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The real reason doctors are being instructed in the ethics of waste The real reason doctors are being instructed in the ethics of waste
(35 minutes later)
All waste is immoral, but some waste is more immoral than other waste, and sometimes what looks like waste isn’t actually waste at all. Wasting food is really bad (the perfect solution, although not available to everyone, is to keep pigs). Recycling the dress bought in a moment of self-delusion via the charity shop is not a perfect solution, but it is less bad than wasting food. Using disposable instruments in hospital instead of relying on sterilising machines looks wasteful but actually saves money by not giving patients avoidable infections.All waste is immoral, but some waste is more immoral than other waste, and sometimes what looks like waste isn’t actually waste at all. Wasting food is really bad (the perfect solution, although not available to everyone, is to keep pigs). Recycling the dress bought in a moment of self-delusion via the charity shop is not a perfect solution, but it is less bad than wasting food. Using disposable instruments in hospital instead of relying on sterilising machines looks wasteful but actually saves money by not giving patients avoidable infections.
Waste in the NHS is a favourite moan of its critics who mostly think it is too big to prosper. But that doesn’t mean it’s not a problem – how could it not be in an organisation with a budget of £100bn a year. One wrong decision is going to ramify with appalling waste across the country. So although it seems a superfluous edict, it was good to hear the Academy of Medical Royal Colleges declare that doctors have an ethical duty not to waste.Waste in the NHS is a favourite moan of its critics who mostly think it is too big to prosper. But that doesn’t mean it’s not a problem – how could it not be in an organisation with a budget of £100bn a year. One wrong decision is going to ramify with appalling waste across the country. So although it seems a superfluous edict, it was good to hear the Academy of Medical Royal Colleges declare that doctors have an ethical duty not to waste.
On one level, this feels so obvious that it teeters on the banal. Its advice is so breathtakingly unexceptional – better use of hospital beds and medication, restraint when ordering tests – that you really wonder that no one has mentioned it before. But perhaps there is a bit of a sleight of hand going on here, an avoidance of a trickier prescription.On one level, this feels so obvious that it teeters on the banal. Its advice is so breathtakingly unexceptional – better use of hospital beds and medication, restraint when ordering tests – that you really wonder that no one has mentioned it before. But perhaps there is a bit of a sleight of hand going on here, an avoidance of a trickier prescription.
The flip side of waste is efficiency. Efficiency, in the context of “efficiency savings” means cuts – cuts like those which have taken £20bn a year out of the NHS budget in the past five years (at least on paper). This is the Nicholson challenge, issued by the former NHS boss Sir David Nicholson. Managing cuts can produce spectacular waste: one of the first fruits of the challenge was a huge shake-out of NHS staff, followed almost immediately by their rehiring as hospital trusts rushed to meet new minimum nursing requirements introduced after the Francis report into the Mid Staffs care scandal.The flip side of waste is efficiency. Efficiency, in the context of “efficiency savings” means cuts – cuts like those which have taken £20bn a year out of the NHS budget in the past five years (at least on paper). This is the Nicholson challenge, issued by the former NHS boss Sir David Nicholson. Managing cuts can produce spectacular waste: one of the first fruits of the challenge was a huge shake-out of NHS staff, followed almost immediately by their rehiring as hospital trusts rushed to meet new minimum nursing requirements introduced after the Francis report into the Mid Staffs care scandal.
Human nature being what it is, if the people who spend the money in an organisation think efficiency is management-speak for aggravating their daily struggle by endless eroding resources, they are likely to resist. All change tends to be viewed with deep scepticism, and most particularly if it looks as if it might save money, because obviously if it does save money, then that must be the reason for doing it.Human nature being what it is, if the people who spend the money in an organisation think efficiency is management-speak for aggravating their daily struggle by endless eroding resources, they are likely to resist. All change tends to be viewed with deep scepticism, and most particularly if it looks as if it might save money, because obviously if it does save money, then that must be the reason for doing it.
Take the experience of something called “enhanced recovery”. This is a system, developed in Denmark, which links the whole sequence of events around surgery in the way most likely to result in a mobile, pain-free patient at the end of it. It requires a different way of working, not just for a doctor or team of doctors, but for ward staff, primary care and social services, and the patients themselves, who all have to communicate and co-operate. Take the experience of something called “enhanced recovery”. This is a system, developed in Denmark, which links the whole sequence of events around surgery in the way most likely to result in a mobile, pain-free patient at the end of it. It requires a different way of working, not just for a doctor or team of doctors, but also for ward staff, primary care and social services, and the patients themselves, who all have to communicate and co-operate.
The advice on how to introduce the new system discreetly reveals how tricky a process it can be. There is a helpful list called “barriers to implementation”. It starts with getting the management on side – after all, why should the NHS be exempt from the “not invented here syndrome” – followed by failures of communication and consensus building. Then there is the note that it “can be challenging getting ‘late adopters’ on board” which is code for the Sir Lancelot Spratt figure on the consultants’ team. And finally, the killer blow: “can be seen as length of stay initiative”. That is, if it looks like another devious attempt to get patients out of hospital quickly in order to save money, forget it.The advice on how to introduce the new system discreetly reveals how tricky a process it can be. There is a helpful list called “barriers to implementation”. It starts with getting the management on side – after all, why should the NHS be exempt from the “not invented here syndrome” – followed by failures of communication and consensus building. Then there is the note that it “can be challenging getting ‘late adopters’ on board” which is code for the Sir Lancelot Spratt figure on the consultants’ team. And finally, the killer blow: “can be seen as length of stay initiative”. That is, if it looks like another devious attempt to get patients out of hospital quickly in order to save money, forget it.
Enhanced recovery does cut hospital stays. It cuts hospital stays because patients are getting better quicker so they go home. It also saves money; not a huge amount, about £275 a bed according to one estimate. The trouble – according to a BMJ analysis – is that management sees enhanced recovery as exclusively about saving money. It is not interested in patient experience. It can’t count the benefit of being able to go home and eat proper food and sleep in your own bed. If only they would, then maybe doctors would not need instructing in the ethics of wastefulness.Enhanced recovery does cut hospital stays. It cuts hospital stays because patients are getting better quicker so they go home. It also saves money; not a huge amount, about £275 a bed according to one estimate. The trouble – according to a BMJ analysis – is that management sees enhanced recovery as exclusively about saving money. It is not interested in patient experience. It can’t count the benefit of being able to go home and eat proper food and sleep in your own bed. If only they would, then maybe doctors would not need instructing in the ethics of wastefulness.