Friday, 26 September 2014

Things That Are Disposable

How often do we hear of waste within the NHS? Barely a week goes by where some distant politician doesn't remind us how very inefficient our health service is. In fact, it isn't and the latest international survey found that it was actually the 2nd most efficient health service in the developed world. We spend just 9.2% of our GDP on healthcare, whilst the average in other countries is 11-12% (WHO)

But I don't think I've EVER heard anyone ask a patient about waste. Can you ever remember seeing a panel debate on Sky, BBC, ITV or C4 news discussing healthcare that included an actual patient? Someone who uses the system and sees a different perspective? God forbid we should ask the people who actually have to use the system, what would they know?

Well, actually we know a lot. We see the medicines opened for just one dose, then thrown away. We see the extortionately expensive £1,000 bags of liquid feed thrown away because no-one thought to put them in the fridge, rendering them useless.

Recently, I watched a Netflix documentary about a brilliant brain surgeon who went to give a lecture in Kiev back in the 80s. He was so appalled at the lack of specialism and facilities, that every year since, he has returned to Kiev and carried out as many of the most complicated cases of brain surgery he can fit in.

He crams his suitcases with equipment and devices that just aren't available to ordinary people in Kiev, equipment that we would use once and throw away. He risks the wrath of the Russian authorities with every case he takes on. One mistake and he felt there was little doubt he'd go to jail. The doctor he works with in Kiev has already been suspended twice for helping him.

But there was a moment, when the doctor from Kiev showed the drill he used to get through skulls. It was an ordinary Bosch hardware drill and he explained that the drill bit was one the UK doctor had bought over TEN years ago and he'd been using it ever since. The UK doctor estimated that just on those drill bits alone, each one used once and then discarded, his hospital spent £40,000. That's one instrument of very many used by one surgeons every day, up and down the country.

A few days ago, I finally had the line fitted into my vein that they would feed me through. It is done in theatres under strict sterile conditions. The Dr inserting it mentioned that the scissors he was using were "one-use". They appeared to be very sturdy, stainless steel scissors, very similar to the ones you can buy for home haircutting. Even in the stores, these are expensive, around £12-£20. Anything bought through the NHS - perversely for an organisation with such huge procurement power - seems to cost 3 times more than the high street equivalent. He snipped through one sterile plastic line with them and that was that. They didn't even touch my body or blood.

So why do we do this? Surely things like scissors and drill bits and scalpels can be effectively sterilised to use again? Sure, we don't want surgeons using blunt scissors or drill bits but one-use???

We do it, because at some point, a very serious condition has been found to be transferred by re-using anything used in a sterile environment. The results may have been statistically imperceptible, perhaps just 2 or 3 cases in a million, but because of that, every last implement must be disposable. So, for instance, we might make sure that every single surgical pack used is thrown away after use, because 2 people were infected with CJD ("mad cow's disease") at the peak of the public interest over it. Even when we can be totally sure that whatever bacteria or virus causing a certain condition is killed under sterile cleaning, the chance that somehow just one scalpel or pair of scissors misses the bleach-bath means that we waste another few billion per year.

There have been several studies into how many "avoidable deaths" there are in the NHS every year. Results ranged from 10,000 to 40,000. The most recent was thought to be the most accurate, using the most detailed methodology and it put the figure at 12,000. The majority of those deaths were due to understaffing or under-resourcing. If we could save, say, even half of those lives for the sake of 2 or 3 aren't we peculiar not to?

Ethically, this might be a difficult question, but as a nation, are we prepared to accept risks many, many times smaller than, say, being hit by lightening twice or winning the lottery, to save many billions of our tax money from literally, being thrown away? And if that minuscule risk means that we take much, much smaller risks with lives in other areas by providing a better funded service to every member of the public rather than legislating for the exception rather than the rule, might the public choose to accept it?

Perhaps this isn't something the NHS or it's staff should decide. Perhaps we should have a public debate and allow everyone to have a say?

NHS managers are making difficult decisions every day as they try to cut vast sums from their budgets without affecting patient care. Perhaps very expensive cancer drugs that can only extend life rather than save it become unavailable, or patients are discharged to soon. If this measure could save many billions of pounds every year, should we not at least consider it?






21 comments:

  1. Surely the tiny risk of re-using a piece of equipment is better than trying to make savings through decreasing staffing, and having a MASSIVE risk to patient care through understaffed wards? People are going to die a lot quicker through understaffed hospitals than they are over a re-usable scalpel.

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  2. The best ideas are often the simplest. And this IS simple!

    I'm going to have a think about what waste I 'may not have noticed' during my 3 visits to hospital this week :)

    Hmmm...

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  3. It is true that the NHS is very very wasteful - To not use a drill bit more than once when they could very easily sterilize it is ridiculous!! The amount of waste is one of the reasons why it if falling in so many ways. They buy a light bulb we could get from ASDA (other stores available) for £1 yet they pay £10 for the same thing. It is TIME they too back their control and THEY - TELL - the companies supliying them that if they do not act - NOW - Then we will simply send one of our nurses to a local store and buy at a decent price! As the NHS has no competition for it's goods, then the companies supplying them just sdo what they like - Same with people who decorate hospitals - The moment the know it is a hospital - The price doubles - The NHS need to take back their CONTROL and tell the companies that no longer will they allow themselves to be fleeced - This could save them billions of pounds - WHY they have never done this is beyond me - It is simple supply and demand - And mathematics! If they fleece you - You go elsewhere!

    We do need debate on this issue and to get a NORMAL person in to balance the books - Cos they have no idea whatsoever how to balance their books - That much is blatantly obvious!

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  4. We who use the National Civilian Prosthetic Limb Service could in fact give chapter and verse of the massive amounts of waste, so much so that one charity which for the moment shall remain nameless actually collects unused limbs for the scrap value of the hi-grade medical quality metals, listen Scrap Value of Prosthetic Limbs. Limbs which could be used in the third world to enable disabled people to feed themselves and family through work..

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  5. Wow, macpegleg that's amazing. I'd never have thought of that, but being able to re-use prosthetics in the developing world is SUCH a great idea

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  6. My wheelchair comes from the NHS wheelchair service. The chair I had at the time was a Quickie and they are spectacularly shit and unreliable. I've had a few; and never had one last more than a month before it needed its first repairs.

    This particular occasion: My wheel had collapsed. Obviously my chair was unusable and I needed to be able to get to work. So I took my wheel to a bike shop to get it repaired.

    When the NHS's contracted repairer found out about this; they confiscated and scrapped the repaired wheel, deeming it unsafe. According to them a collapsed wheel is safer than one that's been repaired by someone outside the NHS.

    A perfectly serviceable wheelchair wheel destroyed for no reason.

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  7. They do collect prosthetic limbs for re-use in the third world but that's because when a limb no longer fits it is useless to the wearer. I don't think that is on the same level as the kind of waste Sue is referring to. When I last had a new artificial limb (because I'd lost weight) I had to wait a lot longer than before because the prosthetist had to fill in far more paperwork than before to justify the need for a new limb. That was this year. An artificial arm or leg that doesn't fit can be harmful and it may appear there is more waste than there actually is if you happen to see a storage room full of apparently unwanted limbs.

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  8. What I do not understand is why they dispose of so much stuff on the grounds of safety/hygiene but will use dirty and half worn tourniquets, sometimes no gloves and unpack a load of needles on a tray for blood tests but put the bucket for used needles next to the clean ones with a fine mist of blood obviously on the table. Also why put dirty stuff in a paper bag stuck to the table you eat at? Try getting some staff to wear gloves when they deal with blood because sometimes you have to insist. There are surgeons who walk around after surgery who have their rubber shoes on with what looks like iodine and blood etc on (not just the NHS because I also saw that at a private hospital while I waited for a friend). Surely if the issue was purely to do with safety/hygiene then they would sort out the free options first. I know that it goes back to staffing levels but 2 seconds to put a pair of gloves on? A second slipping into clean shoes? One step more to a bucket for dirty needles?

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    1. Please stop the spamming, Laura or Sarah.

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  10. Personally I do not wish to contract hep c, or any other blood borne disease. I do not trust them to sterilise correctly. Yes there is waste but this is not the way to tackle it. I had a nurse with one finger poking out of his glove give me a blood test and I was too ill at the time to protest. I feel you are shooting yourself in the foot with this one.

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    1. I find this bizarre. I don't understand why people are so apply to accept risk on the grounds of underfunding, in exchange for infinitely smaller risk of re-using surgical equipment. I'm not suggesting they use them straight from one transplant to the next appendectomy. I'll let them give 'em a rinse first, lol

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  11. Oh Sue, it's not just in patient facing areas where waste takes place. You ought to see the stacks of IT kit used once and then thrown away, the expensive brand new laptops that are given to new starters in some NHS organisations and then not re-issued when that person leaves a month later and a new person comes in to do the same role and is given yet another brand new laptop.

    I've witnessed this first-hand and was disgusted at it.

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  12. When you have witnessed a loved one die a slow, agonised and terrified death from CJD you might change your mind about drill bits and other equipment used in brain surgery. Prions cannot be eliminated by autoclaves, bleach or even DMSO. Keep chucking the neuro-surgery equipment away I say. You might mock the small risk, but it isn't relative risk, it's actual risk. Would you be happy for your children to undergo brain surgery using drills that have only been autoclaved? I doubt it.

    There is a huge amount of equipment, supplies and medicines wasted in the NHS that with thought, better training of staff and some common sense
    could be stopped and a lot of money saved. But instruments for neurosurgery isn't an area to pinch pennies.

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    1. It seems you know much more about it than me and I'm sure you're right. Unfortunately, I've watched countless elderly (and some not so elderly) patients die for want of a well staffed ward. That's actual risk too.

      I'm terribly sorry that you went through such a horrible experience - was it contracted through surgery? I just think we take the current risks of understaffing and underfunding way way too lightly. People should be more informed on the actual risks and be allowed some say in what risk they find acceptable.

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  13. Thank you for some very reasoned and pertinent points and as you say in your penultimate paragraph 'Perhaps we should have a public debate and allow everyone to have a say?'.

    The NHS is a vast organisation, which is doing much more than was ever envisaged. At its incept who would have forecast the numbers of patients now being treated, the longevity of life and the advances in medical science. Anyone of which would cause problems for such a service.

    So there is waste, but the answer is can the waste be avoided, well maybe some can, but then again, maybe some can not. We as non-medical personal can only think how the waste can be avoided, but do we consider the dreaded Health and Safety, the relation to legal considerations both to the NHS and its staff and a manner of many other regulations.

    You mention 'CJD', but what about HIV and Aids, the various forms of Hepatitis and other infections, then there is the current trend to claim compensation for anything against the norm.

    You mention sterilisation of instruments, but can this be guaranteed to be 100% effective and is the cost factor that much different to the bulk buying power of the NHS, especially that in many cases the practice of instrument cleansing is now outsourced. So this brings in the time factor for the return of the cleansed instruments.

    But some of the waste can be stopped and for this the NHS has to be transparent, honest, open and be accountable. Some or all of this is not part of the organisation, if it was would the issues over the last years have ever occurred, The Stafford Hospital scandal being only one.

    One answer is the constant monitoring by outside organisations, such as CQC and Healthwatch.

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  14. Whilst the political elite treat the disabled like this i dread to think what will become of the NHS

    http://www.morningstaronline.co.uk/a-b8e0-Labour-conference-Disabled-delegates-forced-out-of-front-row#.VCetZldBodj

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  15. I prefer to leave such matters in the hands of the NHS medical practitioners professional bodies. i.e surgeons. Personally after my own successful operations I have never had any complications due to infection. Some operations are life threatening but one has to sign that you are aware of the risks. I have todate placed my full trust in the medical profession who always give me the percentage risk evaluation . I only allow those that I trust to operate on my body , so far I have fortunate. However this November I am aware that I may no longer be so lucky to be able to make my own decision in regard to my 2nd Aortic Aneurism close to my heart. This I regard as hereditary condition as is my deafness , neither of which I can place blame on the NHS doctors, nurses or surgeons . Neither do I blame the NHS for the lengthy GP waiting times which is politically inspired by this current coalition Government.

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  16. This is really wasteful of NHS. Such practices should be checked and regulated and it should not be allowed to waste the public resources without care. GMC has devised a system to keep a check on doctor through revalidation which involves collection of supporting information for appraisal and revalidation by the doctors to demonstrate that they are fit to practise.

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