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You can find the current article at its original source at https://www.theguardian.com/healthcare-network/2018/jun/02/hospitals-are-massively-overspending-but-more-money-is-not-the-answer
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| Hospitals are massively overspending. But more money is not the answer | Hospitals are massively overspending. But more money is not the answer |
| (about 9 hours later) | |
| Forget the revelation that hospitals overspent by almost £1bn last year. The figure that really matters is the Nuffield Trust’s estimate that the true underlying deficit is closer to £4bn. | Forget the revelation that hospitals overspent by almost £1bn last year. The figure that really matters is the Nuffield Trust’s estimate that the true underlying deficit is closer to £4bn. |
| One-off bungs and accounting sleight of hand may flatter the Department of Health’s end-of-year figures, but they do nothing to solve the hospital overspending problem, as the health secretary, chancellor and prime minister wrestle over the size and timespan of the anticipated long-term financial settlement for the NHS. | One-off bungs and accounting sleight of hand may flatter the Department of Health’s end-of-year figures, but they do nothing to solve the hospital overspending problem, as the health secretary, chancellor and prime minister wrestle over the size and timespan of the anticipated long-term financial settlement for the NHS. |
| The magnitude of hospital overspending puts the government in a horrendous bind. It propels ministers towards a substantial spending increase, but one that could be almost entirely consumed in plugging the hospital deficit, with little money left to invest in the community-based services which are crucial to tackling the root causes of galloping demand. | The magnitude of hospital overspending puts the government in a horrendous bind. It propels ministers towards a substantial spending increase, but one that could be almost entirely consumed in plugging the hospital deficit, with little money left to invest in the community-based services which are crucial to tackling the root causes of galloping demand. |
| That means that in a few years’ time there is every chance we will have to go around this block again – which is precisely why the Treasury is always so reluctant to give more money to the NHS. | That means that in a few years’ time there is every chance we will have to go around this block again – which is precisely why the Treasury is always so reluctant to give more money to the NHS. |
| Alarming evidence published this week underscores the growing harm to patients from a system struggling to cope. Nuffield Trust and Health Foundation analysis shows that between 2010 and 2017, the number of patients having to be readmitted to hospitals in England within 30 days rose by more than 19% – from 1.16 million to 1.38 million. | Alarming evidence published this week underscores the growing harm to patients from a system struggling to cope. Nuffield Trust and Health Foundation analysis shows that between 2010 and 2017, the number of patients having to be readmitted to hospitals in England within 30 days rose by more than 19% – from 1.16 million to 1.38 million. |
| Even more worryingly, they identified a 41% rise in emergency readmissions for potentially preventable problems such as blood clots, pneumonia and pressure sores. | Even more worryingly, they identified a 41% rise in emergency readmissions for potentially preventable problems such as blood clots, pneumonia and pressure sores. |
| The NHS is now locked in a cycle of overworked staff making avoidable mistakes, in turn creating more demand | The NHS is now locked in a cycle of overworked staff making avoidable mistakes, in turn creating more demand |
| These figures suggest that the NHS is now locked in a cycle of hugely overworked staff making avoidable mistakes, which in turn create more demand – and more pressure. | These figures suggest that the NHS is now locked in a cycle of hugely overworked staff making avoidable mistakes, which in turn create more demand – and more pressure. |
| Against this backdrop there are moves to raise the threshold for some surgical procedures. The London Choosing Wisely programme aims to standardise access across the capital to eight common procedures, including hip and knee replacements, knee keyhole surgery, shoulder decompression and cataract surgery. | Against this backdrop there are moves to raise the threshold for some surgical procedures. The London Choosing Wisely programme aims to standardise access across the capital to eight common procedures, including hip and knee replacements, knee keyhole surgery, shoulder decompression and cataract surgery. |
| The draft policy on hip replacement, for example, says it will be restricted to patients whose osteoarthritis is having a substantial impact on their quality of life – and who have not responded to treatments such as painkillers, exercise, physiotherapy and losing weight. | The draft policy on hip replacement, for example, says it will be restricted to patients whose osteoarthritis is having a substantial impact on their quality of life – and who have not responded to treatments such as painkillers, exercise, physiotherapy and losing weight. |
| Predictably, the proposals have already sparked sharp criticisms from the British Medical Association – although trying to lose weight and get by with painkillers and exercise before having someone come at you with a saw would seem like common sense to most people. The interventionist hospital culture needs to be challenged in the interests of patients as well as NHS finances. | Predictably, the proposals have already sparked sharp criticisms from the British Medical Association – although trying to lose weight and get by with painkillers and exercise before having someone come at you with a saw would seem like common sense to most people. The interventionist hospital culture needs to be challenged in the interests of patients as well as NHS finances. |
| However, with consultations compressed to just a couple of weeks and little public debate on the proposals, criticism that they are being rushed through seems justified. If the excessive enthusiasm of NHS hospitals to operate is going to be questioned across the country as resources become ever tighter, it needs to be done openly – and the evidence underpinning a less surgical approach needs to be explained. | However, with consultations compressed to just a couple of weeks and little public debate on the proposals, criticism that they are being rushed through seems justified. If the excessive enthusiasm of NHS hospitals to operate is going to be questioned across the country as resources become ever tighter, it needs to be done openly – and the evidence underpinning a less surgical approach needs to be explained. |
| But it will take more than a few postponed hip replacements to solve a financial problem of this scale. Any extra funding from the Treasury will be welcome – and longer term plans, such as increasing the number of home-trained doctors, will eventually provide some extra capacity (in the absence of overseas talent barred by the Home Office). But expectations of a financial bonanza for the NHS’s 70th birthday to solve many of the health service’s difficulties are naive. | But it will take more than a few postponed hip replacements to solve a financial problem of this scale. Any extra funding from the Treasury will be welcome – and longer term plans, such as increasing the number of home-trained doctors, will eventually provide some extra capacity (in the absence of overseas talent barred by the Home Office). But expectations of a financial bonanza for the NHS’s 70th birthday to solve many of the health service’s difficulties are naive. |
| No amount of cash should be allowed to distract from the hard truth that the only way to ensure the financial and clinical sustainability of the NHS is continuing and accelerating the slog of system reform begun almost four years ago with the Five Year Forward View. | No amount of cash should be allowed to distract from the hard truth that the only way to ensure the financial and clinical sustainability of the NHS is continuing and accelerating the slog of system reform begun almost four years ago with the Five Year Forward View. |
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