Changing policies can help strained NHS to shape up
THE NHS is in the spotlight once again following the recent Budget. Indeed, the rise in National Insurance contributions was defended on the back of pledges that the extra revenue raised would go towards addressing some of the backlog to healthcare and homecare from the pandemic.
One of the biggest issues facing the NHS is the problem of ‘delayed transfer of care,’ more commonly referred to as ‘bed-blocking’. The scale of bed-blocking impacts upon almost every area of healthcare provision and obviously has a knock-on effect on waiting times causing delayed or cancelled treatment, which can then exacerbate health conditions or slow recovery rates.
It’s been estimated that the problem is so bad it costs the NHS around £3billion a year and cancelled operations, due to bed-blocking, are thought to cause around 8,000 deaths each year.
There are many causes of bedblocking, but one of the biggest is elderly and disabled patients waiting for homes to be adapted before they are discharged. The healthcare industry has been aware of this for years. Indeed, the British Healthcare Trades Association (BHTA) commissioned a report from the London School of Economics into the cost benefits of investing in homecare.
The report concluded that if investment in homecare aids and adaptations was at the heart of its adult social care reforms it could yield a potential annual saving of £1,101 per person, per year. The NHS Alliance highlighted the correlation between effective primary care (social and community care) and secondary care (hospitals) as part of the solution to an overstretched health service.
It also stressed the significant benefits to healthcare of patients being discharged from hospital more quickly into a social-care environment.
Things like more rapid assessment in hospital, addressing the shortage of Occupational Therapists, and greater provision of Trusted Trained Assessors could all help to address the problem. Everyone agrees that greater integration of health and social care systems is crucial.
There also needs to be a fundamental overhaul on the way healthcare and social care is procured.
Many public-sector contracts are awarded using what is called the ‘Most Economically Advantageous Tender’ (or MEAT for short). Too often, current procurement practice does not allow for cost efficiencies to be taken into account when buying or evaluating supply contracts and tenders if the beneficiary is a different department or healthcare organisation to that of the purchasing budget holder.
Invariably, lower prices tend to override speed of delivery when it comes to the supply of community care equipment.
This often proves to be a false economy when other costs are factored in such as additional community nursing needs, respite care provision and all the costs that follow from delayed transfer of care.
Therefore, procurement policies need to change to promote speed of delivery and long-term cost/benefit analysis for all involved.
Primary care providers need to change from a strategy of ‘cost effective procurement of goods and services’ to one of ‘cost effective delivery of goods and services’.
Key to this change will be the ability to identify any cost savings and efficacies in other areas of healthcare and beyond. These savings can then be factored into the overall evaluation of future healthcare procurement.
In summary, a more rapid assessment of the need for community equipment and a more appropriate procurement process, prioritising speed of delivery, could assist significantly in reducing the scale of the problem to everyone’s benefit. As someone who was part of the team that drafted the BHTA bed-blocking paper, I would be the first to say it won’t be quick or easy.
However, if the key suggestions are embraced, implemented and persevered, there is a real opportunity to reduce considerably the instances of bed-blocking and all the associated misery and waste.
However, herein lies the problem. Despite acknowledgement of this, current procurement practice has not changed. This was illustrated a couple of years ago when Durham County Council chose not to award a regional community care contract to a local company.
It felt the cost benefits to the NHS of being able to discharge patients back into the community three weeks earlier than previously wasn’t a consideration the council could take into account, as the cost savings would not be reflected in their budget and to do so would contradict procurement rules.
Understandably, the company from Newton Aycliffe that lost the tender were left frustrated and wondering why they should bother developing cost-effective solutions to homecare if they can’t be considered or realised.
Council and social service budgets for community care are invariably stretched and under increasing demand, so it isn’t surprising there is little appetite for cross departmental co-operation, but that doesn’t mean it shouldn’t happen.
Presently, public-sector procurement strategy is placing much emphasis on “cost-effective procurement of goods and services,” when perhaps they should be looking at “cost-effective delivery of goods and services.”
There is a small, but significant, difference between the two and if they focus on the latter, we could get a lot more healthcare for our taxes.
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Lower prices tend to override speed of delivery when it comes to the supply of equipment. This often proves to be a false economy Angus Young