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.
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!
Thanks for the update Rory. It's nice to hear that your voice has been heard - social media does have its uses.
I'd love to hope that change will happen, but it's going to take a massive push. I don't have such extreme examples as some of the other's who have commented, but certainly a couple of disconnect examples.
I take a drug for arthritis that requires regular blood tests and there is a "shared care" arrangement between the consultant and GP. A couple of years ago one of my indicators was raised - the GP told me to stop taking the drug and it wasn't until I had my routine consultant appointment 3 months later that they knew anything about this.
The other more recent example relates to a cold jab I had last May. This was done at a mobile clinic in an Ikea car park (!) and done by pharmacists. I received no info at the time. Later, checking my NHS covid record online via the .gov website there was no sign of the vaccination having been done. I queried this and was told it would be uploaded "soon". I checked a couple of months ago - still no sign. Queried again, and was told it's on "their" system even though I couldn't see it on my NHS record via the .gov website and was told that the matter was complete and there was no point in contacting them again.
Thank you for throwing a spotlight on this - it’s not just about financial resources. This week I received a text to say there was an update on my local hospital portal regarding a new appt ( there was I checked). I’ve now received two hard copies in the post of the letter on the portal...
My partner was in and out of hospital often as an emergency. As busy people we tried to be as organised as possible and every visit we went in with a typed-up sheet of current medications to avoid any confusion.
On discharge the letter would state medicines that were not current and exclude those that were. All too often drugs were not given during the stay because the prepared sheet we had taken in with us was ignored. On checking the discharge letter prior to discharge, we would tell the staff that we did not need a lot of the drugs prescribed and that others were missing but were told there was nothing that could be done, and we were discharged with some drugs that were of no use.
To compound the problem the GP would not prescribe the required drugs excluded from the list because he pedantically worked to the discharge list, and then he also prescribed the drugs no longer needed. The hospital ward would not respond to phone calls and the situation was only resolved by camping out on the ward and refusing to leave until someone dealt with me.
It was difficult to get any information on treatment while an inpatient, as one stage Salbutamol was dispensed through the air-line but we were not informed and still used the inhaler which was left on the table.
After manifestly strange behaviour and a refusal from the staff to believe anything was wrong, who assumed such behaviour was normal, Salbutamol induced hypoxia was finally diagnosed.
There are dedicated professionals in the NHS, but their work is undermined by the sclerotic stubbornness of colleagues that borders on incompetence. So much is wasted on mis-prescribed medicines which end up being disposed. Users of the service are loathe to complain in case their treatment is prejudiced and moreover you struggle to believe some of things are actually happening to you.
We all know that “our” NHS is badly broken. It will only change when there is the political will to do so. Our politicians have consistently refused to take the logical,step of forming a cross-party group to study the entire system and come up with the answers to improve things, and restore the “world leading” NHS to compare with the healthcare systems adopted by countries such as France, Germany and Australia.
I have worked in and alongside the NHS for over 30 years. The core processes that underpin the patient pathway (or not) in many trusts have evolved rather like a coral reef - a complex and often covert ecosystem of behaviours and habits rather than a set of streamlined and documented value adding steps that actively support patient and clinician on the pathway. And then we put megalithic IT systems on top of that complexity and are surprised when it makes things worse/slower - no amount of computerisation will make a complex mess anything other than a complex mess hidden in a black box. The fundamental skills of Operations Management are not a prerequisite for NHS management.
In the grand scheme of what you’re talking about this is perhaps a minor point, but more user input to systems design earlier in the process could really help. So many big government systems are designed for the people that take the information out but not the ones that put it in. And then they wonder why there are problems. Not just user testing, but get users involved at the earliest stages of designing the project.
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!
Thanks for the update Rory. It's nice to hear that your voice has been heard - social media does have its uses.
I'd love to hope that change will happen, but it's going to take a massive push. I don't have such extreme examples as some of the other's who have commented, but certainly a couple of disconnect examples.
I take a drug for arthritis that requires regular blood tests and there is a "shared care" arrangement between the consultant and GP. A couple of years ago one of my indicators was raised - the GP told me to stop taking the drug and it wasn't until I had my routine consultant appointment 3 months later that they knew anything about this.
The other more recent example relates to a cold jab I had last May. This was done at a mobile clinic in an Ikea car park (!) and done by pharmacists. I received no info at the time. Later, checking my NHS covid record online via the .gov website there was no sign of the vaccination having been done. I queried this and was told it would be uploaded "soon". I checked a couple of months ago - still no sign. Queried again, and was told it's on "their" system even though I couldn't see it on my NHS record via the .gov website and was told that the matter was complete and there was no point in contacting them again.
Thank you for throwing a spotlight on this - it’s not just about financial resources. This week I received a text to say there was an update on my local hospital portal regarding a new appt ( there was I checked). I’ve now received two hard copies in the post of the letter on the portal...
(Apologies for duplicating this comment from your last post.)
Poor communication extends to the outpatient setting. Best practice is for the hospital doctor to write a letter directly to you, the patient, and copy it to your GP. This practice is endorsed by all the professional bodies and the government has committed to implementing it as routine. https://www.gov.uk/government/publications/government-response-to-the-independent-inquiry-report-into-the-issues-raised-by-former-surgeon-ian-paterson.
Sadly it is still the exception and the voice of the patient is too weak to drive change.
I hope you do receive a letter written to you but if you don’t, don’t hesitate to ask for it.
My partner was in and out of hospital often as an emergency. As busy people we tried to be as organised as possible and every visit we went in with a typed-up sheet of current medications to avoid any confusion.
On discharge the letter would state medicines that were not current and exclude those that were. All too often drugs were not given during the stay because the prepared sheet we had taken in with us was ignored. On checking the discharge letter prior to discharge, we would tell the staff that we did not need a lot of the drugs prescribed and that others were missing but were told there was nothing that could be done, and we were discharged with some drugs that were of no use.
To compound the problem the GP would not prescribe the required drugs excluded from the list because he pedantically worked to the discharge list, and then he also prescribed the drugs no longer needed. The hospital ward would not respond to phone calls and the situation was only resolved by camping out on the ward and refusing to leave until someone dealt with me.
It was difficult to get any information on treatment while an inpatient, as one stage Salbutamol was dispensed through the air-line but we were not informed and still used the inhaler which was left on the table.
After manifestly strange behaviour and a refusal from the staff to believe anything was wrong, who assumed such behaviour was normal, Salbutamol induced hypoxia was finally diagnosed.
There are dedicated professionals in the NHS, but their work is undermined by the sclerotic stubbornness of colleagues that borders on incompetence. So much is wasted on mis-prescribed medicines which end up being disposed. Users of the service are loathe to complain in case their treatment is prejudiced and moreover you struggle to believe some of things are actually happening to you.
We all know that “our” NHS is badly broken. It will only change when there is the political will to do so. Our politicians have consistently refused to take the logical,step of forming a cross-party group to study the entire system and come up with the answers to improve things, and restore the “world leading” NHS to compare with the healthcare systems adopted by countries such as France, Germany and Australia.
I have worked in and alongside the NHS for over 30 years. The core processes that underpin the patient pathway (or not) in many trusts have evolved rather like a coral reef - a complex and often covert ecosystem of behaviours and habits rather than a set of streamlined and documented value adding steps that actively support patient and clinician on the pathway. And then we put megalithic IT systems on top of that complexity and are surprised when it makes things worse/slower - no amount of computerisation will make a complex mess anything other than a complex mess hidden in a black box. The fundamental skills of Operations Management are not a prerequisite for NHS management.
In the grand scheme of what you’re talking about this is perhaps a minor point, but more user input to systems design earlier in the process could really help. So many big government systems are designed for the people that take the information out but not the ones that put it in. And then they wonder why there are problems. Not just user testing, but get users involved at the earliest stages of designing the project.