When will politicians and leaders of CCGs and health Trusts realise that we need to start having more ‘joined up’ thinking when we consider cost effectiveness of drugs and other treatments?
How does incentivising GPs not to refer patients urgently for scans and other cancer screening tests actually save money long term? It may mean the CCG saves money there and then, but the patient could later develops cancer and metastases needs palliative care in the home, district nursing care and GP support.Does that make sense?
Likewise, in the world of diabetes, which is costing the NHS a fortune, (and my speciality), fixed dose combination drugs such as metformin and vildagliptin, known as Eucreas, are often not on CCG formularies. Why do we think patients are more likely to take four metformin and two vildagliptin, than Eucreas (the combined version) which would mean only two tablets each day? It is well known that a large proportion of patients with chronic health conditions, who are prescribed multiple medications, do not take their medications as prescribed, (while never admitting to it to their nurse or healthcare professional). Hence those with diabetes may end up with poor control and then cost the NHS substantially more. However, this may come from a secondary care budget, in terms of managing complications such as amputations, MIs, strokes and renal or retinal problems.
It is time our care provision was ‘joined up’, and we started working across primary and secondary care. Should we not be making more of an effort to practice quality cost-effective healthcare, which keeps the patient fitter for longer? Is it right that one hospital may spend thousands of pounds on treatment to keep someone alive a few more weeks, when someone wanting a different, much less expensive drug or treatment to actually improve their quality of life long term is refused it at another setting close by? Would time and money be better invested in working to try and prevent Type 2 diabetes, be more cost effective in the long term than limiting monitoring equipment, and asking prescribers to prescribe cheaper versions of various treatments including Insulin?
It is surely time now with money in such short supply in the NHS, that we seek to address long-term cost savings rather than so much focus being on short-term financial gain.
Margaret Stubbs, specialist diabetes nurse