The NHS - Making it Better
The reaction to my post about my experience battling to get my fractured elbow mended by the NHS has been extraordinary. “Never read below the line” is usually sensible advice but in this case the online comments were almost all deeply knowledgeable and thoughtful. Most striking was how familiar my experience of delays and poor communication was to many people, both patients and healthcare practitioners.
Two messages described cases far more serious than mine. A mother described how her teenage daughter broke two bones in her foot and was sent home after two days in hospital with no clear timetable for an operation - the family decided to go private.
A woman told of how her elderly father had broken his shoulder more than a year ago and was still waiting in constant pain for an operation, his mental as well as physical health severely affected. This case sounds nothing short of scandalous and I will be trying to find out more.
I was pleased to receive this week a letter from a senior figure at my local health trust admitting that there were some “issues” with my treatment, resolving to improve communication with patients and thanking me for helping them to identify some problems with the way people with broken limbs and other injuries are processed through the hospital. I don’t kid myself that this letter would have been written if I hadn’t made quite such a public fuss but I also think many NHS staff and managers are impatient for change and deserve our support as they try to make things better.
I also had a message from someone involved in the current drive to roll out Covid boosters and flu jabs with an illustration of how relatively minor tweaks in software programs could save the NHS time and money. Here’s what he wrote:
“Up until this week, as a vaccinator, you could not record a covid jab and a flu jab on the same system on the software used (Primary Care Network "Pinnacle"). First, you had to log into "Outcomes for Health" enter the patients' details, search for them, and confirm it was them by checking with them their postcode and give them a covid jab and record all the details. To give them a flue jab you then switched to open the very similar but different "Pharma Outcomes for Health" , enter all the patients details one more time (name, DoB, NHS Number, Postcode) and then give them a flu jab. As you can imagine it slowed the whole process down tremendously- and being very honest very few paid vaccinators or admin clerks cared because it dragged the job out and kept them in work. The only people that did care were those doctors surgeries and pharmacists running the centers as last winter it was £15 for each covid given and £10 for a flu. Needless to say they have now updated the software just as the big effort to jab this year is petering out.”
I draw two lessons from this. To effect a change in any organisation you need there to be an incentive, a vision of how things could be better for both the individual and the whole system if things were done differently. But you also need someone to see it as their job to crack on and push the change through and in a vast and complex organisation such as the NHS it is all too easy for everyone to assume that someone else will take on the task.
Change is also often unpopular - “but we’ve always done it like this” - so let’s hear it for those NHS managers bold and brave enough to press for the improvements we all know are needed.
The problem is that as a country we are so tied into the NHS as a fine institution, that we are unable to properly critique and fix the bits that need fixing. Any suspected slight on the NHS is met by those who argue it's world class and any attempt to change it would be to load it with unneccessary middle managers or even, god forbid, private companies.
Everytime I've had involvment from the NHS, it's been the same - clinical care at the sharp end is excellent (world class even), but the organisation is broken. You are pushed from one process to another without anyone having oversight of your entire journey/treatment. As soon as X ray are done with you, the X ray people couldn't care where you go next...
Two examples - my father recently passed with pancreatic cancer. Having decided not to engage with chemo, he was discharged by the hospital and referred back to his GP. I say discharged - literally discharged to the extent we needed to rush around the hospital to find a spare wheelchair to take him back to our car. The GP was completeley out of her depth and we relied on Marie Curie who were marvellous. On the morning Dad passed away, the Marie Curie nurse needed the GP to sign the death certificate. She phoned the surgery, and sat on the phone for 30 mins listening to it ring as my father lay there. Eventually she got into her car, drove to the surgery and was seen by a receptionist before anyone answered the phone. Three weeks after my father passed, we received a letter from the surgery asking him to come in for a wellness check....
My other example - I have a long standing condition - my consultant is excelleent, he tells me about a new drug on the market and tells me he'll arrange for me to come back in 3 months time to see if I can get on a trial. I go to book a new appointment at his reception desk to be told the next possible appointment was 9 months later and sure enough no trial took place...
We need outside help to change the culture but there is no way it can happen whilst every single area of the NHS is pigeon-holed into their own little area with no-one overseeing process. But hey, middle managers....privatisation....can't talk about it so we'll all suffer in silence.
I have a chronic medical condition, which necessitates numerous trips to A&E and stays in hospital for observation or treatment.
Watching hard working health care professionals run themselves ragged, day after day, clarifies the need for reform in the NHS. I fear that layers of management have been stripped out from the health service, over the last 13 years. The myth that managers are unnecessary and all resources should be focussed on doctors, nurses and to the front line continues to be perpetuated.
This results in systems that don’t talk to each other, or even align, staff members repeating time consuming tasks over and over again, massively wasted energy and resources and long, long delays.
Money spent on good, efficient management systems is vital investment in efficiency and resource maximisation.
The net effect on patients of these over stretched staff and resources, are experiences like yours and the multiplicity of stories I could share!