Monday, 20 April 2015

Closing hospitals with a community spirit: is it possible?

This week we have a couple of tweets from Richard Smith, former Editor of the British Medical Journal. The first one which is quite persuasive; sends us to one of his articles published in The Guardian where he raises a controversy, since against all appearances, hospital beds have become, in political terms, prevention goods against the spending cuts. But the reality persists, says Mr. Smith, and however you may look at it, the number of hospital beds must be reduced, not to preserve health system resources but to strengthen community services. Closing hospital beds with a community spirit he says, takes talent, investment and time and doing things right. But if this is not done correctly the price can be very high, as treating people in hospitals when they could have been treated at home, is uncomfortable, dangerous and expensive.

The second tweet relies on a post from Richard Smith’s own blog in which he wonders why the NHS negotiates the price of palliative services while paying without hesitation for the very expensive bills for people dying unnecessarily in ICU. Since specialized care in the last months of life, he says, is an expensive and inadequate way to attend to this stage of life, the commissioners (outsourcers of the English public system) should urgently consider how to change the methods of payment for these services. It’s a win-win plan because the situation is so disproportionate that certainly minimising specialized services (and the logical increase in community services) to attend to the end of life period of time, would easily achieve the "Triple Aim": quality, results and costs.

The English Humour Note

If you click the post, you’ll see Richard Smith’s declaration of conflict of interest towards the end. We must clarify that he wrote the post after a conference at Trinity Hospice, a historical London institution. The statement reads: "I must confess that after the conference, I had a meeting with the Director of the Centre. I didn’t charge them anything, but I told them that I would like that, when I reach my last few days on Earth, I’d like them to be the ones who’ll take care of me."

Jordi Varela

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