By Matt McKeever.
NHS spending has spun out of control and it's up to us to fix it.
Do you know how much money is in your bank account to the nearest penny? Do you know how much you've spent on food and drink this week? I don't suppose you know how much tax was deducted from your pay cheque last month do you? The latter is more likely, but perhaps this is because we resent not having a clear picture of where the money's going?
We are given the option of receiving a receipt everywhere in life other than the NHS. Whether it be at the supermarket, coffee shop or cashpoint we're often asked, "Would you like a receipt?" and usually reply "No thanks, I don't want to waste paper," ( here meaning : "I don't want to be confronted with how terrible my financial situation is.") which is fine for personal finance, (or not as the lending crisis has shown) but when we're talking about billions of pounds at stake there surely has to be more transparency or at least some working shown.
I once heard a story about a man who worked in a bar, he would charge for an extra drink every round that had more than 3 drinks and pocket the difference. When he was confronted about this thievery he responded by saying, "Oh it's fine, most of these people don't care how much it is as long as they get their drinks quickly." Applied to the NHS, this could be disastrous not because people are "cooking the books" but because large discrepancies can remain unseen in busy and large organisations.
The NHS has gigantic economic challenges. The numbers are unfathomable (which is the main problem); a £95.6 billion budget to serve an ageing and growing population of 63.2 million (plus health tourists), a £30 billion spending gap that’s set to grow (and already equates to >25% of the annual budget). It’s all too easy to dismiss large numbers or feel pessimistic when confronted with the scale of these challenges but the most important thing is to “eat the elephant one bite at a time”.
Logic would suggest that £1512/citizen/year (total budget divided by total population) should be more than enough to cover the cost of healthcare, especially when you consider that roughly 50% of people will require any treatment in any given year. However, some of the economic truths about the NHS are scary and unexpected. For example approximately 25% of the population accounts for 100% of the NHS's annual spend in some areas and some £500 million is incorrectly billed every year (from billing the wrong practice through to billing a birth from a man!) We must flag these issues and set about resolving them because if the money goes wrong, quality of care will inevitably follow.
It's all too easy to point the finger at procurement specialists, commissioners and managers, especially when we the public could make the largest impact. As is often the case reflection is required before seeking to play the blame game. So what are the problems that we could help with and how could this happen?
Lack of Transparency
Currently facts and figures about how much things cost are not shown to us until we ask for them. This needs to change because we shouldn't have to ask how much a hip replacement costs (£5-10k) or how much having your tonsils taken out costs (£1,500) to understand what's really being spent. It took more than 20 days to hear that NHS England couldn't respond to my FOI request, instead being directed to search multiple websites to establish that the cost of a GP appointment is £3/minute and an A&E non-admittance costs £120. This urgently needs to change so that we are able to track variation of quality and cost better.
Low perceived value:
At the moment everyone perceives the NHS as being free when it isn't, there is no such thing as a free lunch, and there is definitely no such thing as free healthcare. We're in danger of behaving like young children or the super rich who have no requirement to know, let alone understand how much things cost. Unfortunately when there are no perceived consequences (direct or indirect) for missing appointments, no appealing incentives to be efficient and no chance of the NHS closing down, people will take things for granted.
Rising expectations and sense of entitlement;
It's far too easy for us to hold high expectations of what care should look like and to calculate how much care we're entitled to receiving especially when we know how much we've paid in taxes. Perhaps a better approach would be to understand expenditure as well as income to make an informed decision on what's good or bad.
One way we could address these problems is by sending receipts to patients after receiving treatment. But why not go one step further than this and get them to sign off on the treatment they received? This could empower patients to flag incorrect billing (for treatment they didn't receive), raise problems around quality of care as well as raising perceived value.
Increased transparency relating to quality of care appears to be improving due to increased patient feedback (thanks to wonderful organisations like IWantGreatCare), patient data is looking like it will become more transparent, let's hope economic transparency is next.
Giving patients receipts isn’t going to be the golden bullet solution that cures the financial problems of the NHS, but it might be a good first bite of the elephant.
Next time you’re out and about shopping I hope you look at the label, even if you don't ask for a receipt.
*UPDATE: Here is our example Patient billing certificate
*UPDATE: Pete Crutchley responds to this article with some very interesting thoughts on how sending patients bills will reduce waste - read more here
(Matt McKeever is Network Locum (now Lantum)'s Head of Corporate Services.)
