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UROLOGY
The difference between value and cost
Chris Whitehouse, chairman of the Urology Trade Association, discusses the impact of the availability of medical devices on management of continence issues affecting millions of patients across the UK; and how the NHS, when contemplating serious financial pressures, faces demands to reduce costs that reduce availability of medical devices and impact of quality of care.
In 2018, the NHS will be 70 years old. Despite hitting what is quite a milestone – made all the more impressive given how unique the health service was (and still is) when established back in 1948 – it’s unlikely the champagne corks will be popping at the Department of Health’s offices on Whitehall.
Why? Because it’s difficult to argue the NHS has ever faced a greater financial crisis in its lifetime.
When the Chancellor rises to the Despatch Box to deliver the Budget, the total amount of money allocated to the NHS will exceed £100 billion. It’s one of the biggest expenditures of government. And yet it’s still not enough. The reasons for the health service being in the financial version of critical care are well documented. The population has grown exponentially in recent decades. Developments in treatment have ensured life expectancy has increased over the last 20 years. And medical care is, fundamentally, an expensive business. New technologies, medications and techniques cost money. The NHS is also a massive employer. And once technology, medications, resources and staff are paid for, that £100 billion plus just doesn’t go as far as you’d expect. The problem for government is how to fund the health service to the level it needs. As the Prime Minister famously said recently, there’s no magic money tree at the Treasury’s disposal. That means there’s only so much money in the public purse, and so ministers can’t commit endless funds to the NHS. Not unless there’s a willingness to make potentially substantial cuts elsewhere. This means that while there have been numerous requests and demands for more money into the health service (the Five Year Forward View being amongst them), the pressure is on every level of NHS and Department of Health staff to do as much as is possible with existing resources.
SEPTEMBER 2017
urgently needs to learn and take to heart to address the demands on its finances while ensuring quality of patient care. And such lessons are particularly needed for areas such as urology and continence care. More than six million people in the UK experience continence issues. For many it’s part of their management of chronic or degenerative conditions. For every individual, continence problems can rob them of their independence, confidence, dignity and quality of life.
Chris Whitehouse, chairman of the Urology Trade Association.
Cost savings are a major focus. NHS managers and budget holders face nearly daily demands to find efficiencies. But this environment is not necessarily the best one for decision making that reconciles patient needs and expectations with these financial pressures. Simply cutting costs does not necessarily equate to getting best value and utilising financial resources to achieve the best patient outcomes.
An industrial strategy
This is where the Government’s industrial strategy becomes important.
When the strategy was published amidst much fanfare earlier in the year, ministers included value for money from public procurement as one of its central pillars. While this was positioned from the perspective of how procurement can support economic and industrial growth, it also highlighted the importance of the public sector getting best value from its purchasing and contracts. These are lessons the NHS
Managing continence issues requires not just access to medical devices including the many types of urinary catheters, sheaths, drainage bags (those for both night and day), and the cast range of ostomy products. It also requires access to the products that meet the individual needs of the patient, both in terms of their conditions and their daily routines. What’s not commonly understood – including within the NHS – is that one catheter or drainage bag, to give but two examples, is not the same as another. And, while the differences between products may appear minimal, at least to the casual observer, for patients reliant on these devices, small distinctions can be fundamental in enabling independence and the greatest possible quality of life and dignity in managing their continence.
Accessibility is key
Access to the right products can be the difference between enabling them to carry on their daily routines or not. It can be the difference between going to work, or even leaving the house, or not. Unsurprisingly, however, this accessibility to the right products is at risk as a consequence of NHS efficiency drives. And this misunderstands the importance of a range of products to delivering high quality patient care. It assumes that providing a range of products is a luxury rather than a necessity to meet what are often very personal needs.
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