I read a headline last week from
the Health Service Journal (HSJ). I couldn’t read the whole article, as it’s
behind a paywall and I absolutely don’t want to give any of my hard-earned cash
to the HSJ. The headline suggested large acute Trusts in the NHS were
shouldering unreasonable risk, because their funding had been ‘top sliced’
to pay for ‘well-meaning’, but unproven neighbourhood health schemes.
This claim came from Shane DeGrais,
who is the Group CEO of Barts Health. St Bartholomew’s Hospital is the oldest
hospital in England and is one of five hospitals that make up the Barts Health
Group. Developing and investing in neighbourhood health centres is part of the
NHS 10 Year Health Plan. It is one tangible example of what moving care from
hospitals to the community might involve; one of the so called ‘left shifts’.
A couple of things struck me, as
I read the headline. One: - for many years, the acute sector has enjoyed a disproportionate
amount of national NHS funding, in comparison to mental health services,
primary care, and community care service. The acute sector has grown exponentially
over the past few decades. Two: - the acute side of health services has been
and probably will always be, a political hot potato.
Long waits to be seen in A&E
departments, long waits on waiting lists, too many patients stuck in hospital,
because community care services are not readily available, are what keeps most
Secretaries of State for Health and Social Care awake at night. And of course,
the media loves to tell a story about health care failings. The HSJ is no
exception.
Reality is a little more nuanced,
however. Last week, I read with glee, an article published in the BMJ, written
by one of my favourite commentators on NHS services, David Oliver*. David is a
consultant in geriatrics and acute general medicine. He practises in Greater
Manchester. His observations would give any cultural anthropologist a run for
their money. David questioned whether the ‘home good, hospital bad’ credo
is a possible false binary. His is a well-articulated and fair article. You can
read it here.
Among other things, David puts forward
the case that hospital stays can both be harmful in some situations, but
allowing a patient to stay in hospital for a day or two longer if they are not
ready to leave, might be a good thing. Based on an average cost of £2300 night
for an acute stay, those folk responsible for managing hospital finances might
challenge this latter assumption. Acute beds are nearly always scarce, hence
why so many acute hospitals resort to using corridor care. One in every eight NHS
beds are filled by those, who are clinically ready for discharge, but where appropriate
community care to meet their ongoing needs is not available.
It’s a complicated picture for
sure. In such circumstances I seek to be grounded by my own experiences. Regular
readers of this blog will know I’m a great fan of primary care services. Where
I live, near Blackpool, we have both great primary care services and fairly
comprehensive neighbourhood health care. Last week I received a letter stating
that following my recent CT scan, I was not showing any signs of lung cancer.
Phew! The CT scan was carried out a few weeks ago by mobile scanning services
set up in a rather dodgy carpark in South Shore Blackpool.
Now don’t get me wrong. When Jane
needed specialist neurosurgical care, she got it from a great NHS specialist
service just 10 miles down the M55. A fantastic intervention that saved her life.
Improving her subsequent quality of life, well that came from a brilliant community
neurological service firmly embedded in our wider neighbourhood health care
services and the exercise referral team. So, I’m thinking, if others can benefit
from such services, then sorry Shane, but let’s move the money. Reach out your
hand and together we will make a difference.
* You can follow David here David Oliver (@mancunianmedic) / X