![\"ceinwen_giles2\"](\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2015\/09\/ceinwen_giles2.jpg\")
<\/a><\/p>\n\u201cIt\u2019s outrageous.\u201d<\/span><\/p>\n \u201cPretty soon there won\u2019t be anything left to cut.\u201d<\/span><\/p>\n \u201cWhat the <\/span>actual\u2026.???\u201d<\/span><\/p>\n These w<\/span>ere the comments I heard from<\/span> nurses and<\/span> fellow patients at <\/span>my <\/span>immunology <\/span>clinic a few months ago. The source of their ire was not, as one might expect, the cutting of access to treatment or extended wait<\/span>ing<\/span> time<\/span>s\u2014<\/span>it was biscuits. <\/span><\/p>\n I\u2019ve been attending the same<\/span> <\/span>clinic at a large, modern hospital for fi<\/span>ve and a half years. Because <\/span>the<\/span> treatment <\/span>I receive <\/span>is administered by IV<\/span> every four weeks, I\u2019ve gotten to know many of the other patients fairly well. We<\/span> have an odd sort of <\/span>camaraderie<\/span>,<\/span> sitting together hooked up to various <\/span>bits of equipment<\/span> and drugs<\/span> for hours at a time. W<\/span>e chat about our families,<\/span> holidays, and current events, b<\/span>ut few conversations have become as animated as what I <\/span>now <\/span>think of as \u201c<\/span>Biscuitgate.<\/span>\u201d<\/span><\/p>\n Biscuitgate<\/span> started three months ago when we turned up at our usual day and time to find that the clinic\u2019s biscuit tin was empty. It soon emerged that the tin was empty due <\/span>not <\/span>to oversight, but<\/span> rather<\/span> to financial cuts. <\/span><\/p>\n \u201cIt started years ago\u201d<\/span>, <\/span>one fellow patient mused<\/span>. \u201cThey cut the <\/span>Branston<\/span> <\/span>pickle in the cheese and pickle sandwiches, and it\u2019s been downhill from there.\u201d<\/span><\/p>\n \u201c<\/span>That <\/span>Jeremy Hunt stole my biscuits\u201d, <\/span>muttered <\/span>another patient <\/span>loudly<\/span>. <\/span><\/p>\n Indeed, the last few years have<\/span> seen an increasingly rapid process of <\/span>cut<\/span>s<\/span> to the snacks offered to patients. It may have started with<\/span> the<\/span> pickle<\/span>,<\/span> but it<\/span> <\/span>expanded to <\/span>all <\/span>sandwiches, orange juice, and yogurt. The biscuits and tea were all we had left. <\/span><\/p>\n H<\/span>ere\u2019s the thing: I don\u2019t even usually eat these biscuits<\/span>. <\/span>But hav<\/span>ing witnessed the uproar that the de-<\/span>biscuitisation<\/span> of the clinic caused, I decided I needed to fight for the right of my fellow patients to have their infusions with a side of<\/span> cookies whether I personally eat<\/span> them or not.<\/span> <\/span><\/p>\n Online research showed me that a catering box of 100 biscuit<\/span>\u00a0packets<\/span> cost<\/span>s<\/span> <\/span>approximately<\/span> \u00a318<\/span>. Estimates by <\/span>my <\/span>nurses vary<\/span> but, on average, the clinic gets through two to three boxes a month. At <\/span>this price<\/span> we\u2019re talking about a cost of<\/span> <\/span>around <\/span>\u00a313 a week. <\/span>The NHS Trust where I receive my treatment has an annual budget of more than \u00a3800 million<\/span>.<\/span>\u00a0<\/span><\/p>\n<\/div>\n<\/div>\n I initially<\/span> approached a non-executive d<\/span>irector of the hospital who<\/span>m<\/span> I know personally, and<\/span> I told her of our <\/span>pligh<\/span>t. <\/span> I pointed out that during hours of a somewhat unpleasant treatment, the biscuits are a small kindness. When the treatment makes us tired and nauseous, as it often does, the biscuits offer a small sugar boost and can help settle the stomach. Yes, we can bring food with us (many of us do) but when you\u2019re sitting in the same chair for four hours at a go, the food goes quickly.<\/span><\/p>\n The director<\/span> <\/span>understood how much small things <\/span>can matter<\/span>, and promised to look into it. The biscuits made a <\/span>short-lived <\/span>reappearance<\/span>, <\/span>but <\/span>this month they were cut again. Word on the stree<\/span>t (or hospital corridor, as it may be) is that although the matron has<\/span> approved the biscuits, an operations<\/span> manager of some description has<\/span> re<\/span>fused to sign off the request. In any case, t<\/span>he biscuit tin is again lying empty.<\/span><\/p>\n The repeat cutting of the biscuits led me to question whether I was fighting a losing<\/span>,<\/span> or perhaps unimportant<\/span>,<\/span> battle. The clinic I attend does, after all, provide me wi<\/span>th very expensive drugs for free. <\/span>However, having now debated t<\/span>his topic<\/span> far and wide,<\/span> my conclusion remains<\/span> the same: the biscuits matter. <\/span><\/p>\n We may be living in the age of austerity, but <\/span>good<\/span> patient experience should be seen a fundamental dimension of healthcare quality, not just a nice-to-have afterthought. With increasing cuts <\/span>and little hope of more money for the NHS anytime soon, <\/span>we all need to make difficult decisions,<\/span> but surely these should be made in partnership with those who are impacted most? <\/span><\/p>\n W<\/span>hoever is responsible for the raid on biscuits has, as far as I can tell, never spoken to the staff or patients in this clinic about their experiences. Instead, they\u2019ve made a unilateral decisio<\/span>n without understanding the true value of the biscuits. <\/span>I\u2019d postulate that <\/span>\u00a313 spent o<\/span>n biscuits is probably more than returned in<\/span> terms of an increase in trust <\/span>and respect f<\/span>or the hospital and it\u2019s staff, as well as improved adherence to treatment protocols.<\/span> <\/span><\/p>\n I\u2019ve raised another complaint, but have yet to hear if any chang<\/span>e is in the offing. In the meantime, if you see a group of people outside a hospital with <\/span>a sign<\/span> <\/span>saying<\/span> \u201cThese cuts really take the biscuit\u201d, you\u2019ll know why.<\/span><\/p>\n<\/div>\n Ceinwen Giles<\/strong> is a director at Shine Cancer Support and a trustee of the Point of Care Foundation. She also works as a consultant in patient involvement and experience and is an associate at Swarm<\/a>.<\/em><\/p>\n Competing interests:<\/strong> I have received fees for consulting from GlaxoSmithKline UK. I’m a trustee of Shine Cancer Support and the Point of Care Foundation. My speaking engagements have had travel reimbursed (but no other fees paid) by a number of organisations: King’s Fund, Macmillan, Lymphoma Association, NHS Employers, NHS Confederation.<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":" Stopping the clinic’s biscuit supply may seem trivial, but small things make a difference, says Ceinwen Giles […]<\/p>\n