Budget slashed for life-saving kidney treatment

Guest blog by a Consultant in Imperial College Healthcare NHS Trust

So with three days to go before you vote, what is the true state of affairs of the NHS locally? And if this does not matter to you, don’t bother reading on. I’m not going to throw billions of pounds at you, nor share reams of data, but just my local experience. I am a consultant in the world class Kidney (renal) centre at Imperial NHS Trust (Charing Cross, Hammersmith, St Mary’s Hospitals).

We deliver some of the very best treatments available, undertake the most complex operations and transplants, look after the sickest patients, and are renowned internationally for our research and teaching. Despite this it is clearly true that patients don’t get the quality of care they need all the time. And none of this is “elective”. People don’t choose to have kidney failure, they don’t choose to need dialysis nor choose when this might happen.

Almost all of it occurs suddenly, out of the blue, and most patients need life-long care that just cannot be delivered by excellent local GPs. And the number of patients just grows and grows (expanding at about 4% per year), since these are often diseases of ageing, linked to diabetes, occur in patients with multiple other diseases, and this is despite enormous advances in diagnosis and treatment.

10% budget cut for 2020

So what is happening now? Well, I have just been asked to save nearly 10% of my budget in 2020 (we were supposed to save 5% every year for the last 4 years which we have not managed to do).

How to save 10% when kidney diseases is becoming more and more common? We already have amongst the second lowest number of doctors per kidney patient in the UK (this is bad), and over 50% of our nursing staff are from overseas and extremely anxious about Brexit; many are thinking about leaving. My clinics are already over-full, and patients often wait ridiculously long either to get an appointment or in a clinic. None of this is of course our choice.

Which bit of the work would the Minister like me to stop doing? Stop giving a kidney transplant on the first Monday of the month? Refuse to dialyse anyone over 65 years old? Stop using any life saving drugs which cost more than a packet of crisps? Although I am trying very hard, I cannot stop kidney disease in its tracks.

Poor social care, hospices full, no money for investment

We certainly could get some people out of hospital sooner, except that social care is so poor that care homes don’t have capacity to immediately take residents, or hospices are full (and mostly funded by charities).

And we certainly could be more efficient, except that that would take some up-front investment which is never available. For example currently we have had a huge boost in the numbers of kidney transplants being done locally (because of change in the allocation system nationally; a good thing), but this means we are frequently cancelling other routine operations as we only have one operating theatre we can use. Which of course is terrible for those patients affected. This could be solved by using two operating theatres, but we have no funding for this (mostly staff costs).

But, say the more right-wing conservatives, you (the NHS) are just so organisationally inefficient compared to my private GP or private consultants. Inefficient. Well, my £60 million turnover department with several hundred clinical staff, is led by one full time manager, one consultant working two days leading the unit, three middle level managers and eight administrative staff (who also do all secretarial work for 25 consultants).

And unlike my teams, the private sector just says “no” if it does not want to look after you (kidney disease is very expensive to treat), and never takes patients requiring emergency care. It never does the kidney transplants in the middle of the night. It never takes acutely sick patients. It is easy to be efficient when cherry-picking your work. And of course the private sector doesn’t need to cope with the homeless, poor, malnourished, or refugees.

Staff stressed and working very long hours

So are my renal unit colleagues stressed and disheartened? Five of my consultant colleagues have been off sick this year at some point. All those over 50 are thinking about how to just stop doing some work (we are all working more than 55 hours a week, and many more than 60). And I have not even mentioned the sorry pension saga affecting senior health care staff, mostly but not only, doctors.

It’s complex, but basically we are all being taxed more for any extra work we take on (to help patients): I face an extra tax bill (on top of my forced pension contribution and income tax) this coming year of £25,000, because I am being paid an extra £6,000 as governance, risk and quality lead for my department. And if I do extra outpatient clinics to cut the waiting list I will face a similar hit. I am paying the government to do more work. It simply doesn’t stack up!

Election promises

And so the promises. Parties can promise any numbers of nurses, but if they stop immigration of people earning low salaries (nurses) or don’t pay a decent living wage, it cannot happen. Ask any nurse if they can live in Chiswick (they cannot!). The current government abolished the nursing bursary which allowed mature students to take up nursing in huge numbers, but no longer.

And the promise of 40 new hospitals? Surely this will solve it? Imperial is one of the “new hospitals” on the magic list. But of course this promise is not funding a new hospital locally. Not even in your dreams. All we have been offered in reality is pump-priming for building, repair, renovation (and Imperial has amongst the biggest back-log of repairs and infrastructure problems of all hospitals in the UK), and an amount which does not come anywhere close to what is needed. But certainly not a new hospital.

The pension mess is not even on an agenda. One party has been in power for eight years and I can find no evidence for any benefit locally: no increase in staff, no extra funding, no new resources actually in place to make healthcare better. And I have not even mentioned GPs. Clearly investment needs a revenue stream meaning an economy generating wealth, but it then needs a genuine will and commitment.

One party has made a sensible promise for increase in income tax to be dedicated to the NHS. As for the rest, I am unconvinced by the rhetoric which strikes me mostly as meaningless and completely devoid of any sense of reality.

The author is a Consultant in Imperial College Healthcare NHS Trust

See other guest blogs by the same author

A doctor’s view of Charing Cross Hospital A&E decision

NHS – one of the hot topics during the 2019 general election campaign

See what the candidates for Brentford & Isleworth constituency Ruth Cadbury (Labour), Helen Cross (Lib Dems) and Seena Shah (Conservatives) had to say about the NHS during our election debate:

The Chiswick Calendar 2019 general election debate