Dear NHS - please get joined up
When the battery of tests you have performed are duplicated at a different facility you have to ask why?
Even though I’ve rarely used it until recently, I love the British National Health Service. The NHS provides a blanket of security for all citizens (and many visitors) who, when they get sick, know that medical help is at hand, free at the point of entry.
But as many will know, the NHS is under incredible stress with nurses threatening strikes for the first time in their long history. When that action looms among a group dedicated to preserving life, then you know things are bad.
Waste is a perennial talking point for large publicly owned/managed bodies. In this case, the waste issue appears to being magnified by the quasi-public/private nature of some services. Here is my example.
I have age related wet macular degeneration or WMD. It means my central vision is blurred, requiring regular eye injections to keep it under some semblance of control. It’s incurable so I’m in for the long haul. It’s debilitating when trying to undertake tasks requiring close vision but it’s not life threatening. Small mercies.
Recently I learned that I also have cataracts but in both eyes. The macular unit consultant suggested my going for an evaluation at a local specialist unit. The appointment came through quickly and today was ‘The Day.’
The sprecialist unit is a privately owned outsource provider for cataract services in my area. That’s because the local hospital is overloaded with case work. I have no issue with this when it ensures good service provision, even though I could equally argue about NHS infrastructure investment. That’s for another day.
Where I have issue is in information sharing. The specialist unit ran the exact same battery of vision tests I undergo each time I receive WMD treatment but with two that are not undertaken when at the macular unit :
Blood pressure/heart rate/blood oxygen levels (thankfully sort of normal for my age)
Vision prescription.
The rest were duplicates. I asked if the unit received my records from the macular unit. No. This is a colossal waste because while the cataract unit focus on a different problem, they could have seen the progression of cataracts from the years of images and records the macular unit holds on me.
I asked if the results of today’s consultation will be shared with the macular unit. No. It is up to myself to share the outcome on my next visit. I didn’t ask whether that’s because we agreed ‘no treatment’ at this time (I am registered as ‘discharged’) or whether it’s normal practice. But - the specialist unit has the NHS logo on its letterhead so you’d assume they’re part and parcel - albeit outsourced.
Here’s the thing. I live in an ageing world where many of my age need treatment for WMD/cataracts. The waiting room in today’s specialist facility was busy in my view yet I was told it is one of the quieter units. The WMD unit is always busy. I have no clue how many people they treat each day/week/month but I’d be surprised if it is less than 30 a day. That’s a lot of records where the potential for information sharing and efficiency is self evident.
The explanation I got from the cataract unit was curious. Apparently some other units/hospitals do share data but not all. There’s a level of complexity right there that must add cost to the services we receive.
My question is this - if it’s true for my set of conditions then is it true for other conditions and specialties? I can only think the answer will be ‘yes.’ If that’s the case then what is the cost to those of us who have or do pay to support the NHS?
Solving this issue would be a quick win for everyone and I wonder why I’ve not seen it raised in Parliament or locally among our politicos.
Finally and for what it’s worth, I’m told the fully costed treatment each time I attend for WMD injections is in the £700-1,000 range. That’s for one eye. How much of that represents costs that could be eliminated by sharing across specialist providers?
Hello. I had a similar process alignment issue with my now poor departed Dad. In the BRI. One example - A feeding tube was required a couple of weeks after admission due to an unrelated issue of being unable to swallow properly.
Monday. Nasal gastric tube inserted whilst Dad was on the ward. Awaited appointment at x-Ray to ensure it was located in the right place. Few hours later, wheeled from ward to x-Ray. Tube not in right place. Dad wheeled back to bed. Doctor arrives next day, tube moved, await X-ray, doctor arrives next day. This went on until Thursday whereupon I lost my shit as it was clear Dad was fading through lack of nutrition. Asked if doctor could be present at X-ray and make the necessary adjustments in situ in the X-ray department - seemed like a more efficient way of managing the process. This wasn’t done but the next time the doctor visited after said losing of my shit, the doctor aspirated the tube to check pH levels and lo and behold the tube was finally in the right place and feeding could begin. 4 days and numerous ping pong journeys between ward doctor and X-ray and Dad wheeled around the hospital by a porter each time. Often missing his once-a-day-turn-up-whenever physio slot.
What an absolute waste of time, resources, money and more importantly a stress for the patient and family. What was worse, NO ONE I SPOKE TO CARED. For sure they apologised each time I pointed out a failing, but nothing changed.
Despite all the staff being constantly glued to a computer, whenever I asked a question about Dad’s condition, treatment or general comfort no one could ever give me an answer without saying “I’m not looking after him, you’ll have to speak to nurse xyz” all the nurses had scrappy bits of paper with handwritten patient notes scribbled on them.
Asking about pathways for Dads care when he left hospital - no department was joined up - Dad was stuck in the respiratory ward, when he should have been in ENT for the impact of previous surgery (he had a total laryngectomy 13 years ago) or Elderly care and there was no synchronisation of information to relay to Dad’s family.
I experienced shrugging of shoulders when asking for care for my Dad, I was told sometimes they were too busy to provide pain relief, and we experienced awful levels of cleanliness and hygiene in Dad’s side room. He got covid in hospital. He recovered from covid. He fought though frail.
He was admitted after a fall which resulted in a broken clavicle. He was admitted fully independent. He died 6 weeks later having been left in bed for almost all if that time. An occasional once a day if you were lucky visit from physio to get him out of bed onto his chair. He was never helped to the toilet and passed away incontinent.
Dad lived independently for 13 years after his laryngectomy yet deteriorated in a matter of weeks in hospital, admitted because if s broken shoulder and was left totally dependent on hospital staff and his family. His family provided many of his basic care requirements quite simply because there wasn’t enough staff each day servicing the needs of patients. I’m some ways Dad was fortunate he had family who could provide this care. Others did not.
Shame on the NHS management and the political leaders of this country. The system is systemically broken but by saying “the NHS is free at the point of need” does not address its fractured core, nor provide a service fit for purpose in many many cases.