Monday, 1 June 2015

Cancer Treatment

From the BBC

A fundraising appeal is being launched in Wiltshire to help hundreds of radiotherapy patients receive treatment closer to home.
The Great Western Hospital (GWH) in Swindon needs £2.9m to equip its own radiotherapy cancer treatment centre.
Around 700 people had to undertake a 60-mile round trip to Oxford for treatment in 2013/14 - some doing it several times a week - the NHS said.

I'm curious about the ongoing costs of this. OK, you raise £2.9m for equipment with I guess, a five year lifespan. But now you've got a load of duplication of staff like receptionists, administrators and maintenance people. You no longer have a single centre of excellence - the expertise gets split.


Furor Teutonicus said...

Here we have a hospital bus service. If you are a patient that must go for regular treatment, the hospital has a contract with a firm that has a fleet of Transit/VW type buses, that the hospital book for you to pick you up, and take you home. They also have some of their own, as the firm is only contracted for weekdays.

Maybe THAT would be the cheaper option.

Sobers said...

700 people, as you say lets spread it over 5 years, so 3500 in that time. Cost of machine is £3m. Running costs must be 250k/year in staff, pension contributions, building cost, maintenance etc., so thats another £1.25 over 5 years. All in £4.25m. Divide that by the 3500 prospective patients, and you could give each one £1k in transport costs, and it still be cheaper.

60 mile round trip is about 1.5 gallons of fuel for a fairly basic car these days, so about £9 per trip. I have no idea exactly how long a course of radio therapy takes (a friend did it for breast cancer some years ago, I have in mind a couple of months). Say 3 times a week for 3 months, lets say 40 trips. So if the State paid a mileage expense of £9 for fuel plus 10p/mile in vehicle running costs, the average radiotherapy patient would need £600 to cover their travel expenses. Thats less than the cost of the machine over 5 years. In fact the machine cost alone would pay for the individual travel costs of all the patients for nearly 7 years.

Then you should look at the cost of providing a free minibus service, say 2 round trips per day, 5 days per week. I reckon if you put that out to tender you'd get plenty of takers to provide that service at £100/k year. Hell double that and have 2 buses doing two round trips so people don't have to wait too long after treatment. Still only £200k year, and I'm being very generous there.

Typical NHS costing as usual.

The Stigler said...

I think that's probably what's already done.

It doesn't even sound close in terms of value (there's some value to saving people a trip, although the time saving is mostly irrelevant - it's not like people go to work after radiotherapy).

I always get a bit questioning about this stuff because someone once explained to me that raising money for MRI machines in each hospital was a disaster and that you'd do better to raise money for more operators and have machines in fewer locations operating 16 hours a day and transport people to the machines.

There always seems to be this love of raising money for capital projects, when realistically things have to be looked at in terms of TCO.

Mark Wadsworth said...

Fewer large hospitals usually works out better

Lysistrata said...

I have cancer, and have had radiotherapy treatment - fortunately at a large hospital that's fairly near and we have our own car anyway.

I'm a great believer in centralised specialist services for stuff like this. It attracts and retains the best professional staff. The hospital I go to has 12 machines running from 8.00am till 7.00pm including Saturdays. Well, eleven of them run at any one time as, sensibly, there's a constant planned maintenance scheme in place.

But hospital transport services are a standing joke - whether inhouse or contracted - often running very late (we're talking up to 1.5 hours), which messes up all the appointment times. Plus, after radiotherapy, you get extremely tired as well as beng ill and in pain to start with, so having to wait for hospital transport afterwards - usually running even later by then - is a real problem for patients. Volunteer-based car schemes work slightly better, though still patchy.

Yep, cheaper to pay for taxis.
And yep, it's easier to fundraise or lobby for something that can be photographed, preferably with some worthy pointing at it in a press release. Picking up the running costs tab is some other bugger's problem...which is why so many expensive machines lie idle and cobweb-covered.

Random said...

Curtis said...

But now you've got a load of duplication of staff like receptionists, administrators and maintenance people. You no longer have a single centre of excellence - the expertise gets split.

Surely you aren't saying that receptionists, administrators and maintenance people are the expertise.

Well, maintenance requires some expertise, but they can travel. As can doctors, which is what actually happens in most places outside of the home counties.

If the cost of duplicate staff is only a little bit more than the cost of paying everyone to travel then it is probably worth it in terms of benefit to the patients. Perhaps the machines in Oxford have reached their capacity and the decision was between adding one at Oxford and installing one in Swindon.

The other thing you're missing is that 700 people may no longer have a 60-mile round trip, but 2000 people may now have a 20-mile round trip instead of a 40 mile trip.

James Higham said...

The expertise and as you say, the cost is multiplied. In admin.