“There’s no point in coming into the hospital. There’s nothing to see,” says Dr Aodhán Breathnach, a consultant microbiologist at St George’s Hospital in south-west London. “There’s just me, filling in forms. This happens out in the community.”
Part of the drive to save money in the “Big Idea” is too allow more people to manage themselves from home and save the cost of hospital treatment.
One such example is John Hick who manages his long-term condition at home, hopefully saving hospital money
There will be pressure on Public Services to be delivered both “better and cheaper”.
For John Hick, a 55-year-old former cavalry officer and property consultant, that is undoubtedly the case.
His spine was broken in a traffic accident while on army service in Oman in the 1980s and he is a wheelchair-bound paraplegic. Last year he developed a deep-seated and life-threatening spinal abscess that requires intravenous antibiotics three times daily. Normally, this would be done in hospital.
Initially, Mr Hick spent two months in St George’s Hospital. Since November, however, he has been administering the antibiotics himself, at home, through a line installed in his arm.
“It is,” he says, “a win-win. It is cheaper for the NHS than me being in hospital and it is certainly much better for me. I can get on with my life.” And, says the man who chairs the medical charity Spinal Research, “I’ve been pretty busy.”
A decade ago, the idea that patients themselves could administer intravenous antibiotics would have been revolutionary – given the risk of serious infection if the procedure is not completely sterile.
But “patients are delighted with this”, Dr Breathnach says. “They are in their own environment, not stuck in hospital. They can get on with their lives. They are much less likely to pick up hospital-acquired infections. It is a better service.”
He cautions that it is not suitable for everyone. “You can’t use it for people with chaotic lifestyles,” he says.
Given the considerable daily cost of a hospital bed, the hospital believes that the service, run in partnership with a Home Healthcare company, does work out cheaper.
But, Dr Breathnach says, “it is not enormously cheaper”. The pre-mixed antibiotic fluid has a short shelf life so Mr Hick requires three deliveries a week. The drugs are temperature-sensitive so patients receive a dedicated fridge. “We can’t be sure that someone’s domestic fridge is good enough,” Dr Breathnach says.
And Mr Hick still needs visits from the Home Healthcare nurse, regular blood tests and hospital appointments to check the antibiotics are working.
Dr Breathnach’s service is a prime example of what the Department of Health means by “care closer to home” – an approach it claims will produce a mighty £2.7bn of savings, or about 2.5 per cent of the NHS budget, during the next few years.
While undoubtedly “cheaper and better”, the service is not releasing cash. No beds have gone at St George’s as a result. They fill up with other patients.
“There’s no shortage of sick people out there needing stuff done to them,” Dr Breathnach says. “It’s not my area of expertise. But in my opinion we are not going to be able to shut a load of hospital beds to save money until we improve primary care and prevention so patients who don’t need to come to hospital stop doing so.”
From an article by Nicholas Timmins