Monday 9 May 2016

Why the NHS is swamping its own A&E

Fancy going to Accident and Emergency with conjunctivitis. I mean, what kind of feckless, ignorant type would do that?

That was the sort of attitude I felt from the handful of medical staff I encountered there early on Saturday morning. It wasn't even bad conjunctivitis, and actually it wasn't even mine: it was my nine-year-old's.

But when your child's eyes swell up in the early hours of Saturday and they are tearing at them with their fingers, you have to do something. It isn't as if you can wait until Monday morning for the surgery to open.

So what were my options? The GP surgery here was firmly shut. Not even an hour for urgent queries.

What I know I'm supposed to do is to dial 111 and they will deal with this kind of minor health issue that is urgent but not crucial. The trouble is, they wouldn't. They told us that, to get any kind of attention, "it has to be life-theatening".

The lady on reception at the accident department at the local hospital was extremely helpful and told me this was nonsense. The nurse told me I would have to stay there in order to get a prescription. In the end, I stayed for two wasted hours, as the sick and lame filled up the waiting room and jumped the queue ahead of us - as clearly they should have done.

Then someone came in with very serious conjunctivitis, her eye swollen to vast proportions. This happened to coincide with my parking meter running out, so we legged it.

I was rescued by a community pharmacist, God bless him. I should have gone there to start with, but have had so many disapproving conversations with pharmacists in recent years telling me all the things I shouldn't do to treat my child but explaining that they were nonetheless powerless to help.

I could also have told the 111 service that it was an allergic reaction, but why should I have to lie?

But let's just analyse this for a moment. Because, when accident departments are overwhelmed, these issues are important. The real problem here was the failure of the 111 service contracted out to Harmoni (part of Care UK) to do their job properly, which is to replace the GP service at weekends.

I have no problem in principle with contracted out services, but note that the contracts tend to be won by companies whose main skill is the delivery of target data to their commissioners. Since commissioners - like central government policy-makers - are completely blind to the difference between good data and good services, this is a problem.

The difficulty isn't therefore so much the privatisation of the NHS; it is the concomitant growth of American contract culture, which sets out complex deliverables which can be blurred - broadening the definitions and narrowing the mandate - so that they can maximise their profit on a tightening budget.

Hence you get a 111 service which simply replicates the emergency service, which is utterly pointless and succeeds in spraying extra costs around the system.

I have every sympathy with the government wanting to shape a seven-day a week NHS. But I find it strange that they are fighting to the death with the hospital doctors, when the real impact would come from making primary care work seven days a week effectively without humiliation.

I speak as one who has experienced the Croydon out of hours service, run at one time by a subsidiary of Virgin, where the service shared an atmosphere with the Raft of the Medusa.

This the government has signally failed to do, and has failed since the Blair years and the new GP contracts brought in so disastrously in 2004.

What we need to happen is for Whitehall to wake up to the big gap between the data and the service quality - a kind of Emperor's New Clothes distinction. But what can possibly make them aware of that?

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1 comment:

Oh, la la said...

Conjunctivitis doesn’t require a visit to the GP, even less a trip to the A&E, it’s one of those annoying childhood things like warts. Hot compress to remove the eye’s gunk, repeat, great care and depending on your parenting style, a bribe – pizza and ice cream if you stop touching your eyes, or a threat – I will break your fingers if you touch your eyes again. You visit the GP if it doesn’t go away. The NHS has gone digital as well and offers info, and how about the middle class bible’s Mumsnet?
I don’t understand what happened at the A & E? Did you get seen and told to wait for a prescription? Or did you get told you would get seen eventually and the prescription would then require more waiting? You then decided to leg it because it was taking too long and were unwilling to extend the parking – what no app for it? If you use public transport or a taxi to get to A& E, this problem does not happen.

Either way, it seems a lack of respect for a service and the people working for it, that you pay via your taxes and that is FREE. Experience other health services, and you will really like and cherish the NHS. It has its problems. The 111 service is, having used, quite a joke. If you need to go to the A&E, it will take time, you need patience. If you work all week, can’t take time off to go to your doctor because your pay will be deducted or you have run off of holiday, and your problem is not going away, then the A&E is your only option.

The NHS offers a 7 days service already, but obviously not for those suffering from conjunctivitis. Break your arm, of suffer a road accident, or flu symptoms after your chemotherapy, treatment won’t wait till Monday. But then again, you must be lucky with your A&E.

Hunt, I won’t call him by his surname, wants to offer a 7 days service with no extra money and while doing some heavy budget cutting. You must be really lousy at your job when the top brass mucks in and covers junior’s docs on strike. I mean these guys are not exactly selling the Socialist workers mags at the weekend, know what I mean? Hunt has a face you want to slap, a brown-nosing smirk and the past obsequiousness towards Sky’s owners that makes been taken seriously as a little people’s guy or even as the guy who stands up to vested interests for the greater good impossible.

The Big Data is happening, sold by data analytics consultants as the next best thing because it cost savings – obviously not the consultants’ fees. The big data may tell you where service is needed, but if you don’t have enough nurses or doctors to cover those services because of lack of funds, you will still be stuffed. Common sense is cheap yet so rare, better play politics.
Billions have been wasted, via bad management, money lavished on private providers who can’t deliver, over spending and servicing the PFI's debt.The government is starving the NHS of funds, hoping necessity will be the mother of invention and the back-door planned privatisation will come as salvation. This is from a group of people who are millionaires and let corporations little tax as possible (also called avoidance by not so polite people) and led by a guy who took a few days to cough up he had benefited from funds from his dad’s offshore account.

Hope your son’s conjunctivitis is getting better.