I’ve been in London for the past week or so. I came across the following story on the BBC on March 22 about Fresenius laying off 29 health care assistants redundant across the West
Midlands. In the report Dr Nick Richards, Fresenius' medical director, says
that overall, patient-care is "exactly the same". The spokesperson
for the University Hospitals Birmingham NHS Foundation Trust says: "We
have been informed that Fresenius are implementing a staff reduction programme
at Aston Cross, City, Hereford, Tipton and Kings Norton dialysis units….We will
continue to closely monitor the service delivered to ensure that Fresenius
uphold the standard of care required in accordance with the terms of the
contract."
In January a similar story about a Fresenius
clinic in Sheffield cutting evening shifts, also reported by the BBC.
Fresenius Medical Care is the largest independent provider
of dialysis care in the UK with over 50 dialysis clinics. They are
well aware that cutting health care assistants and access to evening dialysis
services won’t improve dialysis quality, and if anything, will make things
worse. After all, not being able to provide evening services is likely to
affect younger patients’ who work and then have dialysis. Getting rid of staff in the name of efficiency is all very well when you're operating a factory but in my experience it doesn't translate well in health services.
While the UK does publish its unit specific dialysis outcome data, unlike the USRDS it doesn’t identify the dialysis provider. Still, I am
sure that with some effort one could do an analysis to see if the units that
have been affected by the cutbacks have had a reduction in one or more quality
metrics. I hope the NHS scrutinizes whatever provider specific data it has
very carefully.
In the US where across-the-board reduction in
patient-nursing staff ratios have occurred over the past decade it’s still hard
to figure out whether this has affected outcome because quality of life data by
patients is not reported. The data we do have is that for mortality and
dialysis treatment time; the "for-profits" lag behind "not-for-profits" and more generally, the US lags behind Europe and Japan.
My bottom line: When a dialysis provider cuts services by
laying off staff I would ask is this another case of "the fox guarding the
henhouse"?
