Posted by: talkjack | May 31, 2008

The NHS Choose and Book system in action

For my American friends, let me just clarify that NHS stands for the National Health Service, which is the UK’s hospital service paid for by UK taxpayers.

Anyhoo, I have been poorly for the last few weeks. Being ill was in fact one of the reasons why I decided to start blogging – I always wanted to write a column before I die. Funny how ill health focusses the mind.

I digress, this post is about the super duper new Choose and Book system that the NHS use, which according to the official blurb… The idea is simple, your doctor (GP) does some paperwork, you then are given some helpful info to compare hopitals such as waiting times, you choose your preferred option from the list, phone a free number and book an appointment in the very short future. No more months of waiting on NHS waiting lists – Choose and Book is supposed to solve all that, and introduce some customer choice.

My experience was pathetic in comparison. Firstly, the act of getting the Choose and Book letter was confusing and took two weeks. My GP told me to come back to their practice during the next week to pick up the Choose and Book letter. Fair enough I thought. Next week, queue up at Reception, to be told by the staff that the letter had not come in yet, come back in a few days.

So, go back at the end of the week. This time to be told that that the doctor had made a mistake (I assume her Reception colleague standing two feet away had made the same mistake.) Apparently the letter is posted to you by the hospital, and you do not collect it. D’oh. Two wasted trips. Does unnecessary travel due to the NHS staffs bad training count towards my carbon footprint? I don’t want to be an eco-criminal 😉

While waiting I tried accessing the official NHS Choose and Book website, www.chooseandbook.nhs.uk but every time I tried to go beyond their home page the site kept freezing or giving me ‘page cannt be displayed’ errors. I guess their server is underspecified for the job in hand and is being overwhelmed by customers. How ironic.

The week after that the Choose and Book letter came. So did another letter, containing my Choose and Book passwords. They were delivered at the same time and left in my front porch where anyone could steal them, because the postman was too lazy to actually push them through the letterbox into the house; he just left them on the floor as usual. Not very secure of the NHS to send them together really is it? Surely if one letter gets stolen there is a high chance they both will?

The Choose and Book letter told me to pick from the list of options below. Pan down to the end of the letter, and sure enough I am being intructed to pick from a list of only one option. What brilliant service Choose and Book seems at that point – you are given the illusion of choice. I was interested to see the waiting list and other statistics for the only hospital available to me. naturally the letter described them as ‘unavailable’. Brilliant, I feel conned even further.

So much for the Choose part of Choose and Book. How would the booking go?

I was pleased to see it was a free phone call to make a booking to see a doctor in the hope of getting some treatment. (At this point understand I am physically tired and very stressed due to my health issues and do not want to deal with any hassles). I phone up, and join a call queue. I wait.

Eventually I give all my details to the helpful lady. She was very professional and helpful. Better still, English seemed to be her first language, and for once I had no trouble understanding her, unlike overseas call centre staff. (And before you go off jumping to false conclusions – I have a hearing impairment too, and often struggle to understand Indian call centre staff who cannot prounce my surname because they pronounce W’s as V’s and so on). I was put on hold while the computer ran its search routine to offer me an appointment. I am taken off hold five minutes later and the kind lady explains to me that there are no bookings available. She puts me on hold while she searches again, just to be certain. Fair enough on her part, but I wish the NHS had specified the computer system correctly so it ran the search in seconds (I have programmed real business databases myself so I know what I am talking about.)

Yup, the Choose and Booksystem can offer me no bookings. The lady goes quiet waiting for me to speak. I do not know what I am supposed to say at this point.  I think, and simply ask ‘What happens next?’. ‘What happens next is that you are put on a waiting list, and if there is a cancellation you will be contacted to come in.’  I ask how long this will take. I am told the NHS are have a target, if it takes more than 11 weeks (which will be 13 weeks or three months since I had a five minute consultation with my GP) then I am to phone again.

So there you have it. Speaking as a customer, I judge that the NHS must have redefined the words ‘choose’and ‘book’ when they decided to call their system the Choose and Book system. For me there was no choice except to go to the local University hospital (the one which has been in the newspapers recently due to the high number of patients they have killed due to bad hygeine / superbugs compared to the national average). There was no information available, in contradiction to the official NHS Choose and Book spiel. And they have redefined the work ‘book’ because I could not book, I just got added to a waiting list. No choice of appointment date or time for me 😦

So, the old NHS system was that you saw a doctor (GP) , got referred for treatment, went on a waiting list to be called. The new Choose and Book system did exactly the same as that for me, except wasted more of my time on phone calls and trips to collect letters. Oh, and it gave me false hope as well.

I am left feeling depressed, ill, and wondering how they got away with calling it Choose and Book?

… talkjack

——————

Update15 June 2008

This week I received a letter from the NHS chastising me for failing to book an appointment as yet. They tell me that it is important to do so as soon as possible.  Talk about rubbing it in! I would book an appointment, but the NHS keep telling me that none are available when I try.

Where is the value in this letter, I wonder. Does it offer the NHS a way to blame me for not booking an appointment in time? It certainly does not help me to get any treatment. I feel ill. At this point, I would like them to contact me by telephone when an appointment is available, rather than write to me like this.

… talkjack

——————

Update19 June 2008

Aha, another letter arrived today from the NHS. I opened it hopeful of being granted an appointment, but was disappointed to see that it is a duplicate of the letter I received last week telling me to Choose from the one choice on the NHS menu, then phone up and Bookan appointment.

So tonight I phoned up, but the NHS voicemail told me that all their staff are busy due to ‘heavy demand’ (i.e. they have not employed enough staff) and I should book online if possible. I tried to book online, but was unable to get a stable internet connection earlier tonight. This was because Tiscali’s internet connection was ‘very busy due to heavy demand’. (i.e. Tiscali have failed to provide adequate network bandwidth for me, their paying customer.)

I phoned back to the NHS, ignored the same recorded message, waited it out (at my expense) and eventually spoke to a friendly, helpful chap called Abdul. (i am very greatful that Abdul did not try to pass himself off as ‘Andrew’ or similar, which is an annoying habit of overseas call centre staff who plague me, but that is another story!)

After a wait for the NHS computer to wake up, Abdul gave me an 0800 number to call. I called that number, spoke to a different lady at a nearby clinic. This lady did not give her name, but was also friendly and polite. She too had to apologise for the slow NHS Choose and Book computer system she was using, but eventually she was able to give me some unhelpful information.

It seems that there are still no appointments available for me, and I should continue to wait until I hear from the NHS. I was also told to ignore the two letters I had received so far.

I empathise with the lady for sounding genuinely disappointed that she could not help me. I am also becoming aware of the waste of both my and NHS time and money caused by a poorly programmed NHS Choose and Book computer system which keeps generating pointless letters requiring me to phone up and wait for a service that is not available. Why call it Choose and Book? I can still  do neither, and have wasted a month trying to book the one and only choice that I may possibly be allowed to make one day.. just maybe..?

…Talkjack

 ——————

Update 02/07/08

Still no appointment yet. However, after failing to send me pointless NHS letter last week, this week I received a fat envelope. When I saw the NHS logo on the paperwork my hopes were raised because I could tell this time the envelope was thicker. I opened the envelope and saw a map of a hospital. Had my Choose and Book appointment finally been made?

The hell it had. I turned the papers over and found not a Choose and Book appointment, but… An NHS letter asking me to let them know how good their Choose and Book system is. There is a two page survey questionnaire for me to fill in. It is printed on very thick, heavy, expensive looking paper, almost like card.

The accompanying letter tells me reassuringly that the survey is completely confidential and not linked to my patient records. However the top of the survey form has a big bold hospital reference number mailmerged onto it. Not very reassuring that it cannot be traced back to me then, is it?

I take a closer look at the survey. To the right of the NHS logo is printed Ipsos MORI. I wondered how much this exercise cost.

The actual survey questions are all multiple choice. If you have ever designed your own business questionnaire you soon learn that restricting people to a tiny number of fixed answers per question makes working out your stats very easy. It requires the least effort on your part. It also prevents respondents from telling you the sort of information you really ought to be finding out, such as what it is really like to have dealings with your organisation.

There is nowhere on this survey for me to let the NHS know what my Choose and Book experience has been like so far. Half the back page is devoted to five sub questions all asking me for my ethnicity.

Question 8 is quite amusing in a tragic way. I am asked to tick as many boxes as I can to let the NHS know which factors are most important in choosing a hospital. Ignoring the questionable English (surely only one can be MOST important?) the list includes things like:

Car Parking (but no mention of extortionate car park prices)

Convenience of appointment time (I wish the NHS would let me make an appointment at any time!)

Low levels of infection (duh, who wants to go into a toxic, dirty infection zone while they are already ill? Wonder who wrote this?)

There is no tick box to shout ‘I HAVE BEEN GIVEN NO CHOICE OF HOSPITAL SO STOP ASKING ME ABOUT MY CHOICE WHEN I THE NHS DIDN’T OFFER ME ONE!’ or how about ‘I KEEP TRYING TO MAKE AN APPOINTMENT BUT YOU KEEP TELLING ME THAT NONE ARE AVAILABLE!’

I suspect this is not the sort of information the NHS management want to know. Otherwise they would have asked, right?

I decide not to fill in the NHS / Ipsos MORI survey right now. I keep it with the growing mound of wasteful NHS letters until after I have actually had an appointment. I will probably send it back then.

 …Talkjack

 ——————

Update 12/07/08

Yay! Finally! A very thin envelope adorned with an NHS logo arrived this week. Only one piece of paper inside. A letter telling me that I have been allocated an appointment in two weeks time. I am feeling very relieved.

Unfortunately the NHS could not resist beginning by thanking me for choosing this particular hospital, which in the circumstances feels like bad taste. The hospital I have been allocated to apparently has high incidents of MRSA or C-Diff infections. However I am so relieved to have been given some time with a consultant (or one of their junior team members apparently) that my spirits are still higher today than they have been since I saw my GP in May.

After all, they say ‘beggars can’t be choosers’. Hey, maybe that would make a funny, ironic nickname for the NHS Choose and Book system?

… Talkjack

 ——————

Update 26/07/08

Finally saw a consultant this week. Stress wise, I am feeling much relieved now.

Last time I went to this particular hospital there was blood all over the gents toilet floor. This time the toilets had been cleaned.

This time I chose to walk for nearly an hour each way to the hospital rather than pay the extortionate car parking charges the hospital management levy against the sick and their loved ones. I find this practice cruel and unfair.

The NHS staff I saw this week were frindly and competent. Apart from one mistake where they gave me the wrong telephone numbers to call to confirm that the next consultant I need to see is actually at work on the day in question and not on call at the time. Probably this part of the NHS booking procedure could be imporved by better resource management. A nurse smoothly intercepted me on the way out, before I became aware of the mistake with the phone numbers. She explained that the consultant often does that, then corrected the post-it note for me.

Apparrently I also yet another set of blood tests and before the six week swait to see a different consultant now. I could not get the blood tests done because that part of the hospital was closed at the time of my appointment. Rather than having to take time  off work on another day (which would force me to drive and park to save time, meaning I would be ripped off by the NHS car park charges) I asked about the possibility of having the blood samples taken at my local GP’s practice. The staff looked surprise, hesitated then said ‘yes’. So I have booked up for that now, for next week. After that, five more weeks to wait till I see the other consultant.

… Talkjack

 ——————

Update 02/08/08

Had my blood taken for tests this week. Blood was taken at my local GP’s surgery as requested. There was a one week wait before I could get the appointment for this.

Whilst waiting in the waiting room for 10 minutes past my appojntment time I was amused by the sign on the wall informing us that 47 people missed their appointments in the last week, wasting 470 minutes of the NHS staff’s time. I idly wondered if they would deduct my 10 minutes from that figure 🙂 To be honest, I have previously had to wait more than an hour after my appointment times, so was delighted that it was only ten minutes. I cannot recall ever being seen on time.

The lady who took my blood was friendly and courteous. She did not recognise one of the tests the consultant had requested. She looked it up on her latest printout of blood tests but could not find it. She consulted with a GP about what was required while I waited then took my blood in a caring, competent manner, for which I am grateful.

Probably no more progress for another five weeks now when I am booked to see the next NHS consultant.

… Talkjack

 ——————

Update 04/09/08

My appointment with the specialist finally arrived. I felt nervous and relieved at the same time.

Thanks to the draconian parking fees at the hospital in Coventry I took an extra hour off work so that I could park my car at home, then walk to the hospital. It took me ages to walk there, and I had to walk past rows of half empty buses idling at the hospital, which forced me to breathe in their fumes. I also had to walk past rows of smokers forcing me to passive smoke on the so called smoke free hospital grounds. I was literally coughing when I arrived. There is nothing eco-friendly about overcharging for car park places.

Absurdly, I also walked past a huge empty area of land on the hospital grounds which would have made an ideal cheap or free public car park, but it was all fenced off and badly maintained. I think the word ‘eye-sore’ would be appropriate. So much for rip-off hospital parking charges, which just made me tired, cough,  and forced me to take extra time off work. But then draconian hospital parking charges are a fact of life in Bully Britain (unless you live in Scotland, as was revealed this week! More racism against the English then?)

When I got to the hospital I tried to use the toilet facilities but they were overcrowded and the floor was puddled. Nasty. I decided to ‘hold it’ till I got home!

I was kept waiting about 35 minutes past my appointment, but because I arrived ten minutes early it felt even longer. To amuse myself I sat in the waiting area watching everyone walking past the ‘You must clean your hands now with this gel’ sign on the door, and only counted three people actually obey it. Not one staff member did. I hate touching door handles in hospitals. In this century, why do the doors not autoamtically slide open like shop doors do?

When I was seen the specialist was very polite and obviously knew his stuff. The first thing he did was tell me that all my raft of blood tests were fine, which is a huge relief to know they have eliminated cancer, kidney, liver and assorted other potential causes.

After an examination the specialist recommended surgery and discussed options. I took his advice and opted for the least intrusive surgery. I am now facing a general anaesthetic, a quick operation and a few days off work to recover. I will probably be on pain medication because he said ‘it will feel like I have been kicked by a mule’. I appreciate the honesty and am prepared to deal with the pain.

So now I go back on a waiting list. I guess this is still part of the Choose and Book process. The specialist has to meet his three month target to offer me an appointment for the operation. Therefore he told me to expect at least two months wait, I should be offered a date towards the end of November or in December.

It is now four months since I initially saw my GP and started following the NHS Choose and Book system. So far I have been impressed with the way the NHS staff have treated me, but have been dismayed by the administrative side of Choose and Book.

There is clearly huge scope to improve computer based parts of the Choose and Book process to provide a better care service. At the moment it feels as though Choose and Book has been a beard to hide the waiting times. Lets be honest, I will still have waited half a year for treatment. It feels as though it is standard practice to enfore a minimum six week wait between each stage of the referals, and a minimum two month wait for an operation.

But, looking on the bright side, at least I hope to get some treatment at the end of this year. Beggars can’t be choosers, and I cannot afford private care. I cannot even afford the extortionate NHS car park cahrges, and have suffered accordingly. I will be grateful if the NHS Choose and Book system does finally get me some treatment.

So, I begin the next stage of waiting now. I will let you know what happens next when there is some more news. Perhaps I will be lucky, and get offered an appointment for my operation in the next month or so?

… Talkjack

 ——————

Update 22/09/08

Completely out of the blue I had a phone call from the hospital. They have had a cancellation and want me to go in at short notice. After checking I am OK for time off work I quickly agreed. At the moment I am waiting for a letter to arrive telling me exactly what to do, as I am unfamiliar with NHS procedures on Day Surgery, so do not quite know what to expect, or where to report on the day.

Hope the letter arrives quickly, so I can make arrangements for looking after my kids, and maybe I will need someone to take me home afterwards?

… Talkjack

 ——————

Update 26/09/08

Last minute panic! When there was only one day to go I had still not received the promised letter with all the important details from the hospital such as when to stop eating, stop drinking, when I was likely to leave, and what to take with me. Critical information when you have childcare arrangements to make, and to organise time off work.

I finally got the letter as I returned home from work on the evening before my operation! It included important information such as not to smoke for two days prior to the operation. Stupidly, the NHS had only posted me the letter one day previously, giving me no chance to comply with such instructions! I also noticed they had not filled in any of the empty boxes on the pre-pritned form they sent regarding general anaestheits. Not promising. I did not sleep well that night, as you can imagine. I did just manage to meet their nil by mouth instructions though.

… Talkjack

 —————–

Update 11/10/08

I have written a long article detailing my experiences and treatment by the NHS on the big day. I have decided to post the full article in here, because it will add a sense of closure, and some of my conclusions about NHS management make more sense if read in conjuction with my notes on the Choose and Book system .

All the best, Talkjack. Here is the article:

Talkjack’s NHS hospital Experience

Perhaps I should have called this article ‘Dear NHS, while you are talking about patient dignity, please leave my penis alone!’ Read on to see why!

Day Surgery Day finally arrived! After months of waiting and a raft of tests, I woke up on the morning nervously realising that the big day had finally arrived and I was due for day surgery at my nearest NHS hospital in Coventry. This is the only hospital which was available to me for the treatment I needed. The Choose and Book system had been a facade.

Here are some of the highlights of my day:

I was determined to remain in high spirits throughout the day, and am pleased to say I achieved this. I was friendly and polite to everyone I encountered.

I did not suffer too much from hunger during the day. I was booked for surgery in the afternoon so was able to have a small breakfast and some water later on. I recall only 24 hours earlier, frantically trying to research the fasting requirements at work because I had not received my letter.
Environmental unfriendliness

Being unable to afford the parking fees I chose to walk to the hospital carrying all the stuff I was told to take with me. To take public transport would require two bus journeys; the first in the opposite direction all the way into Coventry City centre and the second back out to the hospital. This triples the distance travelled and is environmentally or financially efficient. I have always felt that the bus service in Coventry is geared up to maximise journey distance and profit, and has scope to be much more eco-friendly.

Upon arriving on foot at the hospital grounds there is another 10 minute walk from the road to the main entrance. There was no public transport to save walking this last half mile or so. I walked past big signs banning smoking in the open air, and plenty of red lined roads and obstacles to car parking anywhere except on the expensive car parks. Ten years ago there were many cars parked out of the way of roads and footpaths upon grass verges on the hospital. These facilities have gone now that the NHS has imposed their huge car parking charges. The ‘free’ car park near the entrance now has a barrier and appears to be reserved for paying staff only. I imagine all these manipulations help the NHS managers to make more money from ill people.

Approaching the main entrance on foot, one is forced to cross the road twice. As usual I found buses waiting there with their engines idling. This forces sick people and their visitors to inhale exhaust fumes as they are steered across the road to the central bus stops. This is dumb. In the interests of health and safety, bus drivers could switch off their engines when waiting for several minutes, but they do not. See what I meant about there being scope for the buses to be more eco-friendly?
Next I traipsed past all the smokers. The NHS has a voice recording playing constantly, proclaiming that the hospital is a smoke-free area. (But not a diesel fume / pollution free area I thought!). The anti-smoking noise pollution seems to have no affect on the array of smokers I was forced to walk past, other than some of them hide around the corner. Really, the NHS haven’t thought this one through, have they?

Get Lost!

Lungs full of diesel fumes and second hand cigarette smoke, I entered the hospital. I found and tried to use the toilet, but there was a queue at the gents again, and my appointment time was imminent. I decided to hold it, and look for the correct reception area to report to.

Not having a medical background myself, it took me a while to work out that the NHS use the terms ‘Day Surgery’ and ‘Short Stay Surgical Unit’ interchangeably. At least it appears so, comparing the written instructions in my letter to the signage at the hospital. After some confusion and wandering around to check all signs in the main entrance area, I fast walked across the hospital and arrived at the correct reception area with seconds to spare.

After a short wait I was taken through with a group of people into the Day Surgery Ward. (I’ll stick with that name). I was taken to the far corner of the room and plonked inside a small area delimited by a curtain. The area was just big enough to squeeze in a trolley (half sized bed on wheels – the NHS may have another name for it) and a chair.

Upon the bed were my patient notes, lying where any other patient could have picked them up and read them. This, of course, puts patients at the risk of being identity theft victims. Not very clever of the NHS to do that, I thought. I was left unattended for 15 minutes, so I glanced through my own notes to pass the time.

Patient indignity

A nurse walked up to me and exclaimed ‘You haven’t got changed’ I smiled and replied ‘Sure, I can do. No one asked me to change’. The nurse glanced down at the bed and said ‘Oh, they haven’t given you a gown. She then went and fetched me a gown to change into.

I closed the curtains and changed. Just as I removed my trousers another nurse stuck her head through the curtains without warning, paused for a couple of seconds then went away again.

I changed into the gown, and the original nurse tried to help me do it up. This proved impossible because I had been given a damaged gown with some of the fastenings ripped off the side. So I spent the rest of day with my backside sticking out of the gown. Strike one point for patient dignity.

I offered the nurse the urine sample the NHS letter told me to take. No one wanted it. Not having a suitable bottle at home for this, I had purchased one specially. I ended up carrying a bottle of my own pee to the hospital and taking it home again. Strike another point for patient dignity.

A nurse weighted me and took my blood pressure and pulse rate. I was told that my pulse was a bit high but not too much. I explained how far I had walked in carrying my gear.

I waited around for a while, until the surgeon came. He drew on my chest with a marker pen, then told me he was doing three operations that afternoon and had not yet decided in what order to perform them. It later turned out I was second of the three.

I needed to use the toilet. A nurse gave me directions and I wandered off, keeping the rear of my gown closed with one hand, to protect the posterity of my posterior. I only found a single disabled toilet where the nurse directed me. I spent another two minutes looking for the gents, then. In danger of wandering too far I gave up and returned to the disabled toilet. I later found out that the disabled toilet was the only one available for that ward.
I returned to my trolley. More waiting around, which I had anticipated. Feeling hungry now.
 
Whilst waiting I was interviewed several times by NHS staff about when I had last eaten or drank anything. I was asked if I had painted my toenails. I would have liked to have responded in an Al Murray Pub Landlord voice ‘No, I’m normal!’, but I remained calm and slightly amused.

I was asked if I had any metal on my person. No I replied, except for a crowned tooth. This proved insufficient. The nurse went on to ask question me twice more on this until I had firmly established that I do not have any genital piercings. I can guess why the NHS has to be certain about this sort of thing before an operation, but I was embarrassed by the question. I thought I had covered the subject with my initial answer. Strike a point for patient dignity.

When my turn came to be taken to surgery there was a problem. It was a bit vague, but for three quarters of an hour I was asked in the anaesthetist had seen me yet. They had not. No one turned up for that. Apparently the anaesthetist should have discussed things with me before the operation.
In the end they gave up waiting and wheeled me off to be operated on. I was told to leave my slippers behind, which I did.

Two nurses wheeled me along on the trolley. After a few paces, one of them put down a clipboard of notes. To be specific, she put it down resting right on top of my penis. As they wheeled me along the trolley, the notes slid left and right, and the two ladies occasionally pushed them back to the middle. To be frank, I did not enjoy having my penis pushed from side to side repeatedly. Being an old school English sort of guy I was too polite to say anything. I lay there quietly feeling embarrassed.

When we reached the lifts the nurses apologised to me because one of the lifts was out of action. We spent five minutes or so waiting for a vacant lift to arrive. Ironically the nurses started having a discussion about patient dignity whilst they each in turn picked up the notes off my penis, glanced through them and then put them right back on top of the old chap!

The nurses expressed their concerns about patient dignity because patients had to share a single lift with orderlies. I did see some young guys wheeling equipment along, they too were waiting for the lift. They politely waited around the corner to avoid me seeing them, glancing periodically through the glass panel to see if I had gone up yet. Given the uncomfortable penis situation, I was entirely unconcerned about orderlies waiting for a lift, although the nurses seemed to think it mattered.
Strike more points for patient dignity!

Whist waiting on the trolley I tried to distract myself by reading the graffiti on the broken lift door. It appeared that hospital staff had affixed a piece of A4 paper to the lift door; a handwritten note about the lift being out of action. I presume that the graffiti was written by staff, criticising the Estates department. My favourite was ‘How inept are these people?’ to which someone had replied ‘Very!’.

I arrived upstairs had had a chat with an anaesthetist. He was an Indian chap who spoke perfect English in a clear, comprehensible accent, and he was very friendly and helpful. This is important to me because I have a hearing impairment so I often struggle to understand people with strong accents, or those who speak poor English. Please do not interpret this as racism on my part. Ignorant politically correct people sometimes do so, which I find that hurtful and rude.

Pillowgate!

Moments away from going into theatre, there was a major crisis. At least the only member of staff in a blue uniform made it seem so. It appears that, like several other people, I had been sent to theatre without a pillow. The lady was very vocal and seemed rather annoyed about this. She said that patients were not allowed into her theatre without a pillow. I could see clean pillows on the shelf near the clean linen, but they must have been reserved for more important people because I was not allowed to use one during my operation.

One of the nurses from the Day Surgery ward was waiting next to my bed until I was taken into the operating theatre. She was ordered downstairs to go fetch me a pillow from her ward, and dutifully obeyed.

In the mean time, another friendly, helpful lady came and needed to wheel me off to surgery. The operating team were ready to begin. Rather than delay for a pillow from downstairs, and being unable to use one of the pillows from upstairs because the ranting lady would not let anyone take them, the lady from the theatre team improvised a pillow from a blanket and pillow case. I liked this lady; I would have done the same thing if the situation had been reversed.

The big moment

The final journey to the operating theatre was interrupted because the staff had blocked the corridor with equipment. There was a short scuffle with empty beds and other kit I could not identify before enough room was made to squeeze my trolley down the corridor.
Outside a set of double doors I was asked to step down off the trolley and walk out of the corridor into another room, then climb onto another trolley. I managed to do this OK, but was trying to hold the gaping rear of the hospital gown closed with one hand keep my backside covered. At the same time I wondered exactly how clean and MRSA free the floor was here, because I hated being barefoot in this busy corridor outside the operating theatre. Maybe I am paranoid, but there are a lot of newspaper reports of large numbers of deaths under NHS care in recent years due to superbugs such as I did not witness a single member of NHS staff clean their hands the whole time I was at the hospital as they went from patient to patient, nor did I see anyone clean the floor. I wished I had been allowed to keep my slippers on.

I climbed onto the trolley for my operation, had a friendly chat with the staff while they knocked me out. The last thing I remember was the anaesthetist making small talk about my work, and the pain in my right arm as they drip-fed the anaesthetic into me.

I regained consciousness 20 minutes later, waking up from a dream about being at work. I was very sore and had a dressing on my chest. I have to say that the anaesthetist seems to have done a perfect job as I had no ill effects from the anaesthetic at all. This was a very different experience to the general I had when I was a teenager, which left me sick and unable to walk without falling over during the subsequent two days.

Recovery

When the people wheeling the trolley back to my ward took a wrong turn and paused to work out which way to go, I was able to give them directions. I spent the next few hours in the Day Surgery ward, and was given extra painkillers. These did the trick, as even the weight of a single bedsheet was extremely painful at the time.

There was an argument amongst the staff because I had been returned back to my ward on a bed rather than a trolley, and the tiny alcove I had been allocated was a bit too small to accommodate a bed. I was suffering a lot of pain, and was very glad they did not decide to make me climb onto a trolley at that point.

There was also a deal of conversation about a missing pillow from the Day Care ward, because a nurse had taken a pillow up to theatre, but I had returned without it. I wondered if the shouting lady upstairs was collecting them.

As the anaesthetic wore off I started feeling very hungry. Eventually, one of the nurses came over and offered me some food. I gratefully accepted the tea and toast which filled the gap. It was very painful to eat, but I got by without help.

Two minutes after I finished by fifth piece of toast, I felt pleasantly full. I was grateful to lay back down after the pain of sitting up. At that precise moment, another member of staff appeared and offered me dinner. I would have loved to have eaten the lamb stew she offered, which sounded much nicer than plain toast. Talkjack’s timing usually works out like this.

A nurse came over and gave me some pain killers to take away. She also sat down and with a piece of paper to explain my after-care requirements specific to myself and the hospital treatment I had received. Well, actually they were the instructions and private notes of the chap in the next bed, but I spotted this after 30 seconds or so, and the piece of paper was whipped out of my hand and replaced with the correct notes. I am normally quicker thinking than these, but it is understandable that I was feeling distracted and stressed.

Telephone racket?

To be honest, the rest of the waiting passed quickly. Eventually I was allowed to go home provided that I had someone to pick me up. My father had offered to do so, and was waiting for my phone call.
I had a problem phoning my father because my mobile phone had no signal. This sounds suspiciously like the NHS car parking racket. The hospital provides telephone facilities at a premium cost. The NHS used to ban people using their mobile phones claiming that they interfered with hospital equipment. Now that this ban has finally been lifted, the hospital faced losing revenue from sick people because there would be less demand for their premium telephone service.

The solution? Easy really, just install a mobile phone jammer on the premises so that sick people are unable to use the emergency mobile phone they took in with them.

To get around this problem I made my way just outside the building, where the mobile phone signal resumed. I phoned my father and waited for him to arrive. Feeling tired, I waited on the pavement amidst the smokers for my lift to arrive, filling my lungs with second hand smoke. Had the NHS allowed me to use my mobile phone indoors then I could have found an indoor seat and phoned from there.

Parking nuisance

My father arrived, he pulled the car into the drop-off bay, and I carefully picked a seat behind him so that the car seat belt would not touch my chest wound. At that point he tried to drive off, only was unable to do so. His car was blocked in with a vehicle behind, and a selfish person in front who had parked their car with the hazard lights on, blocked the exit from the drop-off bay and wandered off.
We had a five minute wait and eventually managed to squeeze our car out backwards. As we drove off I saw the selfish driver return to their car. It was a lady wearing an NHS identity badge who had blocked the road, ignoring the no parking road markings!

When I got home I washed my hands and feet for hygiene’s sake. My clothes went straight in the wash. Can’t be too careful given the NHS reputation for spreading superbugs, especially after you have been walking barefoot outside operating theatres and touching hospital door handles. I then had the luxury of spending a few days at home doing as little as possible while I recovered, managing my own pain relief with the thirty odd tablets I had been given.

Aftercare

I was instructed that my practice nurse would have to remove or change my dressings after 72 hours. I guessed correctly this meant to contact my GP’s surgery and book an appointment with their nurse, however for all I knew a practice nurse may have been a kind of trainee at the hospital. I was given some additional dressings in case they were needed.

I made the appointment with the practice nurse at the start of the following week. I spent an hour in the waiting room because her previous patient significantly overran their appointment. When I was seen there was some confusion over why I was there. I told the nurse that I had been given a letter from the hospital to be given to my GP, which I had handed in to the receptionist when I arrived. I wonder why the NHS did not use a computerised system to transmit this information to my GP’s surgery, or why they do not trust their own postal system.

The nurse removed my dressings, and got a colleague to check me over. They reached a consensus that I was healing well enough and it would be better to let air get to the wound. I left without a dressing on my wound, grateful that I had planned ahead and worn appropriate light clothes which did not rub. I would have preferred to remove my own dressing; I am sure I it would have been less painful to pull in the opposite direction. Oh, and I would have given myself less of a chest wax too!

The follow-up hospital visit

When I had left the hospital following my operation, I was told that I needed to come back six days later. The nurse said that I would receive a letter with my appointment time and place. No such letter arrived.

It took phone calls to the hospital on the previous day to find out the time and place the NHS wanted to see me. Confusingly, they never did send me a letter for this appointment. When I arrived they only had my name hand-scribbled on a torn off sheet of A4 paper along with the time. The receptionist told me I was a walk-in patient, whatever that is.

I knew I was in the right place, because I sat in the waiting area next to the guy who had been in the adjacent bed the week before. While waiting I did not mention that I had been given his notes to read! He seemed the short tempered type.

There was some more confusion when I arrived, because I had no dressing on my wound. I explained that I had been told to see a practice nurse after 72 hours, which caused some frowns to appear, but when they examined me the NHS staff seemed satisfied that all is well.

Conclusion

I have now returned to work, and the bruises from my operation have nearly gone. The scar is still visible, but is surprisingly small and not obvious to the eye. I still have some occasional mild pain, but I have full mobility and look forward to being able to exercise soon.

So there you go – a summary of Talkjack’s trip to hospital. You will hopefully observe as I did that the actual health care was pretty good,. However I could not help notice that the administrative management leaves much to be desired.

From a patient’s perspective there seems to be an NHS management goal to meet time-based targets, but equally a goal to raise revenue from sick people, their visitors and NHS employees through cleverly designed car park schemes and telephone charges which feel like a racket. No wonder Coventry’s Councillor Dixon dressed up as a highwayman for a newspaper article about the extortionate NHS car park charges in Coventry.

From what I observed throughout this process, the NHS health care professionals are mostly good, considerate, skilled people. The administration however let the NHS down in my experiences, and on occasion little incidents like mismanaged appointments, lack of clear instructions and patient dignity felt absurd and farcical. I felt that the health care staff did care about patient dignity, but staff shouting about pillows made me feel that there is some sort of stock check target for staff, which was distracting staff from patient care.

I consider that a correctly installed computer CRM type system would automate business rules for the NHS to ensure that appointment letters are correctly sent out, and that GP’s are given the correct information, whilst at the same time safeguarding patient’s confidential data.
 
Speaking as a patient about my ‘NHS customer experience’ I would suggest that if you have a valid complaint about the NHS then please reflect whether it is appropriate to take it on the front line staff. In my opinion NHS managers are responsible for ensuring that you receive good health care and good customer service. If you are unhappy or angry, please do not take it out on the health care or admin staff. Contact an appropriate manager instead and tell them what you experienced instead; if the manager is competent then they should do something to stop it happening again.

Having said that, if you have experienced any amusing, absurd or farcical treatment at the hands of the NHS the please feel free to leave a comment on this blog and share your experiences.

… Talkjack

 Update 17/01/09

Junk Mail

It would appear that the NHS have decided to send me junk mail now! This week, exactly three months after my operation I received a huge questionnaire / survey from the NHS and MORI askimg me nearly 50 questions about my local GP practice. The survey contents appear to be totally unrelated to my Choose and Book treatment, but I am sure MORI have reuse my personal data without my express permission in order to direct this survey to me. I assume this is because I answered a previous survey during my slow process throught the NHS Choose and Book system, as the style of the survey is identical.

I tried to answer the questions honestly, but the survey was huge, eight A4 sized pages of questions. I lost steam on page five. I felt I could not answer the questions honestly because they were asking me to give negative information about my GP practice. Someone had written in ink long numbers one the first page, which could be used to identify my reply and trace it to me. Given that NHS Doctors have and do expel patients from their practice without giving a reason, it seeme imprudent to give an honest reply about their poor service. I shredded the survey instead of sending it back. Sorry about the environment!

Receiving this paperwork now has brought back memories of my operation, which I have been trying to forget about and move on with my life. Thanks a lot. I am also unhappy that I have received unwanted junk mail because the my data is on the Choose and Book system. I am not aware of being given an opt-in or opt-out choice at any point. It feels that I have been automatically opted into the NHS mailing list beause of the Choose and Book system, which I find questionable under the Data Protection Act. I do not want to receive any more junk mail from NHS or MORI, but have been given no way of opting out.

… Talkjack

 Update 14/02/09

More Junk Mail!

Just received another big NHS branded envelope containing junk mail. To my surprise it turns out to be another copy of the MORI survey they sent me a month ago. This time there is a letter designed to make me feel like a naughty schoolboy not having done his homework!

Forgive my cynicism, but I feel that the NHS seem far more efficient in posting me these unwanted junk mailings then they ever were at posting me essential medical information related to my illness and operation. Remember my last minute panic because the NHS did not post me the letter in time telling me what to bring and when to eat or not eat for the big day?

This survey letter letter bangs on telling me how important my answers are, buy the survey is designed so that I cannot express myself honestly in answering. It steers me to limited responses, making it easy for them to computer mark the answers and produce stats, but in doing so twists my ‘important answers’ into different meanings than what I honestly feel. There is no opportunity for me to write free text replies to the many pages of questions where it matters. Come on now NHS, if you want honesty then allow free answers and anonymous replies, not prescribed limited responses.

Dread to think what the carbon footprint has been shipping these heavy mass mailings across the country. More importantly from an NHS customer point of view, I want to move on with my life and not be reminded of a painful and unpleasant time in my life. These unsolicited junk mailings keep bringing back unpleasant memories, which is depressing.

There is still no obvious way to opt out of this mailing list. This time I have used their prepaid envelope to right back politely asking to be removed from the NHS mailing list. Hopefully they respect my wishes and allow me to move on now.

(c) Copyright Talkjack 2009

Advertisements

Responses

  1. Having been around Choose and Book for a while in my Trust, I can sympathise with the problems you have been having with your appointments.

    The things that you describe are factors of the health service as a whole, rather than the choose and book system necessarily (although I am the first to admit that the system itself isn’t very user-friendly).

    – Really helpful, practical and friendly staff in most places
    – Chronically overloaded waiting lists, with an ever increasing demand
    – Hospital hygiene and cleaning at the lowest possible cost (and therefore generally low quality)
    – Insufficient training at all levels, to understand what should be happening, and what people should be telling the patient about the end to end process.

    You appreciate the honesty about the amount of pain you will feel. It would be good if staff understood the amount of hassle you would be looking forward to when you entered the treatment pathway (sorry for the technical term!), and were equally as frank, so they could manage your expectations.

    I hope evrything goes well for the surgery – keep us informed!

    Axy

  2. Thanks for your kind wishes Axylotl. I am feeling sore from surgery and have some impressive bruises, but thankfully I seem to be recovering well from the operation.

    I do realise that what started as a post about the NHS Choose and Book system has evolved into a history of my experiences with the NHS after the Choose and Book procedure and into my treatment.

    However I think it would be nice to report on my experiences at the hospital in order to give a sense of closure to this article. Besides, looking back at some of the silly things that happened there it might amuse or interest some readers. When I feel a bit better and have more time I will write up the end of the story.

    all the best,

    … Talkjack 5th October 2008

  3. Being an admin Monkey in the NHS, and dealing with C&B a lot, i can completely agree what a farce your first appointment can be.

    C&B is a fantastic idea in theory, supposedly makes i easier for patients and admin staff a like, but in reality it just gives us both more work.

    The majority of my job these days entails correcting f*** ups, either by the GP, other NHS employees or just general C&B failure.

    For example, a patient made an appointment (i don’t know what hassle they had to get that original appointment), a consultant then looked at the referral on C&B that the GP had attached, The consultant then CANCELLED the appointment and dropped the patient on a work list with this reason:

    “Please book patient to see Mr [insert name]”

    Fair enough, i think, and get to work to do as he asks, only to find that the patient ALREADY HAD an appointment with the requested consultant, the appointment that got cancelled. so the patient had to wait an additional 4 weeks for the next appointment with Mr [Insert name]

    The thing with C&B though, is that (at least in our trust) it does not show the name of the consultant you are booking with, so the consultant who review the referrals cannot see who they are actually currently booked with.

    Surely, the most sensible thing to do would be have the consultant review the referral BEFORE the patient gets an appointment.

    Seeing the things i’ve seen, i would say you had a pretty easy ride with C&B.

  4. Useful tip. Recently my father had a pace maker fitted. He had been having problems so we went through the assessment stages etc. We were promised a letter with an appointment in a few weeks. In order to circumvent the normal delays I found out who the Consultants secretary was. after two weeks I called her and chased it up very politely. We had the letter two days later. Since then I have used this method every time a delivery deadline passes. Everytime I have had a positive response. As my father has progressed through his treatment I have had to contact different secretaries and have found everyone of them to be very helpful as long as you are polite and don’t get agitated. It seems that most delays are caused by brilliant surgeons being absolutely rubbish at paperwork which is why they need secretaries. My last guy had his files placed in piles around the floor and took weeks to sign a letter. But all praise to admin staff.

  5. Hi, I agree that NHS Choose and Book is a fantastic waste of NHS money and our time. I went to see one of my local Gps about a twisted ankle that was taking a long time to heal. She vaguely mentioned something about physio but said no more about that, and recommended strapping up the ankle and taking ibuprofen. A few weeks later I got a letter with a booking reference number chastising me for not booking an appointment I didn’t know I was supposed to book. It was only when I visited the surgery on another matter that the receptionist gave me this letter telling me it was “Choose and Book” and offering me the ‘choice’ of one clinic. It told me I could not book online and gave me a number to phone. However, when I phoned this number (after being put on hold for 5 minutes, punctuated every 5 seconds by a voice telling me “all our agents are busy, please hold until a agent (sic) is available), the voice at the other end told me they had no clinic to offer me, and that I had to wait for “the doctors”, whoever they may be, to decide on a clinic, and that I had to ring back next Monday. No choosing, no booking, no nothing. I don’t understand.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

%d bloggers like this: