Joe's Diabetes

NHS: Take a Step in our #135Shoes

This week began with news that the Health Secretary, Jeremy Hunt, is asking doctors (specifically consultants) to work weekends. This is because, at the moment, if you’re admitted on a Sunday to an NHS hospital you are 16% more likely die than if you were admitted on a Wednesday. Fairly shocking.

The doctors argue it’s not just them that needs to accept weekend working: there are other valuable people in healthcare that only work 9-5. Without more support, doctors will be at the hospital but unable to give proper care. In essence they argue more staff are needed because under current weekend working plans the system would become spread too thin. It would mean having the same amount of staff working longer hours. With life or death decisions to make, clearly this is not a good idea.

Of course, they can’t hire more staff because the Government won’t shell out any more money. It’s a classic case of Empty Words Syndrome, for which currently there is no cure.  

Or is there…

Also, in the news was the scandal that 135 people have a foot or lower limb amputated every week, many of them diabetics. As such, it is estimated the 80% of these amputations are avoidable. This has a great human cost: not only have they lost a foot, but amputees tend to be more vulnerable to further complications and disease. There is also an economic cost. Just in terms of healthcare (let alone loss of income, productivity loss due to pain, the energy implications of looking after sick family members etc.) amputations cost the NHS £660m in 2010-11. Given the number of diabetics in the UK has risen since then from 2.6m to 3.2m (+23%), if the number of amputations have grown proportionally then they now costs us around £811m a year. Probably, thanks to an ageing population, cuts to services that may have helped prevent amputations (check-ups, foot clinics, chiropody services etc.) that amount is even higher.

‘Where’s the relation between these stories?’ I hear you ask. That is exactly the problem; there is no joined-up thinking that suggests the one might relate to the other. And yet they do. The first story is about failings in acute care, the second about failings in long-term care. The NHS was set up as an acute service: in 1948 making sure people got healthcare at all was the main concern, and there were far fewer people who had long-term conditions (LTCs).

Now though, long-term conditions are the ever growing problem. Already the cost of diabetes care accounts for around £10bn a year, 10% of the NHS Budget, and as a greater proportion of the population gets older the more of an issue it will become. The problem is that the system isn’t designed for dealing with LTCs. This means time and money gets spent inefficiently, leading to poor healthcare outcomes and further need for acute care. If you improve long-term care, then you should be able to save enough to relieve the pressure on acute care and make everyone’s lives better.

So how do we improve long-term care? Well, the first step is to change the patriarchal attitude of Healthcare Professionals (HCPs), particularly doctors. LTCs need constant care and the people who have are effectively their own medic 24/7. But people need help; to be managed properly LTCs require a partnership between HCPs listening to people with LTCs. Only then can we get the outcomes that will benefit everyone. Only then can we get the healthcare we all deserve.

If you want to improve the NHS, take a step in our #135Shoes.