Opinion by Dr Chris. Editing by Marceline Powell
NHS hospital at home plan, NHS funding, a breaking NHS, and the threat of privatisation. Our very own black British GP - Dr Chris (MRCGP) shares his thoughts.
What a great idea, I initially thought as I saw the first reports about the roll off your tongue U&ECRP – Urgent and Emergency Care Recovery Plan. As a GP seeing first hand the NHS under breaking pressure I wanted to be optimistic.
The plan which was publicly announced today (30th January) plans to treat up to 50, 000 people a month via video link - known as virtual wards.
The Government said that the plan builds on the virtual wards already in place in the NHS, which see patients treated from home while monitored by medics either through daily visits or through video calls.
About 3,000 “hospital at home” beds are due to be created before next winter, with hopes that about 50,000 people a month could eventually be cared for from home each month.
I read in the Telegraph on Sunday, that this 50,000 would eventually equate to half a million patients per year being treated at home. But this is a misleading and inaccurate analysis, and the reality looks very different.
Think about the people who are most likely to be in hospital and those who will need ongoing, multi-disciplinary care – they are the people who are ‘very sick’ and who require ongoing medical care. Most of the patients will be so called ‘frequent-flyers’ and be repeatedly seen through the year- because of their ‘multiple-comorbidities’ (lots wrong with them), who hospitals fail to sort out in the way GPs can, so they become ‘revolving door patients’.
Therefore, the medical professionals for the most part, will be seeing the same patients time and again meaning the 50,000 will largely consist of repeat patients. Therefore, the number of patients seen will not equate to half a million.
The urgent and emergency care plan is being sold as a solution to the ‘gridlock’ in hospitals, but even if the government’s plan to create 3,000 ‘Hospital at Home beds’ before next winter is successful, what of the current 13,000 hospital patients deemed fit for discharge but waiting for residential care or community care? An issue that is compounded by admissions and staff absences due to COVID.
Delivering quality care is what GP practices had successfully been doing since 1948: home visits, telephone consultations, working with Multi-Disciplinary-Teams, Primary Health Care Teams, Community Response Teams, District Nurses, MacMillan nurses, pharmacists, friends, family and in my case even therapy pets to provide a 24-hour, holistic, proactive service.
Funding will come into the NHS to the tune of £14 billion over the next 2 years. Currently, 90% of NHS funding is spent on inefficient hospital care, and less than 10 % on highly cost-effective GP led primary care, if we changed this, if more of this money were distributed among the UK’s 40,000 GPs it would equate to over £100,000 per month: we could reduce hospital expenditure by 10% and double primary care funding and continue to transfer funding from secondary to primary care, until we GPs can once again, mange to prevent most illnesses and treat most conditions at home.
Other NHS professionals have made similar observations about the plan, sharing their reservations about the tip of the iceberg solution.
Saffron Cordery, interim chief executive at NHS Providers, called the plan a “timely announcement” but warned that the plans were “not enough in themselves”. Saying:
“We desperately need action to tackle the vast workforce shortages, staff exhaustion and burnout, and the inability to free up capacity by discharging medically fit patients in a safe and timely way.”
Patricia Marquis, RCN director for England, has also been quoted saying it was the right aspiration, but adding:
“… this plan relies on ramping up community services – services which in the case of nursing have been decimated in recent years,” she warned.
“There is a dire workforce shortage across nursing, and it is biting particularly hard in community services, with the number of district nurses falling significantly in the last decade amid soaring demand and care needs becoming increasingly complex.
“Without investment in staff, this plan won’t make a difference.”
As a GP I wholeheartedly agree with these statements, of course I see the potential benefits in the ‘Virtual Wards’ concept, not least for black and ethnic minority patients who will no doubt have a better recovery experience in their own homes (something they generally fail to get in hospital – see my opinion on this later in the week) But I also have suspicions about the potential wider agenda to privatise the NHS.
The sceptic in me imagines the unintended – or perhaps intended – consequences of virtual wards. I can imagine the Government SPAD advising ministers on a cunning plan to do away with the NHS. Beginning with Hospital at Home, and eventually closing our hospitals to most patients and eventually charging for and out pricing physical hospital treatments. Would the equipment required to continue virtual wards long term, eventually come at a price?
This could easily be followed with a dastardly plan to destroy traditional GP services, (I often wonder if eliminating single handed GP practices that provided personalised care, was phase 1 of that plan and is nearly complete) because no-one will notice except the frail, elderly and vulnerable - everybody else by then will already be forced into private health care.’
Watch this space!