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Spreading good practice in the health service

Fergus Walsh | 08:59 UK time, Wednesday, 30 March 2011

The blood flow monitor could save the NHS huge sums of money

The blood flow monitor could save the NHS huge sums of money

How can the NHS speed up the way it spreads good practice? That is a key issue which emerges out of new guidance from the health watchdog NICE to hospitals throughout England.


It has strongly supported the use of a blood flow monitor during major surgery which reduces complications and speeds the recovery of patients. You can read more about the story here and the full guidance from NICE.

This is not the first time that the monitor has been shown to be effective.

Over the past decade there has been a steady flow of clinical trials and assessments which have demonstrated that it benefits patients and budgets. In a cash-strapped health service it is worrying that the NHS is taking so long to adopt good ideas.

Professor Monty Mythen, from University College Hospital London, which has been using the monitor for 15 years, said it was partly down to what he called "silo-budgeting".

He said: "The cost of the probe - about £100 a time - comes out of the anaesthetics budget. That is a big extra cost. It saves £1,000 in the weeks to come but that saving goes to the surgical budget." This suggests a worrying lack of joined-up thinking.

NICE suggests that more than 800,000 patients a year in England could benefit from being monitored using the ultrasound device. Those are patients undergoing major or high-risk surgery. At present fewer than 25,000 patients are monitored using it.

Of course patients have no idea whether they have had their blood flow monitored using the ultrasound machine, because it is introduced into their oesophagus when they are under a general anaesthetic.

But surgical teams and hospital managers have a duty to ensure that proven technologies which benefit patients get used - especially when they also save the NHS a huge amount of money.

Perhaps we might one day see patients demanding the use of such medical devices in the same way cancer patients have demonstrated over the refusal to give them new therapies.

Comments

  • Comment number 1.

    This comment has been referred for further consideration. Explain.

  • Comment number 2.

    Er... I thought that the whole purpose of NICE was to support and encourage good practice. Or at least, that's what they claim every time someone levels the accusation that they are only interested in saving money and ignore any treatment that's expensive however good it is.

    So are they basically saying that they are failing to do their job properly?

  • Comment number 3.

    At last clinical staff are beginning to ask sensible questions about the benefit /costs of treating a patient rather than budgets for bits and bobs of the process. I wouldn't be surprised if there was separate budget for perfusionists as well!

    But all this was supposed to be done more than 20 years when teams were set up around specific treatment under clinical leadership in of their practice.

    There is another story elsewhere about monitoring intensive care patients breathing which reflects similar issues and includes patients safety.

    A management management accountants approach is in NICE's estimator http://guidance.nice.org.uk/MTG3/CostingTemplate/xls/English for the cost/benefit of the use of the method but the gain is in the patient making a quicker recovery and hence staying a shorter time in hospital. Achieving that has to be managed as well.

  • Comment number 4.

    Add your comment

  • Comment number 5.

    It's incredible that hospitals would cut corners with patient's lives. However, if ultrasound machines with these probes are so expensive, then perhaps the hospital can offer the additional monitoring at extra cost to the patient. With a small fee, the machines will be paid for quite quickly.

  • Comment number 6.

    I dunno we can come up with the money for regime change in libya but we cant afford a few machines to monitor health.

    let alone cheap medicines.
    What I have never understood is why the NHS does not have its own Pharmaceutical division that cherry picks the latest drugs/research especially the important ones on condition of approval of use for the original developer. The NHS could pay a small percentage of the costs back to the developer. Place upon this NHS drugs are for NHS only leaving the private medical services the pick of the Private pharma markets support through products.

    We also need to consider the developers of these systems and products. How does a bunch of electronics and parts go from a basic price to a vastly extortionate price by the time it hits the flaw. Are the right company's building the final product for general ward equipment like this? We can make every other electrical component and device at ever increasing rates and ever increasing compatible with other devices why has medical equipment not been modeled around main stream components? just look at what an average computer can do..! adapt most common medical devices like a blood pressure arm band to a usb device... give em a netbook in a tiny box to plug it into and get it back a week later. I know its not quite the same thing and probably a poor example of mainstream.

    Don't get me started on Cancer and other conditions government claptrap etc ask em about rescheduling Sativex I did ... nice letter back that said nothing at all..... have to rescan it and post it for you... Sativex could increase recovery rates no end provide massive relief boost to diet and immune systems..... but no its made from nutter weed................Small minded.....petty.... EVIL

  • Comment number 7.

    Thank you Fergus for highlighting the difficulties the NHS face in trying to get good proven practice taken up.

    I assumed Post No.2 read the article - NICE are giving the NHS a means to save money, but the budget setup of the NHS is the problem, the £1000 saving comes from another budget, while the £100 cost (NET SAVING of £900) hits the anaesthetics budget.

    Unfortunately we the British public are still in denial - we want the NHS to provide care for everyone & every condition, yet we are not prepared to pay the price. In addition we do not understand the true cost of healthcare.

    The biggest single item is personnel costs, high tech medicine needs trained expensive personnel.

    Drug and equipment costs are high but the requirements to develop them are very high.

    When NICE was introduced it was an independent group looking at the cost/benefit of treatments within the limited funds of the NHS. We the British people can not write an open cheque for the NHS, so therefore we have to LIMIT what it does.

    Maybe if we were brave and let NICE do our dirty work (and then not complain when the results favour the treatment of 10 Cardiovascular patients who will make a full recovery and return to work, over an extra 6 months life for one cancer patient), the NHS could move forward.

    The NHS needs joined up thinking, it needs to define what it does and we the public need to accept it can not do everything.

    I have worked in the NHS, it has treated myself & my family (including my mother as she died from cancer), but having lived and worked abroad I believe it still the best system available, if only we address these urgent issues.

  • Comment number 8.

    There is I believe a real and un-addressed patient care issue. This is seeing a patient as a single individual not just a collection of care events - a holistic view of the patient.

    These new and now abandoned patient care records were supposed to facilitate this - but now we are back to the condition that the patient's GP has to collect together the information for a patient as and when it eventually rolls in via the post from the various parts of the NHS that are treating a patient.

    I have visited a GP with an elderly relative why had fallen and broken their arm some eight weeks ago and it was news to the GP even though I know that the electronic patient records were written up by the fracture clinic. This is a more serious issue that it might seem for the elderly or indeed anyone with complex healthcare issues.

    I have also witnessed patients fatally falling(figuratively) between the care 'stools' of different hospitals and different departments in the same hospital (Thyroid Cancer and at a different hospital Prostate Cancer, possible Multiple Myeloma and (untreated) heart failure in a patient with existing type 2 Diabetes). There was no timely sharing of information between the specialists or the GP. Everyone was relying on the patient to keep them informed at best or blinkerdly ignoring each other. At the inquest all the coroner would say was that it was nothing to do with him and the matter should be addressed to the different hospital's complaints departments (which was a complete waste of time and energy).

    In this day and age surely it is not beyond the bounds of technology to at least have a memory stick with the patient data available to every specialist for every consultation - even if the patient had to carry it around with them! Something simple like that - a patient portable electronic record retained by the patient would possibly have prevented at least one premature death to my knowledge and in all probability many many more.

    An electronic patient record system is important - many of the specialists carried out similar tests in duplication because they did not have access to the other's tests and the GP had absolutely no idea of what was going on for many months when the paper records eventually trickled in and were scanned onto the patient's file! If a timely note had been taken that no-one was treating the patient's heart failure - everyone else thought someone else was doing it (even though there were individually told this was not happening) perhaps the patient would not have died as the patient's death came as a compete surprise to all of the consultants who were treating the patient.

    We need some simple system of portable patient records! (Not some mega complex computer project costing billions and taking decades.) Just with x-ray images on a memory card would help, along with medications and test results.

  • Comment number 9.

    We will never get a handle on diseases until the medical world grasps Glycobiology

  • Comment number 10.

    Sorry to be utterly flippant about this...

    But when I saw the opening of Fergus' report, referring to the increased number of machines present during surgery these days, I couldn't avoid being reminded of 'Monty Python's The Meaning of Life' - and the scene in the hospital with "the machine that goes 'Ping!'"

    Imagine my huge surprise and delight to see that the expert from UCHL being none other than... Professor Monty Mythen! ('Shurely shome mishtake?')

    Either: a) A huge(ly amusing?) coincidence; b) some sort of elaborate meme that would have Richard Dawkins wetting himself; or c) Fergus will be away from his desk on Friday and wants to get his April Fool prank in good and early.

    Anyway - back to the serious stuff...

  • Comment number 11.

    Post 1 was referred for no go reason and has still not been reviewed/published!

    IMHO the BBC health blog is failing in its duty of care by not tackling the fundamental (and once in a lifetime) ethical issues/crisis which the NHS is facing at the moment (e.g. allowing GP's to profit from rationing healthcare - i.e. conflicts of interest), and Nick Robinson isn't either (preferring to focus only on Libya), despite the fundamental concerns raised by every professional medical body. Incompetence, dereliction of duty, conspiracy ... could be any or all of them.

    The BBC appear not to want to upset their paymasters ... and this is not the licence fee payer - but the Government who decide how much (if anything) the licence fee payer has to pay! Independent ... I think not! They are just as bad as the politicians ... i.e. looking after themselves with no responsibility/duty of care.

  • Comment number 12.

    Had to have a giggle at the the story on bonemarrow healing skin.

    Chemical found which 'makes bone marrow repair skin'

    http://www.bbc.co.uk/news/health-12956636
    Seem to remember intorducing you to that a while ago on the blood blog.

    how HMGB1 is prodcued http://www.blackwellpublishing.com/isth2005/abstract.asp?id=47992

    Anandamide = human THC :P


    Do you not think such natural healing drugs would greatly benifit the NHS? Its dead easy to produce costs next to nothing and some stains are even ready now after only 60 days!!! from seed to medicene.!!

  • Comment number 13.

    Europe 'losing' superbugs battle
    http://www.bbc.co.uk/news/health-12975693
    A New MRSA Defense
    http://www.technologyreview.com/biomedicine/21366/?a=f

    we have the answers but no one listens :)

  • Comment number 14.

    Yet more cures
    Cannabis could be used to treat epilepsy

    Cannabis plants are being grown at a secret facility in the south of England in the hope of producing a new treatment for epilepsy.
    http://www.telegraph.co.uk/science/science-news/8440303/Cannabis-could-be-used-to-treat-epilepsy.html

    Think someones covering up something?

 

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