I’m under no illusion as to how much my ‘free’ healthcare costs in the real world. And I’m not even talking about actual treatment, I also mean all the hidden costs to the NHS people are unaware of. I’ve lived in France and experienced how insurance based healthcare works (to an extent) and had the unpleasant feeling of not knowing if my insurance covered an ambulance call out off the top of my head, and could I afford to pay for it out of pocket if it didn’t.
I’m a model patient. I take all my meds, I turn up to all my appointments, do all my physio… if anyone knows how to save the NHS money and use it properly it’s me. But it’s chronically underfunded and isn’t actually equipped to deal with long term chronically sick people because the money it’s given is mostly used to put out metaphoric fires rather than long term provision. Here’s how I ended up costing the NHS a lot of money a couple of weeks ago, despite everyone’s best efforts.
I had a run in with a post office employee, and the counter is based in my pharmacy. I needed an ambulance so I dialled 999 and got put on hold because the ambulance service was extremely busy. One of the questions is about immediate threat to life, so I said I wasn’t immediately dying and not to use the red flag which I have against my name- it gives me a fast call out because of my medical condition. In the meantime, the pharmacist was the only medical person onsite so he had to stop what he was doing to look after me. Which is fine, but obviously him not doing his actual job has a knock on effect and this post is all about how tiny ripples end up costing the NHS.
The ambulance took a long time because it was so busy, so after 40 minutes and because I was getting worse, I rang 999 again and asked them to activate my red flag so I could get an ambulance there on blue lights. But the ambulance they were already sending was the nearest one, so they just upgraded the call from amber to red. In doing so, it set off the blue lights while stuck in road works traffic, which freaked out a driver who ended up having a car accident by driving into a skip lorry. So the ambulance had to stop and make sure everyone was ok before carrying onto me. It was only a couple of minutes but because that happened, they didn’t get to me in the allocated time for a blue light call out so would have had to pay a fine. Big cost number 1.
We got to hospital and a&e was also backed up. There’s nearly always people in the corridors waiting but it was particularly bad today. I got given more treatment by a consultant and then she said I could go to MDU/GPAU to be seen by the medical doctors there. This is a day ward where GPs can refer patients who need hospital treatment and/or a decision about whether or not they need to be fully admitted. This made sense because I didn’t need emergency intervention anymore, but I did need hospital intervention and possible admission.
However, they were also really busy. One of the problems with this ward is there is usually only one senior doctor on and lots of junior doctors. Who normally don’t have a clue what to do with me, and in any case, they’re not actually allowed to make decisions about complex patients like me. The staff on this day weren’t good at working as part of a team, there were a lot of temporary staff or staff who’d clearly been drafted in last minute to cover the hecticness so nothing was happening very quickly. It’s hard to be efficient when you don’t know who anyone is or where things are kept.
But the nature of my condition means I have to have certain meds at certain times, and because I was in hospital, I needed a doctor to decide whether I needed to be on IV or oral doses and write this up. Which meant a lot of arguing with the nurses to get the senior doctor down to decide so that we could get the drugs written up. In making him come and see me, this obviously upset the already fragile ecosystem of the junior doctors which wasn’t working anyway and had a knock on effect.
Senior doctor decided I needed a chest x ray. But by now, it was classed as out of hours, so sending me for a chest x ray from this ward would cost more than if I’d had it in normal hours. Which would have been fine, except for the fact it took 4 hours longer than everyone thought it would. Had I been sent for the x ray from a&e it would have worked out cheaper. In a lot of cases, they would normally discharge someone and tell them to come back the following day for their x ray if that was the only bit of the puzzle we needed. But that’s not possible with cases like mine, which meant I needed admitting until the chest x ray was done.
But there weren’t any beds anywhere in the hospital. Because it’s a medical decisions unit, the ward closed at 2am, meaning that there weren’t any staff allocated to it beyond that time. However, there were 3 of us needing beds and at 2am, the ward would ‘breach’. This basically means go over the target time and everyone gets fined. Plus there’d need to be staff to look after us so either the hospital pays them overtime or they stay on beyond the end of their shift and don’t get paid.
In my case, because I came from a&e, I would I also cause a breach at 12 hours. Which was about 2.30 am. I could hear the ward manager getting more stressed about it as she tried to find me a bed. Here’s what she tried to do:
– no beds on assessment wards so she tried other random wards
– no beds on those so they had to open another ward
– they’d already converted some wards elsewhere in the hospital and they were full so they had to convert a day ward into a night ward
– but day wards have stretchers not beds, so she had to wait for people to physically bring her beds
– then she had to get the senior doctor to sign off on staffing. But he was the medic on call so was elsewhere
– nursing staff had to be found to staff the ward. They took time to arrive
She didn’t manage to get through all that before I breached and they would have got fined. But by now they’d already got fined so she carried on sorting it.
In the end, I ended up on a ward from 3am-7am by myself, with my own nursing/healthcare staff. I’m not even joking. There was me on a ward full of empty beds and 2 nurses and a healthcare. All because I needed an x ray and they didn’t want to pay for out of hours service.
At 7am, 2 other patients joined me from a&e. But, remember this ward is a GP admissions day ward, so they had to convert it back for 8am. So they had to put us in isolation rooms so we had somewhere to be while waiting for ward round. Not a big deal but that’s still cleaning, porter and extra nursing staff that have to do their jobs for this to happen.
Then we obviously needed feeding. I’d told people about my medical diet but the kitchen needs orders in for ward meals the day before and I hadn’t been admitted then. Which means the ward has to ‘buy’ my meal from the canteen, which is another expense, not to mention the member of clinical staff they sent to go get it.
I got my chest x ray, the consultant reviewed me and I was discharged. Had they done the x ray the night before, it would have worked out cheaper. Instead my overnight stay would have cost thousands. The consultant was livid.
The sad thing is, it was a pretty stressful admission for me too, so it’s not like I received amazing care and the staff bore the brunt of it in the background. All of us had a terrible night. The system is broken if staff can’t do right by their patients and if patients are receiving suboptimal care. Yeah, I was kept alive but I didn’t have a place to sleep until 3am, I had to argue for my basic meds, I was herded around like cattle, I didn’t get given a meal from 15.00 one day til 8am the next. Add in an orange jumpsuit and I may as well have been in some kind of prison.
Why’s it like this? Because people are putting out fires rather than thinking about what happens further down the line. The fines they’d have had to have paid on me in that 24 hours would have been thousands. And they were just trying to stop one fine after another. What else can you do? The problem is bigger than the individual hospital. Staff can only do what they can with what’s in front of them at the time.
Add all the fines/costs to the treatment I did actually have and it works out very expensive:
– a&e assessment and intervention – IV HC and fluids, pain relief, blood tests, consultant
– MDU assessment and consultant, medications
– chest X-ray
But I recognise that there are things I can do to help:
– I had my own meds with me so they didn’t have to get pharmacy to prescribe them/buy them in
– I had some of my own food with me so I could have an evening meal
– I have a ready packed hospital bag so I didn’t need to be given pyjamas and personal hygiene items
But I shouldn’t have to do that. Staff shouldn’t be working past the end of their shift because there’s no one to look after patients otherwise. There are so many things which shouldn’t happen but do.
You can say proudly that we have one of the best healthcare systems in the world, the staff are amazing, it’s free for all… but it won’t be free and it won’t be one of the best if things keep going the way they’ve been going. You might also be privileged enough to be able to say that you don’t need to use the NHS regularly and it’s always wonderful when you do. The system works for emergency care or for things which are curable eg an infection needing antibiotics. It doesn’t work for long term use. It’s a victim of its success- people are surviving when they would have died in the past and there isn’t provision in place for this.
With this in mind, remember, the only thing guaranteed in life is that our health will fail and we will all die. Anyone can become ill or disabled, it’s just a matter of when. Please remember this when voting in this week’s general election!!