Sunday, 6 November 2011

Just Business

The following is based on a conversation I was having at work the other day with a few of my medical and nursing colleagues.

We are all feeling a little disenchanted with healthcare at the moment, More and more the focus is being shifted from patient care onto costs and public ratings. If you look in the stock cupboard of any ward in my hospital, on the shelves beneath the boxes containing all the equipment we use on an hourly basis, are labels telling us how much each item has cost the hospital.

Pharmaceutical companies spend hundreds of millions researching and trialing new drugs, and if the drug works really well they pub a massive price tag on it. In some cases this prices the NHS out. We cant afford to buy drugs with high efficacy ratings. I know drug companies have to recoup their investments but once they have done that and start making a substantial profit they still dont drop the prices, so my patients are receiving treatments that whilst still largely effective are not the best on the market.

My hospital recently had a status upgrade, we are now a foundation trust, this means that we receive a slightly increased budget from the Department of Health, but more importantly we get to say how we spend our money. In a normal trust the DoH give you x amount and say you have to spend 10% on this department and 4% on this department. So this financial liberty is a great first step in ensuring we can provide better care......right? I mean we can personalise our budget so departments like sexual health can be downsized as in this area there is an unnecessary abundance of sexual health clinics, the hospital should not be required to provide another, superfluous service. Cutting off the fat should be a good thing.....RIGHT?!. Apparently not, my hospital has just spent over £320,000 on the name change, literally just adding "foundation" into its name on all the signs and headed note paper. £320,000 is how much it would cost to hire thirteen new staff nurses for a year. However clearly the name change is more important. I am sure there is some legal issue requiring the immediate name change however it just annoys me when I am struggling on a ward that has to rely in agency staff of questionable skill and training on a daily basis. Even the best agency nurse wont work at full efficiency on a ward that is not her own.

The nature of healthcare and medical progression is such that it is now possible to offer individually tailored treatments for most ailments. Something like asthma, you can now manufacture drugs in a lab based on an individual patients precise unique physiology, offering a treatment so good its almost a cure. We cant afford that, so when I get a brittle asthmatic in, a normal every day human being whos caught a cold, and she asks me if there is anything else I can do to stop her suffering(and having lungs so inflammed the body is screaming for more oxygen would be my definition of suffering) and I tell her "the salbutamol, aminophyline and magnesium are the treatments we give all our asthmatic patients, you'll be feeling better again in a few days". How can I keep a straight face knowing there are drugs out there that could have her home the next day, or even prevent the acute episode to start with, but they are too expensive for the NHS.

Most Doctors and Nurses get into the job because we want to help people(its sure as hell not for the money or the high quality of life health work provides). Unfortunately our bosses are keen to remind us a hospital is a business.

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