The Vanessa Feltz show is awash with debate on the subject of the governments plans to fine hospitals who release people "too early" and who are readmitted within 30 days. The scheme sounds completely bonkers to me. I was pondering the concept of too early. What exactly is too early? Well there are clearly cases where it would be definately too early. I guess if you are mid operation, with your guts hanging out, then thats too early. If you are infected with dengue fever and pose a risk to other people, then it's too early. This however ( I hope) isn't what we are talking about. We are talking about people who are getting better. People who are well on the mend.
The issue is where are you more likely to get better. Two people can medically be in the same condition, but social circumstance might make early release a good thing for one person and a bad thing for another. Just suppose myself and my next door neighbour got run over a month ago and are hospitalised. We've been laid up and had the same issues. Now we are on the mend. If I come home, I've got a nice house and a wife to look after me and make my food and drinks, whilst I lie in bed. We are financially secure and cash isn't a worry. She can nip down the road and get shopping and get medicines. She can change simple bandages and dressings.
My neighbour (this isn't a real person) lives alone, has issues with alcohol, hasn't got a job, his friends are all in the pub. He has no one to cook for him and has lived on of Jenny burgers for the last ten years. He wants to be released so he can get down the pub, because his mates have promised to wheel him around their in his wheelchair.
Who do you think is more lilkely to be back in hospital in a month? Whos fault is it if we are both released and I'm back on my feet four weeks later and he's dead? My fear is that by imposing these arbitary rules, I'd be kept in. In my case I'd be more at risk in hospital. Hospitals are full of sick people with bugs. If you want to catch MRSA or C-Diff, they are the place to be. I'd feel safer at home. Rules such as this just waste money. In super litigious USA hospitals always perform every conceivable test on patients for fear of being sued. They end up spending twice the amount we do on health, yet the popluation is less healthy. The NHS may not be perfect, but it's better than any of the alternatives I've seen. The trouble is mostly caused by politicians continually tinkering. This is just one more unnecessary bit of legislation.
I worked at the NHS for 8+ years and I know that the entire system is run on number-crunching and achieving targets - people being discharged early to free up beds in order to admit more people and achieve targets. So while the idea of not kicking people out of hospital before they are fully well is an excellent one, fining is not the answer, being nothing more than further number-crunching.
ReplyDeleteWhatever happened to common sense in this country?
I'm not quite sure what the point is of fining a hospital when it is the taxpayer who pays their bills.
ReplyDeleteIt looks like the new government is just as good at talking meaningless drivel as the last one.
It is more cost-effective to get it right first time, so hospitals are effectively fined anyway.
ReplyDeleteEarly discharge is generally better for most people, but you do need to fund services like the Red Cross Home from Hospital scheme, or the befriending schemes run by Age Concern Barnet and Mind
Obviously, social circumstances need to be taken into account when doctors make the decision to discharge someone, but I completely disagree with your concept of blame - we should not judge people for being smokers, suffering alcoholism or having unprotected sex.
If I was in charge of the NHS two really straightforward ways of saving money, which would not increase bureaucracy, would be to change the Abortion Act 1967 so that you only need one doctor and not two to consent to a termination of pregnancy, and to allow unused tablets in foil wrappers to be reused.
And then I would bill private hospitals/ doctors when the NHS has to pick up the pieces for surgery gone wrong, which they do not have the facilities to cope with themselves.
ReplyDeleteFinally the tiers of management structure, where every person involved in commissioning has a counterpart in the PCT/ Hospital/ Regional/ DOH as a result of the market.
I would reduce money spent on litigation (and the devastation caused negligence) by encouraging whistleblowing and improving support and training for junior doctors, and then, if ruled the world....