There are two worlds in the NHS: policy and practicality: Half of the NHS is shiny and full of well-meaning planners. The other bumbles on with changes dreamt up 10 years ago
I find I lead a double life. On one side, I am lucky enough to attend upbeat seminars and conferences about the future of the NHS. I learn about how the regulatory bodies like the Care Quality Commission and Monitor are getting their act together, to stop anything like Mid Staffs or Winterbourne View ever happening again. I hear how the close integration of the NHS and local government's social care is going to provide a seamless care pathway for me when I become senile and incontinent.
I learn how telehealth and telecare are going to keep me – and 3 million long-term care patients – at home, and not forever waiting in A&E or outpatients for care that comes two to four hours later. I understand that Healthwatch will continually monitor patients' views and make doctors and hospitals take account of what patients think. Last week, I learnt at a Westminster Health Forum that David Nicholson has decreed that "innovation" will drive every worker in the NHS.
And the NHS Mandate, published earlier this month, seemed to include all the things I have been going on about for years in these columns, like collecting all patient records in one place, and making them all accessible to patients.
But, what do I find in the real world, as I, and my aged contemporaries, move from GP appointments to outpatient clinics to hospital wards? Despite all the talk and promises, has anything changed?
Not a lot. Some of the new systems promised by Connecting for Health back in 2002 have come to my GP's surgery, such as Choose and Book. Unlike in many surgeries, it has been integrated effectively into the GP computer system, to the convenience of both the GPs and me, the patient.
This year, I understand, my Summary Care Record has been uploaded to the spine, but I gather that the data is seldom used. E-prescribing has at last reached the surgery, much to my joy;and GPs have been able to access electronically my path results in one of the local hospitals. This cuts down the amount of blood tests I have to undergo.
But otherwise, things go on the same as they always did. Last week I went into a local hospital for minor surgery 22 weeks after a dermatologist had called for the op. Whatever happened to the 18-week limit? I was then left hanging about in the prep ward for an hour and a half for no apparent reason or explanation. When I finally arrived in theatre, it was all over in 25 minutes, and quite painless. That is typical of the NHS, clinically brilliant but administratively stuck in the 20th century.
At the AGM of the same hospital a month ago, questioners from the floor complained that discharge summaries took up to four weeks to reach their GPs. I heard the same complaint at last year's AGM. I seem to remember a DH directive about three years ago insisting that discharge summaries should reach GPs not more than 48 hours after the patient left the hospital.
This indicated to me that over several years, consultants at this hospital feel these summaries are a chore, and the DH directive was a waste of paper. They have no thought for the poor GPs wanting to hold timely post-operative appointments with their patients. If that is their arrogant attitude, what hope is there of hospital consultants becoming a part of the brave new integrated primary/secondary/social care being envisaged by the DH? None at all, I would have thought.
The right mindset is just not there.
A final little horror story? Last month, I accompanied a frail 85-year-old neighbour to a pre-op session in a sub-hospital of one of the local trusts. This place seemed to be entirely made up of half-empty WW2 barrack rooms like the ones where I did my national service 66 years ago.
The nurse told him that he needed blood and urine tests, and an echocardiogram, none of which could be done in that hospital. He presented himself at the main hospital the next day, and was told he would have to book the echo test for the following week. Thus, he had to take three bites at getting a simple pre-op done. Is this a cost-effective or humane use of using NHS resources?
There are two worlds in the NHS. One is shiny and glossy and full of well-meaning and highly intelligent people planning the future. The other bumbles on as it always has, with changes dreamt up 10 years ago seeping down very, very slowly. Guardian Professional.
I find I lead a double life. On one side, I am lucky enough to attend upbeat seminars and conferences about the future of the NHS. I learn about how the regulatory bodies like the Care Quality Commission and Monitor are getting their act together, to stop anything like Mid Staffs or Winterbourne View ever happening again. I hear how the close integration of the NHS and local government's social care is going to provide a seamless care pathway for me when I become senile and incontinent.
I learn how telehealth and telecare are going to keep me – and 3 million long-term care patients – at home, and not forever waiting in A&E or outpatients for care that comes two to four hours later. I understand that Healthwatch will continually monitor patients' views and make doctors and hospitals take account of what patients think. Last week, I learnt at a Westminster Health Forum that David Nicholson has decreed that "innovation" will drive every worker in the NHS.
And the NHS Mandate, published earlier this month, seemed to include all the things I have been going on about for years in these columns, like collecting all patient records in one place, and making them all accessible to patients.
But, what do I find in the real world, as I, and my aged contemporaries, move from GP appointments to outpatient clinics to hospital wards? Despite all the talk and promises, has anything changed?
Not a lot. Some of the new systems promised by Connecting for Health back in 2002 have come to my GP's surgery, such as Choose and Book. Unlike in many surgeries, it has been integrated effectively into the GP computer system, to the convenience of both the GPs and me, the patient.
This year, I understand, my Summary Care Record has been uploaded to the spine, but I gather that the data is seldom used. E-prescribing has at last reached the surgery, much to my joy;and GPs have been able to access electronically my path results in one of the local hospitals. This cuts down the amount of blood tests I have to undergo.
But otherwise, things go on the same as they always did. Last week I went into a local hospital for minor surgery 22 weeks after a dermatologist had called for the op. Whatever happened to the 18-week limit? I was then left hanging about in the prep ward for an hour and a half for no apparent reason or explanation. When I finally arrived in theatre, it was all over in 25 minutes, and quite painless. That is typical of the NHS, clinically brilliant but administratively stuck in the 20th century.
At the AGM of the same hospital a month ago, questioners from the floor complained that discharge summaries took up to four weeks to reach their GPs. I heard the same complaint at last year's AGM. I seem to remember a DH directive about three years ago insisting that discharge summaries should reach GPs not more than 48 hours after the patient left the hospital.
This indicated to me that over several years, consultants at this hospital feel these summaries are a chore, and the DH directive was a waste of paper. They have no thought for the poor GPs wanting to hold timely post-operative appointments with their patients. If that is their arrogant attitude, what hope is there of hospital consultants becoming a part of the brave new integrated primary/secondary/social care being envisaged by the DH? None at all, I would have thought.
The right mindset is just not there.
A final little horror story? Last month, I accompanied a frail 85-year-old neighbour to a pre-op session in a sub-hospital of one of the local trusts. This place seemed to be entirely made up of half-empty WW2 barrack rooms like the ones where I did my national service 66 years ago.
The nurse told him that he needed blood and urine tests, and an echocardiogram, none of which could be done in that hospital. He presented himself at the main hospital the next day, and was told he would have to book the echo test for the following week. Thus, he had to take three bites at getting a simple pre-op done. Is this a cost-effective or humane use of using NHS resources?
There are two worlds in the NHS. One is shiny and glossy and full of well-meaning and highly intelligent people planning the future. The other bumbles on as it always has, with changes dreamt up 10 years ago seeping down very, very slowly. Guardian Professional.
No comments:
Post a Comment