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Plug the NHS cash sinkhole before pouring more funds in

Dr Renee Hoenderkamp

Dr Renee Hoenderkamp

I’ve made no secret of my belief that there is enough waste to cut from the NHS to sort most of its problems, and never has it been more relevant than now. As the pressure piles on and brings both A&E and primary care to its knees, the calls for more money increase in quantity and decibel level.

I am however, still unconvinced that extra cash alone would either solve the problem or change anything long term.

Just a quick glance at a recent news story about Boots charging the NHS £1,200 for a special cream that costs £1.62 typifies the kind of waste, and even fraud, endemic in the system.

I was a patient a few years back at a large labyrinthian London teaching hospital. I had the misfortune (it left me depressed) to be in a lift with a couple of members of staff discussing the quote, from an outside provider, for painting their office.

Centralising has to be better economically and for the patient

Now trust me when I tell you that of the 500 or so rooms in this hospital, none can be much more than 4m by 3m in size. The conversation went like this: ‘Did you see the quote to paint my office - £7,000! But its okay, we rejected it and they came back at £5,550.’

It certainly doesn’t take a doctor or rocket scientist to extrapolate the cost for the whole hospital and realise it is not only ridiculously large but could be reduced significantly if: a) outside contractors could be prevented from playing this game of NHS lottery, where they rub their hands together with glee each time they quote a job and add a zero or two on the end; or b) the hospital employed its own small team of contractors who worked for a set wage around the hospital completing all jobs needed.

And yet this tendering process, which in some areas see extortionately higher prices accepted than in the commercial world, is not extrapolated to the areas where providers need to be paid more. Let’s take community care: care homes and social care. Here, councils have driven prices so low that the winning provider cannot actually afford to deliver the service for which they tendered; thus we see the disarray that is social care today.

Subdividing medical specialities must also account for hundreds of millions of pounds of unnecessary spend, and certainly hasn’t delivered better service. Take mental health services, which over the past decade have been carved up into a myriad of unnecessary sections, treating specific mental health issues. Each section then has its own back office support, offices, printers and faxes and all of the service agreements alongside it and so the admin support and costs grow. Time spent delineating patients into the right area and cross referring and handing on grows, with the poor patient an innocent bystander. Again, centralising has to be better economically and for the patient.

And so it goes on. The prescription of common over-the-counter medications such as paracetamol, which costs the patient less than a pound if they go to Tesco but costs the NHS around £43 if they go to the GP for a prescription. The same applies for a long list of products, as we have discussed in the past, including fungal nail pain, suncream, gluten free food and so on.

Now you may say, what is £100m a year on paracetamol, and only £50m on the specials, in the grand scheme of things. But when you take into account all the myriad examples, we could be talking billions overall – and we all seem to concur that extra billions is what is needed, alongside a real cleansing of the rot at the centre that has allowed this situation to develop and grow.

Dr Renee Hoenderkamp is a portfolio and media GP in London


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Readers' comments (11)

  • The descriptors you seek, Dr Hoenderkamp, are:
    1. Soviet communist era economic wisdom
    2. Self-serving bureaucrasy
    3. Vultures around large carcass labelled "free government money HERE"
    4. no or perverse incentives to make things better....communist practices again

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  • yes when the National "NHS" insurance starts kicking in that we all will have to pay out of our payslips I will be thinking about Oz to live and work in.
    I agree that extra money given/generated will be wee'd away as we are all seeing first hand on a daily basis.
    But does anyone actually hand on heart think we can sort this at this late stage?

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  • Biggest “Hole” is the NHS tariff system that hoses vast amounts in to the most expensive and inefficient part of the system.
    I asked Nicholson about this and his answer was that when large amounts of £££ were being put into the NHS they needed a mechanism to get it in there quickly and create more activity.. but that conversation was 6years ago and we still are still using the same “payment by activity” that came in under the profligate labour years, and you wonder why there is so much waste and why we have such a problem.
    Jeremy Hunt a conservative?? .. just incompetent.

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  • Of course there is a scope for cutting good money going after bad. Years ago Hospitals had own maintenance, catering, sterilisation and cleaning in house services. Little by little through the back door, all this was handed over to private providers, large faceless organisations, difficult to take to account. Same applies to in house Locum agency’s responsible to provide Locum cover when needed at reasonable prices. This went to tender too. I personally am aware of one such provider, which owners earned millions out of the NHS, without paying much more to the staff they have been providing. So instead of closing beds and cutting much needed staff, isn’t it time to look where money are leaking to line pockets without any benefit to the NHS. And not to forget the millions, which went to pay for the ambitious IT development project, which went nowhere, overpriced “generics” and compounds. Until all this is addressed, we are going to have this discussion after many winter crises.

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  • Management consultants paid millions, 3000 pounds a day for advice that leaves patients dying on trolleys, cutting doctors and nurses pay [ ie the ones who actually work ], such that there are 40000 empty nursing posts [ You would be reluctant to take any, could be struck off and charged with manslaughter as you would be working for 4 ] while managers gaddy about.

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  • The discussion seems to be around one Goliath organisation v multiple small organisations. This is always going to be a difficult one. Organisations are getting bigger and bigger and that is the current zeitgeist. It does not mean that large is better, but it is easier to control and the powers that be like that. As an analogy banks prefer to lend a one off huge sum to a ‘trusted’ management team / hedge fund than lend the same sum overall to multiple people for multiple mortgages (even less so for small businesses). It is easier for banks to monitor the former. This ultimately leads to more power at the top, which invariably leads to more corruption, rather than ‘a nation of shopkeepers’ as Margaret Thatcher used to call this country.

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  • Just Your Average Joe

    PFI hospital payments bancrupting trusts to point they can't pay for patient care.

    Remove all private organisations from NHS, and ideally government roles, and costs which have silently soared while quality and outcomes have dived.

    The private sector is meant to improve care, instead it lurks like a cancer, leeching off their minimum 10% for profit, and cutting services, pay, and satisfaction, turning everything to Cr@p, while telling us its better than before, like the emperor's new clothes.

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  • Government COULD take a bold step by banning otc drugs on prescription, but it’s far more politically expedient to strongly advise GPs not to issue, whilst still making them available on FP10. Then you can scapegoat the worst GP offenders in a league table, inform the local press to lambast the hapless doctors, et voila, problem solved.

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  • PFI is not inherently "evil", nor are private service providers... IF there were persons within the NHS who are able to understand the nature of the contracts they are signing up to.
    When I was interviewed in 1997 at Medical School I was asked if I thought that there should be any business / economics in the Medical Degree course. I of course with the confidence of youth said "of course not". And then was educated after 5 minutes the importance of at least some understanding. This of course was then not covered at any point from being a fresher to getting my CCT.
    More rigour and expertise is undertaken in choosing a car insurer than is taken to spend money that runs into the billions.

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  • Rory @2.34

    I totally agree with you. One crazy example of economic madness is the one relating to the so-called economic advantages of good management of chronic disease, which supposedly is going to save money. How ridiculous. Good management will undoubtedly increase longevity and probably reduce morbidity, but people just live longer developing far more problems that need to be treated, costing more to the NHS, more in pensions and just delaying the huge social care bill to later in life before the inevitable takes place.

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