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A faulty production line

We need centralised NHS spending plans not ‘Airbnb’ follies

Renee Hoenderkamp

You couldn’t make this up. An NHS trust has seriously considered paying members of the public to take patients into their homes for rehabilitation for £50 a night. ‘All they have to do is supply a bed and bath and three cooked meals a day’, it has said. My god, where to start?

There is no question that the sad state of community care is a major problem in the log jam that we now see in hospitals, resulting in longer wait times in A&E, inappropriate and unsafe discharges and the inevitable dumping of workload on GPs.

So how can this new ‘Airbnb’ style community NHS possibly ease any of that? It can’t in my opinion, and will even be dangerous.

What puzzles me constantly is the lack of forethought and joined up thinking that haunts almost every aspect of NHS planning and running. In a chronically underfunded and increasingly stretched service at every level, what bright spark thought that this would be more cost effective than funding the existing community care provision?

And isn’t this the crux of all NHS over-spending, with the creep of more and more decentralisation and therefore more expensive running costs?

Don’t get me wrong, I am at heart a free market capitalist. But after spending 20 years working in the private sector and then retraining to become a doctor, the one thing I am sure of is that centralisation is the key to efficiency savings in a beast such as the NHS.

Let’s not unpick it all (although I would love to). For the brevity of this piece, I will focus on the main drawbacks of this latest proposal.

Firstly, the cost of paying these new hosts/carers is an open ended cheque book, as length of stay can’t be predicted – as we know from the current dilemma.

But before we get there, there will need to be some sort of vetting and checking system, no doubt adding to the DBS queue that already plagues us. Other staff will be needed to do these checks, and then administer the control and coordination of patient placement and then the payment of said ‘hosts’. So a whole new little industry will pop up within the NHS, a la the appraisal system, the CQC and so on. More on-costs. The NHS managers may tell you it will be handled by the already existing and creaking provision, but of course it won’t. 

Then there is the location. Will these patients be placed within their current GP catchment area? If not, will they be registered as temporary patients at another GP? It is surely inevitable that their health care needs will be high, along with medication reviews and tweaks, dressing changes and on-going rehabilitation needs. This will fall once again into the laps of GPs, so increasing the primary care workload and reducing appointment availability even further.

It is among the stupidest ideas I have heard – and we hear a few in the NHS. We need some sensible thinking about the budget, the on-costs and placing this money into existing services where it might be used so much more efficiently.

And longer term we need an even bigger conversation about centralising all buying and enjoying the power that this would bring in terms of driving costs down.

Dr Renee Hoenderkamp is a portfolio and media GP in London





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Readers' comments (7)

  • The politicians have been staying at airhead B n B

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  • We need a health system that is fit for purpose aling the lines of every other western health system (excluding the U.S.). Co-payments and insurance. DOOOH!!!

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  • Central Planning is a large part of the problem; this scheme may be daft, but local providers need to be free to experiment, to try new ideas and adapt to local circumstances.

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  • Read some Hayek. Central planning is impossible.

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  • Vinci Ho

    Qu Yuan(屈原) (340–278 BC), famous ancient Chinese poet and emperor advisor , threw himself into a river as his emperor, surrounded by a crowd of corrupt officials, refused to listen to any of his desperate and urging advices.
    People missed Qu Yan dearly and they made wraps of rice and threw them into river to prevent fishes eating his body.
    These days , on the 5th day of the 5th month of the Chinese Calendar, we have dragon boat races (to frighten the fishes away) . Indeed , we call it The Dragon Boat Festival or The Duanwu Festival.
    More importantly, these were his famous words:

    ‘’The world is like a pool of cloudy water :
    The wings of a cicada is considered to be heavy but a thousand jun(ancient Chinese weight unit , about 15kg) is light.
    Relinquish the yellow bell ( like Big Ben) and use an axe on roof tiles to make the noise instead.
    Those maleficent are running high but those with talent and virtues are no where to be seen.’’

    This is so telling to me.
    After all ,right is wrong ; wrong is right .
    Our battle goes on ........

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  • This brings me cautious optimism:

    "Don’t get me wrong, I am at heart a free market capitalist. But after spending 20 years working in the private sector and then retraining to become a doctor, the one thing I am sure of is that centralisation is the key to efficiency savings in a beast such as the NHS."

    Even a "free market capitalist", acknowledging that the market isn't the solution to everything? NOw we're on to something!

    The inverse care law is relevant here. Not just the first bit, that everyone knows, but the rest of it -

    "The availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced. The market distribution of medical care is a primitive and historically outdated social form, and any return to it would further exaggerate the maldistribution of medical resources."
    (Tudor-Hart, The Lancet, 1971)

    Big and Small - "Read some Hayek. Central planning is impossible." -
    Friedrich Hayek, Milton Friedman, Ayn Rand and John Nash are basically responsible for this whole godawful mess we find ourselves in.

    "Greed is good", "There's no such thing as altruism" "the automatic system - everything works better if each individual just acts selfishly" - is this really the world we know and love? Who would want to live in such a world?

    Neoliberalism, selfish individualism, has encroached on all areas of humanity over the last 100 years. Now it's coming for the NHS.

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  • Vinci Ho

    Look at the world :There is a Third World War happening and it involves three camps:
    (1) Those(western countries’ elites)who have been supporting neo-liberalism last 20 years with an end product called globalisation . Unfortunately, liberty had been aggravating(instead of solving) inequality .
    (2) Right wing ideologists supporting protectionism(e.g. Farage and Trump) and neo-totalitarianism(Putin in Russia , Xi in China , Erdogan in Turkey , Dutetre in Philippine , Assad in Syria etc). One has to note there is also a lone wolf representing the old totalitarianism on the left wing , called Kim in North Korea.
    The war between (1) and (2) is largely cold in nature up to now ; in fact , the war is often a civil one ( within the same country).
    (3) The Islamic extremism is fundamentally about the religious conflict between Sunni and Shia , two ramifications of Islam. This camp will easily attack anyone in (1) and (2) depending whether he/she supports their opposition. The type of war is direct but also stealth( as characterised by lone suicide bombings , for instance)

    The complexity of this ‘war’ is accentuated by the presence of new ‘transparency’ created by internet and social media .
    Freedom of speech and publication are being critically challenged, by so called ‘fake news’ or more appropriately ,disseminated misinformation(s).
    In nature , there is also a virtual war between digital democracy (zero censorship in western countries) and digital dictatorship (absolute censorship in China , Russia etc).

    Against the backdrop of this ‘war’ , the calamities of Trump and Weinstein/Spacey/ Westminster sexual harassment scandals , perhaps, have now asked the serious question of what should be the telos of western democracies?
    Clearly our younger generation(s) have much higher expectations on our politicians.
    To me , the ideal of clean , transparent and humble politics upholding social justice is the only alternative left in this brave new world of 21st century.

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