Home surgery could spell end of NHS cuts
The BBC last week reported that a man with a gangrenous foot cut off his own toes after a hospital operation had been cancelled. Doctors said the operation, performed with a pair of surgical pliers had probably saved the man’s foot. It also saved the NHS the cost of putting him under the knife.
The government said the case illustrated the potential to improve NHS outcomes and efficiency without inconveniencing taxpayers or putting further demands on hard-working ministers preoccupied with Brexit plans.
Operating framework
NHS Improvement has started work on a self-care tariff that would reward patients with John Lewis vouchers for cutting out layers of bureaucracy including doctors, nurses and hospitals. The so-called "personal surgery budget" will incentivise people to tackle their own diseased limbs and organs rather than relying on the state to intervene.
The Department of Health dismissed concerns raised by leading doctors about quality and safety. “These will be dealt with by the payments system, which will promote high-quality care by only rewarding good outcomes. It won’t be in patients’ financial interest to make a mess of their operations,” a spokesman said.
Patients in control
The government said that a radical move towards self-care could be the solution to the financial problems facing the NHS, with big potential savings in training alone.
"No one has the time for formal medical qualifications any more. In the digital age they can just download a tutorial from YouTube and get going," he added.
A further benefit is that patients would no longer need to travel miles to receive treatment, but would get the care they need in the comfort and convenience of their own homes.
“People would also learn useful new skills, such as sewing, which they could apply in other areas of their lives,” the spokesman said.
Surgical spirit
While there are doubts about the ability of individuals to carry out procedures requiring a general anaesthetic (defined by the new NICE home surgery guideline as more than one bottle of brandy), a leading think tank said this is where more community-based approaches would be required.
Neighbours and networks of community “in-reach” workers could be enlisted for complex procedures including heart surgery.
Children could also be useful, particularly in delicate areas such as neurosurgery where their small fingers could be an advantage.
Public Health England warned that children should not be allowed to perform any surgery without adult supervision and reminded parents to take particular care before letting them loose with scalpels or power tools.
“This idea definitely has legs,” said a government spokesman, “for the moment at least.”
Shares in Kingfisher, the parent company of B&Q and Screwfix, rose sharply following news of the initiative.
DIY editor: Julian Patterson
@jtweeterson
julian.patterson@networks.nhs.uk
That lightened up the morning, very funny.