PETER MOORE: Patients can help by not being ill...

THE message to the NHS is 'Happy new year and, by the way, can you save the odd £20bn over the next four years.' One of the problems, it seems, is too much demand.

A few years ago we looked through the notes of all of our patients who had been admitted to hospital several times and found an amazing fact for which I was hoping to, at least, get a 'Blue Shield' award if not the Nobel Prize for medicine. It seems that patients who keep having to be admitted to hospital are ill. Selfish patients are increasing demand by falling ill without any consideration of the financial consequences to the NHS.

We are also told that we need to increase 'productivity'. The Oxford English dictionary defines productivity as 'the effectiveness of productive effort, especially in industry, as measured in terms of the rate of output per unit of input.' This should not be a problem in the NHS. Nurses keep a detailed record of a patient's output on most wards. They even keep input and output charts. By prescribing more diuretics or water pills we should be able to increase a patient's output significantly.

And, if we want the NHS to balance the books why close hospital beds when they could be making a profit? Why not spend your holiday in Torbay Hospital rather than a hotel? After all the name hospital comes from the Latin 'hospitale' or guest house; the same stem as hospitality. Originally hospitals were charitable institutions for the needy, aged, infirm or young. If politicians want to keep hospitals exclusively for ill people they should use the old name 'infirmary.' The hospital already has a department called 'hotel services.'

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With staff cutbacks we can promise that you won't be disturbed. All hotels offer a good night's sleep but we can guarantee a good night's sleep with the help of an anaesthetist. We would have to warn holidaymakers not to book an evening in the theatre but we could offer karaoke with 'Doc of the Bay.'

South Devon has received national recognition for the 'virtual ward.' These are not real wards built of bricks and mortar but pretend wards; the patient is actually at home but being given hospital-type care. But why stop at virtual wards? Why not have virtual patients?

If we could stop real patients from attending GP surgeries or hospitals the whole service would become far more efficient. A virtual patient might need a virtual blood test or X-ray but these would only need virtual X-ray machines and virtual labs. They may need to take a virtual prescription to a virtual chemist but the virtual drugs would be cheap, or even free.

An NHS without any patients would be clean with no hospital super-bugs. Imagine an appointment system which did not have to deal with the inconvenience of real patients.

Of course, the vital work of the NHS must continue, patients or no patients. We would still need transformation and community managers for unscheduled care, performance and information analysts, patient experience and engagement specialists and Ice (order communication systems) administrators. We must liaise with the stakeholders and feedback to the integrated clinical and management community teams. The new commissioning groups would continue.

Without real patients the NHS could dramatically cut back on doctors, nurses and other clinical staff but the new system would need an increase in managers. Virtual patients can still have 'unscheduled care' and although patient experience would all be virtual, we might need a whole committee meeting, weekly, to analyse what the patient experience would have been had the virtual patient been a real patient. All this work requires extra administrative staff.

All these ideas might help towards saving the £20bn but how much benefit would real patients have from my new virtual system? Virtually nothing.