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We need centralised NHS spending plans not ‘Airbnb’ follies



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