UROLOGY
Simply making a small number of products available on the basis of price doesn’t put the needs of patients first.
It also makes the fundamental mistake of cutting costs without understanding the value that a range of products provides to patients – and actually to the NHS if it means patients are better able to manage their continence issues. Within the primary care sector, reduced access to continence-related medical devices is being driven at local levels. In one sense, this shouldn’t come as a surprise. Despite being very much on the front line, primary care has always been a poor cousin in terms of funding to acute settings. That’s not to trivialise the pressure hospitals are under. But primary care receives less than 10% of the NHS budget, presenting very real difficulties. The demand and need for savings is resulting in increasing numbers of Clinical Commissioning Groups introducing formularies that restrict the range of medical devices available to patients – who would doubtless be horrified that the bottom line was a, and perhaps the, determining factor in their care. It’s a situation that is also compounded by a lack of knowledge and understanding amongst clinical staff and healthcare practitioners, many of whom do not appreciate the importance of a range of medical devices to support the unique needs of each patient. Many clinicians are ill- equipped to advise on the most suitable continence products for an individual. This is a point noted in NHS England’s Excellence in Continence Care guidance of 2015, which recommended improvements on training for continence issues across the health service. But the reality is that while there is a push to make savings, a lack of knowledge prevents the continuing restrictions in the range of medical devices available to patients being effectively challenged.
Impact on care
That means reduced access to the devices needed by patients, with an impact of quality of care, but without the appreciation within the NHS of how short-term financial decision making is not realising long-term value. Speaking on Radio 4’s the Today
Programme before leaving his post as chief inspector of hospitals for England at the Care Quality Commission, Professor Sir Mike
Once it’s accepted that one product is not the same as every other in its type and that there can’t be a ‘one size fits all’ solution for patients with continence issues, it becomes clear that decisions based on cost are but short-term in nature that ultimately don’t address the fundamental issues of NHS finances.
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About the Urology Trade Association
The Urology Trade Association (UTA) is the leading urology industry membership organisation in the UK, representing 95% of urology product manufacturers and
suppliers to the urology appliance market. An estimated six million people in the UK are affected by continence problems and many rely on urology appliances on a daily basis. High quality urology appliances allow users to manage their conditions, maintaining their quality of life
and independence and avoiding repeated medical consultations. The UTA is a democratic association that openly invites the contribution of all members through
regular contact and quarterly membership meetings, during which the Association’s work programme is discussed and members shape and guide the Association’s priorities. For further information visit
www.theuta.co.uk
Richards noted that, while the NHS would undoubtedly benefit from more money, there are still improvements to be made to prioritise patient care – in addition to investing more in the health service. The point we should take from this is, while financial considerations must of course remain a focus, they cannot be the determining factor in clinical decision making. So, what does this mean for continence care as an example of costs versus value? Once it’s accepted that one product is not the same as every other in its type and that there can’t be a ‘one size fits all’ solution for patients with continence issues, it becomes clear that decisions based on cost are but short-term in nature that ultimately don’t address the fundamental issues of NHS finances. Nor are they the best decisions for patients, for whom cost-based planning is harming quality of life, dignity and independence. Such an approach can not only rob patients of their ability or even desire to leave the house, but also can leave them exposed to clinical issues such as increased infections.
And this means the issue of cost-based decision making in the health service isn’t just about patient experience and quality of care. The procurement of continence devices by the NHS will have longer-term consequences on the drive to save money. By limiting the types of continence products available, and reducing patient choice, the health service is unwittingly storing up problems for the future. Patients can be left vulnerable, and with the potential of increasing numbers of infection can – in the most severe cases – require costly admissions to acute care, something the NHS is desperately trying to avoid. The Government’s focus on life sciences and procurement within the industrial strategy was very welcome. But ministers must now reflect on how to ensure that procurement is focused on value as well as price, and how well-intentioned but ill-considered decision making can harm both patient care and the NHS’s finances: truly the worst of both worlds.
CSJ SEPTEMBER 2017
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