesday as it was a bank holiday. The nurse at the desk gave me a knowing smile, explaining that the patient will fail the application today, but will pass after the weekend. In the meantime she will stay in a comparatively expensive acute medical bed so the social services department don’t have to pay for the care. If this is indeed common practice then it is an example of flagrant abuse of shifting responsibilities centred on budgets.
My elderly patients tell me of times they can remember before the NHS – when calling for the doctor had to be carefully thought through because they couldn’t afford it otherwise. Of course our doors are open 24/7 and if you need us we are here. But if you could access aspects of care rather than acute services think about it. And taking a bit more self-responsibility wouldn’t hurt too.
A perfect example of where this is lacking was identified within the report in relation to free prescriptions. “Last year alone £80m worth of prescriptions were written for paracetamol, when they can be bought for as little as 19p at the supermarket, which wastes NHS money and resources,” explained medical director of Benenden, Dr John Giles. Last year 54,419 adults and 725 adolescents were admitted to hospital for alcohol treatment services at a cost to the NHS of more than £18m. Three-quarters of respondents admitted that they didn’t consider the cost of a procedure or worry that the free treatment they were receiving could be taking treatment away from someone in greater need.
I can’t help but feel an inner hopelessness when someone with a lung disease like emphysema comes in yet again because they can’t breathe. I ask if they smoke and nine times out 10 they say yes. One patient, a man with advanced chronic obstructive pulmonary disease, arrived in the department with shortness of breath, so much so that he could only get around in a mobility scooter. His blood tests and physical state identified him as being quite unwell and I put him in resuscitation. It took a while to stabilise him and monitor blood tests. When he began to feel better I knew what was coming. He wanted to go out to smoke. I refused but he went anyway.
One of the first steps in saving the NHS has got to be increasing patient understanding of the price tag on treatments. Only by knowing how much each encounter costs, can they begin to accept responsibility for directly depleting the purse. Then some patients might choose to conserve their use of the NHS for the day when they really do need it.
