Penny Wise…Pound Foolish
It has been snowing nearly every day for the past two weeks here in the Northeast of England. The snow here is not like the stuff back in New York, it is more like hail that falls and freezes into sheets of ice. Driving and merely walking outdoors are now a considerable challenge. I've had to visit the local hospital's Accident and Emergency department to screen potential patients to see if we could safely manage them at home or if they should go to a care home instead. The department was profoundly busy with each bay occupied, full waiting rooms as well as ambulances waiting with more patients. Was this demonstrating a deficiency in the NHS? Not at all! The doctors, nurses, EMTs and therapists were rising beautifully to the challenge. What it did demonstrate was incredible short sightedness of the local councils.
I wrote a while back that the central government funds the NHS but local government allocates those funds and decides which programs to support. The local government now has to support and pay for a very large number of fracture, sprain, and injury treatments and rehab. That money will have to come from somewhere else.
You may ask why I point a finger at the local council. It is because the council has chosen not to fund the gritting, sanding and snow removal projects sufficiently. After a few days of staying home, people needed to get out and replenish basic food supplies, medications and other needs. It was three to four days after the storm when the falls started happening.
Something like snow removal has a profound impact on public health. We tend to think about swine flu, MRSA and smoking as public health issues, but what about our environment? I've done a fair amount of work with a patient in our falls clinic, however it was she whom I met in the A & E because she had fallen on the ice four days after the storm while going out for groceries. No matter what intervention I had applied earlier, this was a fall that I could not prevent. Fall prevention, by the way, is one of the focus areas that the local commission wants the NHS to address.
Sometimes it is not the health care system which is the problem behind rising costs, but rather the poor planning in other areas which then requires greater use of services.