Wouldn't it make sense for the NHS to spend more on...

[RunBackwards]

Early detection and treatment, to save the cost of much more expensive treatments later and provide a better experience for patients?

Two examples at opposite ends of the scale.

• DS2 had an infected toe. GP diagnosed an ingrown toenail (as expected) and prescribed antibiotics but can't treat the cause becuase podiatry isn't available on the NHS unless you're diabetic. It's certain the infection will reoccur, come back for more antibiotics when it does. Thankfully I was able to get the nail treated privately, a minor procedure taking around 20mins and costing £40. If I hadn't, the NHS would have born the cost of regular GP appointments and antibiotics indefinitely....to save £40.

• DH had a cough and was sent for a scan. Long story but the lungs were fine and cough is now better but they found a large tumour on his kidney, which is apparently the way most kidney cancer is found because it has no symptoms until very late. Because of the way it had spread, this resulted in a major operation, involving both Urology and Vascular surgegons and a spell in ICU. Obviously I am incredibly grateful that the NHS was able to do it but I dread to think what the cost was and if it had been found sooner, say by a routine scan, he could have had it a abladed as an out patient.

And in a similar but different example, a fellow patient while he was in recovering from the op had a similar issue but his had been found sooner, so his op was not considered urgent. Obviously knowing you have an aggressive tumor and having to wait months for treatment is difficult to live with so the NHS had been treating him for depression and anxiety and the state had been paying him sickness benefits for months leading up to the operation. Doing it sooner would have been better and saved money all round.

Now, I know none of this can happen overnight, will need investment and major change in processes, moving resources and different/equipment and staff etc but surely saves money in the long run and has to be better than keep increasing funding to the NHS to keep doing what it's doing, the way it's doing it?

Some efficienties (the ingrown toenail) could be effected relatively easily.

People need to be aware so their expectations are correct

This is so true. This has made me realise that perhaps the NHS isnt really that transparent. I think people assume you can get pretty much anything you need done, but its often not the case.

Perhaps the answer then is self referral to services - that would mean other services would have to sift through and filter a lot of extra cases, but it would save the GP having to filter everything/refer/pay for referral fees.

Then the problem with that though is that perhaps people may not know where to go, which would end up in a lot of extra illness/injury due to infection, worsening of the condition etc.

Ideally you’d be able to trust what drs say but after dealing with my dh’s complex medical history you can’t always take things at face value.

You can self refer to Podiatry & physiotherapy in many areas.

The nurse did both of mine in the same appointment last week. Meant I could cancel the second appointment for the flu jab, very efficient.

Sorry, that was meant to be a reply to the above poster about smear tests and flu jabs.

@Fluffycloudland77 I’m not sure you understand the way the NHS works.

Podiatrists May he happy to see non diabetic patients but if the local CCG have decided they will only find the service for diabetics then that is the only group the GP can refer.

If people disagree with this policy they need to complain to the CCG not their local GP who is powerless.

Lots of this stuff came in with austerity pressure to reduce NHS costs. And creates the postcode lottery for healthcare eg. My CCG May fund toenail surgery but the one covering the next borough doesn’t.

I completely agree with the poster who says we need openness and transparency about exactly what the NHS can fund. As a HCP I would like equity of access to services across the country.

OP - approving a screening test is extremely complicated as you need to balance the benefits of locating a cancer early with the risks of the test. Any whole body screening involving radiation fails due to the increased risk of cancer induced by having these scans. Screening with MRI is very controversial due to the burden of investigation induced by finding abnormalities that would never have gone on to cause a clinical issue but because they have been found cause worry, need further investigation and possibly removal which also carries risk.

One of the popular science authors covers assessing a test as a screening tool well but I can’t remember who it is - possibly Ben Goldacre or Atul Gawande. I will post this and have a google (don’t want to lose this post).

It was Ben Goldacre.

www.badscience.net/2008/01/screen-test/

Have any areas said they’ll only fund for diabetics though? There’s still jobs being advertised for MSK specialist podiatrists.

We’d cause a lot of problems by not seeing pvd patients for example.

I wonder this. I mean perhaps I've wrongly assumed this but it seems like in America and maybe other countries that people have a lot of routine and preventative tests as part of their insurance coverage.

Obviously a lot don't have that sort of coverage either but I often wonder how it would work if we had that sort of options on the NHS, would we eventually save money or not?

Best one for me was a few years later when dd was self harming quite seriously. GP said CAMHS were useless and wouldn't do anything. I asked for a private referral and was told to find a therapist off the internet. I refused and insisted on a CAMHS referral. They offered something inaccessible and said they couldn't recommend a therapist because without knowing theor outcomes it was unsafe. Yet I as the parent could find my own and that was safe .

Fortunately BUPA helped with referrals (not everyone has it) and GP became more helpful when I read the riot act to a senior partner.

However once fully supported by a psychiatrist Dr had a crisis (at exam time) and having taken a swig of benylin and 11 anti-histamine 48 hours earlier then took herself to a&e to make sure she had done no harm. A&E then had £1000 for an overnight admission to facilitate a CAMHS review the next morning. A&E didnt know their on-site psych liaison team could assess over 16s. Again after review CAMHS did nothing for three months despite A&E wanting to insist on admission.

The system is utterly broken. DD got well because we could afford private MH care. Nobody told us MH for young people was no longer properly provided. My annual tax statement tells me what I contribute to the NHS but it isn't broken down. It is not honest and I don't feel I get vfm.

I couldn't agree with you more!