For everything else, there is MasterCard...

Yearly Pre-Paid Prescription Certificate: £104.00
Orthotics: £20
13 day inpatient stay, with MRI, CT and medications: ???
Neck brace and consultation with Orthotist: ???
Two days of tilt table diagnostic tests: ????

A supportive healthcare professional who understands: PRICELESS
Getting back sailing: PRICELESS

I recently had the pleasure of doing the opening keynote of the HFMA Costing for Value Institute event. This blog summarises the points I made and reflections on hearing others speak.

I rehashed the Mastercard advert - patient style! As I was preparing and selecting different parts of my treatment and care to have as examples, I was struck by how little I knew the cost of it all. This is the strength of the NHS - when you need care, it is given based on clinical need rather than an ability to pay. Even the costs that are clear to me, such as those that I pay, don't reflect the true value. Prescriptions, for example, don't all cost the NHS £8.40 since some cost much more. During my tilt table tests, I had a pint of full fat milk with protein powder - even the best politicians in touch with real life and able to answer the time-honoured question of how much a pint of milk costs, couldn't guess the price of a pint of milk brought through the quagmire of NHS procurement contracts.

Many of the priceless elements of successful healthcare happen beyond the bricks and mortar of Trusts, and in the day to day lives of patients in our communities. And this is important, because that is where we spend most of our time as patients - in our communities. The oft-cited example of a person with diabetes spending an average of three hours a year in contact with their healthcare professionals highlights this. If we are looking at costing healthcare, we are only looking at a drop in the ocean of costs and influence if we look at those three hours, instead of looking at them together with housing, communities, environment, education and society.

While I was in A&E, wards or outpatient appointments, it was absolutely right that cost didn't enter the conversations. But when I'm not in those situations, as a patient leader, it is absolutely right that conversations about cost include us.

In Dorset, I am Chair of the Patient, Carer and Public Engagement Group, working with Dorset CCG around the transformation agenda. One of the statistics that has stuck with me is this:

If we do not change the way we work, we run the risk of overspending by around £433,000 every day by 2020/21. 

That is a hard figure to try and get your head around... and even more confusing, in the context of the rest of the statistics and figures that do the rounds on local and national media.

There feels like a real lack of consistency in this messaging. On the one hand, we are running out of money, but we are spending lots of things unnecessarily and not spending on what matters? 

Because of this, it is even more important to have sensible conversations with patients and carers who are informed. This isn't about having patients with finance degrees or economic geniuses. For me, these simple steps can really help facilitate conversations about finance with patients as active equal partners: 

- put the figures in context of local/Trust/CCG budgets, overhead costs (so often hidden from patient experiences) and staff and estate costs 

- make sure that both sides of the decision are 'costed', so are we saving money not at the expense of something else important

- take time. This needs deeper conversations that just surveys. 

- provide clear evidence that better services can save money (this is hard to understand, as outside the NHS, in life, generally the more you pay, the better you expect things to be, but the GIRFT report, as presented by Briggs, highlights just how that isn't true!) 

- don't be afraid to talk about finances with patients, but ONLY when they are in a leader/rep role and not when they are in direct receipt of those services in that moment. These are conversations for beyond wards. 

- there is a cost to involving patients, to do it properly. But in the long run, this should save money and time. A picture says a thousand words, so I'll defer to the excellent Rosamund Snow's tweet below...

And of course, David Gilbert's recent blog.

Suzanne Anderson from Virginia Mason who spoke later in the morning highlight the key challenge that this conversations present: "we have to show patients the dirty laundry of our organisation."
This really sums up what makes good patient partner conversations work - mutual trust and respect and shared vision to improve things.

Being a finance manager or director in the NHS must be a really tough job. There are many pressing priorities within the Trust that are competing for money. And they can all have a really clear impact on the bottom line. But for us as patients, that is really only the tip of the iceberg...

My symptoms (that drive appointments/admissions), medications (that cost money), appointments (that push you over your CCG contract) and rest results (that get outsourced or don't meet targets) will all hit your bottom line. But the rest is just as important. Without support with everything else that you don't see, the cost will invisibly grow like a malignant tumour: £70bn per year lost due to poor mental health (OECD); £14.3bn a year lost through workplace illness (HSE). 

Quite simply, we can not afford to not have patients as partners in conversations about finances in the NHS.