Radical plan to streamline NHS services announced

Home surgery could spell end of NHS cuts
The BBC last week reported that a man with a gangrenous foot cut off his own toes after a hospital operation had been cancelled. Doctors said the operation, performed with a pair of surgical pliers had probably saved the man’s foot. It also saved the NHS the cost of putting him under the knife.

The government said the case illustrated the potential to improve NHS outcomes and efficiency without inconveniencing taxpayers or putting further demands on hard-working ministers preoccupied with Brexit plans.

Operating framework

NHS Improvement has started work on a self-care tariff that would reward patients with John Lewis vouchers for cutting out layers of bureaucracy including doctors, nurses, anaesthetists and hospitals. The so-called “personal surgery budget” will incentivise people to tackle their own diseased limbs and organs rather than relying on the state to intervene.

The Department of Health dismissed concerns raised by leading doctors about quality and safety. “These will be dealt with by the payments system, which will promote high-quality care by only rewarding good outcomes. It won’t be in patients’ financial interest to make a mess of their operations,” a spokesman said.

Patients in control

The government said that a radical move towards self-care could be the solution to the financial problems facing the NHS, with big potential savings in training alone.

“No one has the time for formal medical qualifications any more. In the digital age they can just download a tutorial from YouTube and get going,” he added.

A further benefit is that patients would no longer need to travel miles to receive treatment, but would get the care they need in the comfort and convenience of their own homes.

“People would also learn useful new skills, such as sewing, which they could apply in other areas of their lives,” the spokesman said.

Surgical spirit

While there are doubts about the ability of individuals to carry out procedures requiring a general anaesthetic (defined by the new NICE home surgery guideline as more than one bottle of brandy), a leading think tank said this is where more community-based approaches would be required.

Neighbours and networks of community “in-reach” workers could be enlisted for complex procedures including heart surgery.

Children could also be useful, particularly in delicate areas such as neurosurgery where their small fingers could be an advantage.

Public Health England warned that children should not be allowed to perform any surgery without adult supervision and reminded parents to take particular care before letting them loose with scalpels or power tools.

“This idea definitely has legs,” said a government spokesman, “for the moment at least.”

Shares in Kingfisher, the parent company of B&Q and Screwfix, rose sharply following news of the initiative.

DIY editor: Julian Patterson

COMMENT (https://www.networks.nhs.uk/editors-blog/home-surgery-could-spell-end-to-nhs-cuts/view)

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It’s about time people took responsibility for their own illness. It sickens me that they can just turn up to hospital, have someone else do all the hard work for them and then be waited on hand and foot inbetween sleeping. It’s a national disgrace.

As a man waiting for varicose vein treatment (OK under the knife), I could get some school leaver to try out his / her skills with a stanley knife.:+1:

Lazy git, do it yourself.

I’d have thought if you can fit a megabucks cartridge to your turntable you shoud have a steady enough hand to use a scalpel and do the operation yourself.

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Holidays for the disabled.

Butlins camps to be nationalized. After oven and chimney renovations, long-stay vacations for all disability benefit recipients. Immigrants also welcome.

It won’t need any streamlining once we get the £350m a week windfall from Brexit :nerd_face:

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You sound like an enemy of the people. I shall have a baying mob sent around to deal with you. Are you a high court judge? If so, we offer a choice of public crucifixion or the more traditional beating to death with a brick.

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Rather poorly written and explained piece on the Beebs website about the NHS plans to shift care out of hospital and save money. Factually correct but poor analysis.

It’s tragic when what might in fact be rather a good idea is made into a bad one by poor quality implementation. When I was young a good deal of the treatment of mental illness took place in large institutions. These places were forbidding, quite often remote and not cheap and they disempowered patients and their families at precisely the moment that the reverse was needed. But at least they were there, both in a crisis and when longer-term care was required. And their monolithic nature made it difficult to cut their resources (if somewhere has X beds one year and X/2 beds the next, or if it closes altogether people notice).

‘Care In The Community’ actually looked like being a better approach from a clinical point of view for all but the most severely ill patients. It should have allowed substantially better results to be delivered for the same or just a little more money if it was well-organised, properly resourced and rolled out in a way that didn’t leave cracks during the transition. But it seems it wasn’t. Today the treatment of mental illness in this country is quite literally disgraceful. The impacts on things like social services, the prisons and even the education system are the prices that society is paying for doing a cheap shoddy job in the first place. Let’s see how the plans for transforming general health provision measure up against that example. I confess I’m not optimistic.

VB

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“cutting some specialist services such as accident and emergency”

Yea, cos thats a working plan!

I say, stop hurting yourselves!!

I went walking the other day and afterwards my left foot was a bit hurty. I have bought some black market morphine with my own hard earned cash and now I don’t feel any pain and don’t care about anything either :+1:

I’m buggered if I’m going to sit waiting for hours on end blocking up valuable NHS resources for those really in need with serious cuts and bruises when you can simply use your own initiative like I have.

That can happen when you jump off of large dead trees :rolling_eyes:

You’ve been looking on that facepalm site haven’t you :slight_smile:

I’m afraid so :pensive:

Took us ages to axe that tree down too, nice to get out in the country side though :+1:

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Not sure you should be admitting that…
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.Excuse me Sir :cop:

Bloody nanny state again, can’t do this, you can’t park there, lalalalalala, meh!

Agree. The state of mental health care is utterly appalling despite the very strong economic case for investing more resources into supporting greater numbers of people with lower level needs. Millions of working days are lost through stress, anxiety and depression, and the chronic habit of ignoring these is proven to lead to crisis, breakdown and physical health problems too.

The model that mental health reform was built on is entirely sound, and I agree it has been poorly implemented for all manner of reasons. It was top heavy with a disproportionate amount of resources dedicated to relatively few acute cases and almost no attention to the high prevalence lower severity conditions. Largely but not entirely because the clinical leadership in mental health is monopolised by a cohort of dickie-bow wearing, academic leaning, consultant psychiatrists who are only interested in two things, unusual and severe cases, and being published and clearly these things go hand in hand.

What we need more of instead is greater numbers of therapists and a focus on self care and prevention which is enabled rather than gate kept by experts.

Precisely the same logic underlies the mainstream health reforms, that more care could and should be managed and delivered outside of specialist acute centres like hospitals which have a workforce model which is again too centred on the aspirations of consultants which makes the model of care expensive (which is fine) but not appropriate to large numbers of people’s actual conditions which don’t require the utmost level of expertise in every case. But we have grown up with and instituted an ‘all roads lead to hospital’ model by default rather than by design. The system is currently buckling because although the growth in demand for urgent and emergency care was entirely predictable (ageing population with increasing numbers of long term conditions, effects of lifestyle health issues like alcoholism, smoking, obesity and mental health crisis) the building up of additional capacity out of hospital never happened and now the demand crisis is here there is neither the time nor the money to put this in place quickly. That’s why we now have an expensive bed based (horizontal queuing as I call it) care system which is now overly utilised with no release valve in sight. Add to this the short sighted cuts to social care which are resulting in difficulties discharging clinically fit but still unwell older people back into community settings or preferably their own home with care, you can see a perfect storm brewing.

Again it’s a lack of basic implementation skill. The NHS and government should have been having this debate in public over five years ago but instead they’ve pushed responsibility into regions who have then been pulled apart by clinical professions, political interference, interest groups and the public at large. So they’ve largely tried to do this in secret which only leads to suspicion and opposition before any of the facts are considered (which probably justify that cynicism!).

Now we have, as I’ve repeated a few times, a health system in real crisis, with less resources and more urgency to change, but without the support of key clinical leaders, politicians and public. It’s not hard to see the debate around cuts obscuring what is a more fundamental debate and need to make change quickly.

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Let me be the first to say tl;dr :slightly_smiling_face: