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Independents' Day

Save the NHS - hold the ONS!


Someone, somewhere, will have said this week that the NHS needs more money. I know this, because it happens every week. And someone, somewhere will have said that the NHS is inefficient and could save money. Because that happens every week, too.

Both statements are correct. The first could be solved with a hypothecated tax. And the second, simply by asking GPs for suggestions. Because our observations on where the NHS is frittering funds could save the health service millions.

So that’s what I think they should do: the government should ask every GP for one money saving idea. Then the top 50, say, should be implemented. Repeat annually, and the corpse that is the NHS might just be jolted into life.

My personal contribution to stop NHS money being poured down the drain involves precisely that. Or rather, it involves preventing expensive liquids being poured down gullets. I am, of course, referring to that horrific resource and calorie dump which is oral nutritional supplements (ONS).

You know the score. Every elderly person admitted to hospital receives, in their discharge goody bag, along with a pharmacopeia of drugs, antibiotics for a spurious UTI, a falls clinic referral and a list of pointless tasks for the GP, enough ONS to keep a starving third world country out of the headlines at least until the next famine.

What’s noticeably lacking among the standard three page discharge letter is any sense of context or plan on the ONS front. Inevitably, a couple of weeks later, there’s a request for an ONS repeat prescription. You have two choices. You sigh and sign. Or you offer resistance, which you know is futile, because you’ll end up having a conversation with disgruntled relatives vociferously demanding a script on the basis that, ‘The hospital said he needs building up’, ‘He likes them,’ or, most memorably, ‘He’s got no appetite,’ the latter hardly being surprising when he’s got a funnel-full of ONS being forced down his throat, a point which the family always seem reluctant to acknowledge.

Residential homes are even worse. I’m not saying that they deliberately encourage ONS repeats. But I am saying that, if I ran a care home, and I saw an opportunity for the NHS to subsidise my food bill and reduce the time my staff have to spend actually encouraging people to eat, that’s exactly what I’d do.

Result? Highly expensive food supplements end up on long term repeat templates. And we’re only reminded of the absurdity of the situation when, a year later, we happen to do a home visit and realise our previously frail patient is the size of Jabba the Hut, or at least we would if we could force the front door open against the sheer weight of discarded ONS cartons.

Look, the NHS is responsible for many things, but surely not feeding the nation. Let them eat cake. Or, failing that, they can buy it themselves.

Dr Tony Copperfield is a jobbing GP in Essex


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Readers' comments (14)

  • Amazing how the same problems keep reappearing. We stop prescribing, then somebody cunningly sneaks round our defences and gets somebody else to prescribe.

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  • I agree they are a quick fix to a more sinister problem- poor nutrition of the elderly. This is obviously more complex- poor social and family support, depression, and obviously cases where it is inevitable like dementia. And hospital food is, quite literally, an inedible disgrace and nurses and HCA's are either too busy (common) or too uncaring (rare) to feed their vulnerable patients.

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  • Let's see if the soiled bibs of the toothless demented has the same media attraction for the media narcissists like Jamie Oliver, eh!

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  • Vinci Ho

    National Health Service is in effect National Disease Service.

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  • Hear Hear!

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  • Also popular with those who would rather spend their money on recreational drugs.

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  • Please doc, my grandson needs them for building up his muscle at the gym

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  • Also baby milk .

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  • Actually easy to solve!
    Refer to dietitian, only prescribe according to their advice, they keep under review until nutritional supplements are no longer required/indicated and then stop!
    This is our practice policy and we have no arguments about it! Only Refer patients who have a MUST score of 2 or greater!

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  • David Banner

    Another Copperfield classic.

    Apart from the frail elderly, the other abuses of ONS include those who flog it on eBay (after free NHS scrips) and "substance abusers" who don't want to waste valuable smack money on food.

    The dietician suggestion doesn't work in my area, they invariably calculate a high MUST score and recommend huge quantities of the most expensive ONSes which are then difficult to refuse.

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