Tuesday 17 April 2012

Not so obvious

On first reading, yesterday’s report in the Western Mail, that Wales’ health boards do not know how many patients are receiving radiotherapy treatment, nor what the cost of that treatment is, seemed quite ‘shocking’ or ‘staggering’ to use some favourite words from politicians’ press releases.  It seems inherently obvious that they ought to know such things, doesn’t it?  But then I remembered a dictum of one of my old science teachers – “that which is obvious isn’t necessarily true”.
Jumping from an inability to answer some very specific questions about the detail of expenditure on one particular type of treatment to an accusation of ‘financial ineptitude’ as the leader of the Lib Dems has done might make for good headlines, but doesn’t necessarily reflect reality.  There are, as anyone managing a large budget will know, many different ways of analysing expenditure in order to manage and control it; an inability to respond to a newspaper’s request to analyse it in one particular way does not, in itself, mean that there is a lack of control.
One of the challenges for those managing a large and complex organisation like the NHS is to ensure that they concentrate their attention on key information, and don’t get drowned in mere data.  Finding the right balance can be harder than it looks.  I don’t know whether they’ve got the balance right or not – and yesterday’s story gave me no help at all to improve my understanding.  The most that I can say is that there are some questions which the external auditors ought to look at to satisfy themselves that expenditure is being properly controlled.
What I do know is that ensuring that data is kept in a format which will enable any and every question to be answered on demand is not likely to be the most productive use of resources.  And those criticising the inability to answer this particular question seem to have complained often enough in the past about the numbers of bureaucrats and managers in the NHS.  Asking for more detailed record-keeping seems inconsistent to say the least.
Oscar Wilde described a cynic as “A man who knows the price of everything and the value of nothing”.  I don’t want a health service which simply ignores price issues; but I do want one which understands value as well.


Unknown said...

It seems to me that Velindre trust could answer all these questions regarding quantative breakdown, so why didn't they ask them? Not knowing how many patients end up on radiotherapy and which are given chemo therapy once they have been referred doesn't seem surprising at all, unless they are referred back.

Unlike the NHS in England, price is not a priority in Wales when treating seriously ill people, and it seems quite reasonable that the feedback on each patient's treatment, and the cost of that treatment, once it has been outsourced to another NHS entity should be a matter for them, and the cost of feeding back individual details, and the attendant record keeping at the originating trust would be a bit pointless, and costly. The only point of it as far as I can see would be to answer questions from the LibDems. I hope the Assembly has records of this information at the marco level, though.

Anonymous said...

What IS obvious that the costs of providing radiotherapy is a fixed establishment cost, both in terms of clinical skills and equipment. This is why there is a specialist unit covering South and West Wales at Velindre. In a private business it would be logical to apportion this fixed cost to customers to ascertain 'value for money', and it would allow discounting of the cost at shoulder periods and premium prices for customers at peak times. In this way maximum utilisation of the fixed establishment can achieved. It would also indicate whether it's worth maintaining such a fixed establishment in-house, or out-source. Trouble is, with the NHS customers do not choose when they are ill, and how much use of the establishment will be required when they walk in the door. Powys Health Board figures show it cost £3k per patient to treat in Wales, but £13k per patient to treat in England. Is Kirsty Williams suggesting that the Welsh NHS is four times more efficient than England ? No! It's more likely that in Powys, the more advanced , and by definition, more costly treatment is referred in Liverpool. It actually proves the point that the most effective efficiency measure is not cost per patient, or spend by Health Board, in any given year. A more suitable analysis would be 'benchmarking' the overall cost by clinical outcome, but such an analysis is unlikely to provide politicians with soudbite rhetoric. The real question is how the Velindre Health Centre compares with, for example, with a peer establishment like Beatson Centre in Glasgow. You don't get meaningful answers if you don't ask meaningful questions.

Unknown said...

Asking Kirsty to ask a meaningful question - whilst a good suggestion- is unlikely to produce any meaningful result. Far better is to do what you have done and shown just how ludicrous she is. Good work.

John Dixon said...


Thank you for that cogent comment - and I agree with Siônnyn. But of course the questions being asked - and I thought they came from the WM rather than the Lib Dems who were merely invited to comment on them - are intended neither to inform nor to contribute to debate, simply to seek sensationalist headlines and continue what looks increasingly like a campaign against the NHS.