"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Monday, 14 May 2012

The slippery slope

This evening I attended a meeting at my local NHS hospital. These are public meetings and are intended to inform the public about the services the hospital delivers. The people who attend are typically those active in local patient support groups and FT governors also attend. These meetings are held once a month, and I usually attend every other one because they usually clash with another regular meeting that I want to attend and so I alternate them. At the meetings I have attended over the last five years, I have never seen a local politician (district or county councillor, or MP) attend these meetings, even though the topics are detailed informative and important to their constituents. I would have hoped that those councillors who sit on the Health and Wellbeing Board would attend these meetings, because it would give them an insight into the health issues in the area, and the issues of delivering healthcare to the entire population.

This evening's topic was phlebotomy, the taking of blood, and pathology, the testing of that blood. It was very interesting, especially the part where the manager told us that blood tests are done on the day the blood is taken and GPs are informed electronically as soon as the result is available: hence test results should be available for patients the next day, or within 48 hours at the latest, and not the situation my GP tells me. (I have a GP diabetic clinic in two weeks time and the surgery tells me I have to have a blood test at least two weeks before the clinic.)

At the end of the talk, the manager of the service moved onto to the topic of future developments, one of which was a domiciliary service. The conversation went like this:
Manager: We are looking into running a service where phlebotomists visit patients at home.Chair: Is this intended to be for housebound patients?Manager: Yes. However, there are some private plebotomists who provide the service for people who are not housebound - I think they charge about £15.Chair: There is no reason why we can't do that too. We could offer this service for those patients who would prefer to pay for the phlebotomist to visit them rather than them having to visit the hospital.
What the Chair was saying was that visiting the hospital is not convenient for many people (the Trust is rural, so some people have to travel quite far to get there) but those people willing and able to pay a fee could get around this inconvenience. Those without the money would still have to have the inconvenience. A two-tiered service.

This is the effect of the Health and Social Care Act. Currently the Trust has no private patients. The Chair of the Trust is thinking like a businessman, looking for new income for the Trust. A couple of years ago he would not have voiced this idea because it was simply not acceptable for NHS hospitals to think about delivering a two-tiered service, yet the H&SCA has legitimised this type of thinking. It is a slippery slope.


  1. Yes, this is a sign of things to come. Domiciliary services have been cut and cut again over the last ten years. Podiatry, Phyiso, etc etc. despite the needs of the housebound and elderly. So now they think they can reinstate such services but charge people for the priviledge.
    Many people are charged for Social Services, we pay for dental care, we(some of us) pay for prescriptions.
    Its confusing!
    We need a public debate on these issues.

  2. This is a typical nhs situation. Most of the health Boards and Trusts in this country seem to work in a bubble. I work for the Ambulance service, which always seems to get left out in the cold when it comes to ideas such as the phlebotomy issue, mainly, I think, because they don't really know what we do. Ambulance services across the UK are based in the community with a highly mobile workforce so what is wrong for Health Boards, forinstance, training some suitably qualified staff to go to peoples homes to take blood and get it delivered to the Labs. there would be no need to charge the patients a penny as the efficiencies would come out of the savings the hospital clinics would make because their throughput of patients (who would have to attend the clinic for more specialised tests) would be higher and most probably some savings for ambulance services as well because they would not need to transport people to hospital for blood tests. is this too simple an idea or would it tread on too many toes? this is only one example of where I think ambulance services could be more involved in NHS services in the community.