Appointment date!

I was not really intending to write any more posts for a while, but I had a demand from my "public" to keep writing (thank you R!) and a few things have happened over the last couple of days.

The appointment letter from University College Hospital in London arrived. They got my surname wrong, I am plural, not singular.........in the spelling of my name at any rate, but sent it by first class post. First outpatients appointment on the 10th of December (for my reader from the USA, that's 12.10). Checked out the Professor who runs the team that I will be seeing on the internet: he is at the leading edge of treating prostate cancer, best team I could possibly see, in this country at least. Phew!

If anyone is interested in public service websites, I would recommend a look at www.uclh.nhs.uk It has to be the best I have seen so far. Let's hope that it is not a case of "all fur coat and no knickers".

Now I have certainty about how bad the cancer is and the way forward, I took the plunge and told my parents. This may seem a bit odd, but I had not told them, or my sister, what was going on. Very simple rationale: until I knew what the future holds (at least on the prostate front), no point in worrying them. This is probably a dilemma that a lot of people with a diagnosis of cancer face; there is no easy answer, it just has to be thought through.

Result? Long 'phone call, concern but not panic, and positive support. Means a lot to me.

Parents told my sister who called this afternoon. My father had told her about this blog and she read it all..............in one go!! Must admit that I asked her whether she had a life! Cool and supportive though; if you are reading this: thanks. Additional benefit: the page views for the blog were through the roof today.

Meanwhile, you may recall that I wrote about the idea of helping other people negotiate public services and that (did I tell you?) someone I happen to know was having a real problem with getting the system to work for her. Well, today we started on influencing things. It is an area I have no real expertise in, so our first strategem is to get the local newspaper engaged. The paper has been "following" me on Twitter and it is potentially a good story for them, so hopefully they will take it up. We shall see. Sam's dilemma may well become the focus of this blog for the next few weeks; for those of you who do not like the ritual humilation of politicians, it might not be to your taste.

A bit stuck for a song, but this one is pretty good:
https://www.youtube.com/watch?v=Mln0RciE2o0





Enough rambling for one night......

Inked!

Nothing relevant to healthcare this time.............

You may recall a post entitled "Just do it"? Well I did it, or rather a very pleasant young man called Jack did it for me.

45 minute drive to a town I used to know reasonably well in a previous part of my life. Parking was, as predicted, a nightmare and incredibly expensive once I had found a space which was no easy feat. It was always pretty affluent, but the recession seems to have passed this place by; I think that the term is "conspicuous consumption". If I was rich and could afford to have the principles, the sights I saw might make me think seriously about becoming a socialist!

Tucked away in a very old part of the town centre full of designer this, that and the other, was a tiny shopfront which housed the tattoo emporium. Entering was a bit like going into a reverse version of the Tardis: it was small on the outside, but tiny on the inside!

Waited for a real "hooray Henry" of about 18 to finish his enquiry and explained that I had an appointment with Jack. First thing he did was offer me a nut from a bag of them he was eating. Don't know about you, but I found it really quite reassuring about meeting someone who is about to puncture you with needles and the first thing they do is offer to share their lunch with you; must be a throwback to days long gone.

The downstairs room in the emporium was tiny, the staircase to the upstairs room was even smaller! You know when you see films about people squeezing through claustrophobic gaps in caves? You get the idea..............

Jack went to prepare the stencil based on my design and left me to listen to the really good mix of music playing whilst looking at his artwork framed on the walls of the room. His Japanese dragon (3 toes) and Koi were absolutely amazing.

Chat about why I was having the work done, life, the universe and everything, new kit taken from sterile bags and away we went......

You may have heard that having a tattoo hurts. I think that this must depend on your pain threshold and (I expect) where the tattoo is being applied. Either I have a high threshold or arms are not a sensitive area; it was not at all painful.

Two hours of diligent work on Jack's part and a few interruptions ensued. The interruptions were great fun, particularly when one of his clients / friends dropped in to give him a present from Seattle. This chap took at look at what Jack was doing on my arm and made approving noises. Jack then asked him how the work on his back was, so he showed us: a superb dragon covered most of it!

All in all, a really fun experience and a glimpse into another sub-culture with some really friendly people who were not at all phased by the old bloke coming in for his first ever tattoo. It was more like being welcomed into a new "family".

Job done, time to settle up. You may recall that I described the town this is happening in as being incredibly affluent, but did not tell you its name. There is a reason for that........a precaution just in case the tax man ever reads this.

Jack asked if I had been given a quote (I hadn't), then suggested a figure which he was clearly happy to negotiate about. Call me old fashioned, but if someone gives excellent service, devotes their skills to you for 2 hours and quotes a lower figure than you expected, I think that it would have been appallingly rude to negotiate. Bit of a catch: cash only! In one of the richest towns in the country, what a relief to find a business that deals in cash. However, I did not have enough on me and told him I would need to go to the bank machine. "I will trust you" was the instant response..................

If you live in the south of the country and intend to get a tattoo, you could not go anywhere better! If anyone wants the name of the business and its address, happy to give them if you drop me a note.

Was at a bit of a loss for an appropriate song, but the title of this one seems to fit and it is sung by one of the all time greats:
https://www.youtube.com/watch?v=2TG7AqzyQQU

Going quiet for a bit........

........and going for quite a bit I hope!

Not a lot likely to be happening on the prostate front for a while, so please bear with me if I do not post for a while; I don't want to lose you!!

Just a couple of things that have happened in the last day or so.

Posted the last entry yesterday and sent the collected observations to the hospital, CQC and CCG. That was a challenge in itself when it came to Medway Hospital!

Finding the correct email address for the Chief Executive was a real problem. Tried the obvious, bounced back. Tried the address given on the hospital website: automated reply from the new owner of that address which basically said "if you are after the chief executive, try this address". I think that the third attempt was successful, but who knows?

Sent a copy to the nice manager who has been following this blog (thank you). She was on leave according to her automatic email reply. Received an email from her at 21:30!  It was very much appreciated, but if you are reading this, apologies if you think the next bit is patronising.......speaking as someone who worked in the public sector for over 20 years and got into the "work is life" culture, please look after yourself and those you love first. In the long run, no-one values long hours; it is what you achieve that marks you out. There is very rarely anything which cannot wait another day.

I have been referred by the Medway consultant to a London Hospital, but had also sent an email to my GP to see whether he could "short circuit" the system as a back up. The London hospital would be what is known as a "tertiary referral", so I knew really that he could not do it.

Here is a mark of excellence in General Practice: I had a 'phone call from one of the excellent admin staff to tell me that my GP regretted he could not make the referral. What she said next was the excellent bit: he had received a copy of the referral from Medway Hospital, she had taken it upon herself to call the consultant's secretary at the new hospital and check out how long it was likely to take before I am seen! Talk about above and beyond........... the answer was about 4 weeks. This practice is run by one of the private companies so hated by some politicians (don't they realise that all GPs are small businesses and not NHS employees?) and is superb. Malling Health are excellent.

I will probably be back on Monday evening after the much vaunted tattoo

Until then, not a song, but something appropriate:

 https://www.youtube.com/watch?v=QY9oWfkKt6A

The collected observations

As promised, my collected observations are set out below and shared with you, as loyal readers, before I send them on to the Hospital, Care Quality Commission and Clinical Commissioning Group. I apologise for the formatting, but I wrote this out in Word and copied it here. Nothing amusing in this one, and no song, but you might find bits of it interesting.....

Observations arising from investigations for prostate cancer at Medway Maritime Hospital 2014

 

1.         Introduction

As context, I am a former NHS manager with a background which does not include acute hospital provision. I was well aware of the difficulties facing Medway Maritime Hospital when I was referred and used my knowledge, together with that of friends, family and colleagues to map out potential allies / points of influence should I need them.

Set out below are a series of observations based on a journey through Medway Maritime Hospital in September and October 2014. They are culled from a daily “blog” that I posted online documenting my experiences and sharing them with anyone who was interested. The existence of the blog was shared with the Hospital, CCG, CQC and clinical staff.

During the course of the journey, attitudes towards me changed markedly and I suspect that, by the end, the treatment that I was afforded was very different from that offered to the majority of people using the hospital’s services.

This document ends with a description of the excellent service that I received at the very end of that journey which should set the standards for all other parts of the hospital.

 

2.         Environment

The general environment at Medway Hospital is poor. Although the problems are probably mostly due to the failure to secure funding for re-development, there are some basics which would not be difficult to rectify:

2.1       Piped radio

At least one main outpatient waiting area had continuous commercial music radio piped through its PA system. Given that the vast majority of the people waiting were middle aged or older, the up to date pop music did not create a relaxing atmosphere.

 

2.2       Signposting

Signposting throughout the hospital was poor and the hospital maps on display were both too small for people with a visual impairment and out of date.

The route-finding design within buildings may be helpful to people who have visited frequently and only need reminders, but are very confusing for anyone visiting the hospital for the first time. Symbols and colours are used, but their application is poor.

 

2.3       Automatic doors

At least two sets of automatic doors were not functioning. Unfortunately, these were at the entrance that serves the Day Unit, rendering access to people with wheelchairs virtually impossible without assistance.

 

2.4       General decor

In most clinical areas, the decor was shabby giving the impression that people using the hospital were not valued.

 

2.5       WCs

These were of variable standards of cleanliness. One was an evident hazard to health, obviously not having been inspected or cleaned for some time and with a broken pedal bin which left people either to lift the lid by hand or dispose of used paper towels on the floor.

 

 

3.         Privacy and Dignity

3.1       Gowns

The hospital still uses open back gowns in the areas that I experienced. It might do well to check the dignityincare.org.uk website to see the work of Fatima Ba-Alawi, and the NHSIQ.nhs.uk website.

 

3.2       Cublicles

Perhaps the most shocking sight I saw was of someone on a trolley recovering from the effects of sedation in an area which was clearly visible to me when I went to collect a preparation pack. No effort was made by the staff to shield her and she was in my direct line of sight as I left the unit. On asking at a later date I was told that this was primarily a clinical area and that only “patients” are normally in it. I am still at a loss to understand this attempt at justification.

 

3.3       Changing rooms

In one diagnostic area, I was shown to a small, lockable, cubicle to change into a gown before returning to the waiting area. This department was clearly aware of the potential problems with hospital gowns and had a policy of asking people to don two: one facing forwards, the other backwards.

To store my clothes, I was provided with a second hand plastic bag marked “patients property”. It had clearly been used many times previously. On the plus side, a lockable cabinet was provided to store any valuable metal items I had with me.

 

3.4       Confidentiality

The clerking in process in every area involved me confirming my name, date of birth and address. This was invariably done in full hearing of a waiting room full of people.

 

4.         Staff attitudes

Staff attitudes were variable, with the most junior and most senior generally exhibiting a much better attitude than others.

 

4.1       Introductions

At the start of my journey through Medway Maritime Hospital, very few members of staff introduced themselves either by name or profession without prompting. In one case, I had to prompt a second time to elicit the fact that one of the people present was a student.

By the end of my journey, introductions were made universally and without prompting.

 

4.2       Person vs “patient”

There was a marked reluctance to refer to me as a person, the preference being for the use of the impersonal word patient. Despite asking that I be seen as a person, some staff insisted that, whilst I was under their care, I was a patient. Given that empathy is at the heart of most professional training, I found this disappointing.

A notable exception was a healthcare assistant who told me that she was there because she liked people and felt it important to relate to the person as much as the reason they were there.

 

 

5.         Protocols / administration

5.1       Delay

Following a biopsy, I was told that I would be invited back for a consultation within 2 weeks to hear the results and talk about what needed to happen next. In the event, it took 4 weeks and no satisfactory explanation was ever offered. My hope is that this was an exception.

 

5.2       Series vs parallel

On receiving the results of a biopsy, scan or other test, it should have been obvious to those reporting or making clinical decisions what the next steps should be; I would have expected to arrive at a consultation to find the next investigations already booked. As it was, referrals were only made to CT, MRI etc. after the meeting with me.

 

Whilst on paper it may seem good that decisions are not made in advance of seeing someone, it introduces further delays. In cases where there is no practical choice about the next course of action, it seems nonsensical to introduce administrative delays.

 

5.3       Appointment times

Outpatient appointments were almost universally 30 minutes behind time with a range from 0 (Oncology) to 50 (Urology). I understand that it is impossible to predict accurately how a clinic will progress due to emergencies etc., but it might be helpful if people with booked appointments were sent a text message in advance warning them of delay.

Much emphasis is placed on the user of services letting the hospital know if they are unlikely to turn up, but none on the hospital letting the service user know. If appointment times are seen as a mutual responsibility with a commitment from both sides to tell each other about delays, the DNA rate may fall dramatically.

 

5.4       Website

The Hospital website is extremely poor. It contains very little useful information, is out of date, incomplete and difficult to navigate Given that websites are often people’s first point of call, a good website is vital. Medway Maritime’s website is probably the worst hospital website that I have ever seen. For an example of excellence, I would commend Darenth Valley Hospital’s excellent site.

 

5.5       Appointment notification

Medway Maritime’s practice of a personal telephone call advising of an appointment is excellent.

The appointment letters may be a problem for some as the clinic codes can reveal diagnoses. I my case, I was invited to a clinic with the code MDT, to hear the results of a biopsy. This code told me that I had been diagnosed with cancer. For me, this was not a problem, but others may find it distressing.

 

 

6.         Expertise & knowledge

6.1       Cannulae etc

The insertion of a cannula without leaving residual bruising is a difficult challenge for even the best trained staff. It was a member of staff at Medway Hospital who showed that it is possible, even with a relatively large cannula, to insert it perfectly.

  

6.2       Side effects

For an MRI scan, I was told on arrival in the scanner room that I would need to be injected with a muscle relaxant in order to ensure that clear images were obtained. I asked about potential side effects and was told that the drug had none.

Having driven home directly after the scan, I checked the manufacturer’s data sheet and discovered that a common side effect was dizziness or disorientation and that driving should be avoided. This was a potentially lethal lack of knowledge on the part of staff administering intravenous medication.

 

6.3       Doctors

Three of the consultants that I met appeared to be of outstanding quality, willing to treat me as an equal partner in decision making and having an excellent knowledge base.  

One consultant is mentioned in “National Targets” below

One consultant exhibited the most appallingly arrogant and poor bedside manner, and was evidently lacking in either skill or care in the use of a biopsy needle.

The one SpR that I met should go far and I wish him all the best with his career.

 

6.4       National targets

On receiving a verbal confirmation of a diagnosis of cancer, I mentioned the national cancer treatment targets with particular reference to the 62 day target from referral to commencement of treatment. Neither the locum consultant nor the specialist nurse present was aware of this; the nurse told me that she believed me, but would have to look it up.

This lack of basic knowledge was more than made up for by the attention and help of another specialist nurse later in my journey.

 

6.5       Sedation

Prior to undergoing a colonoscopy, I queried the use of sedation. It was explained to me that a fairly major mix of drugs was used and that I would not be able to drive, make decisions etc. for 24 hours after the procedure. It was only on vigorous challenge that I was offered Entonox as an alternative. Apparently the use of entonox is an innovation in Medway Hospital.

By only offering debilitating sedation, people have to stay in the department for some time post procedure. If entonox is offered as an alternative, the recovery time is measured in minutes rather than hours and there is reduced need for some people to arrange for care on their return home.

 

7.         Endoscopy Suite experience

Having made clear my preference regarding sedation in advance, and, I suspect, the staff having been warned about me by the manager who took an interest in the blog, the preparation, procedure and discharge from the endoscopy suite were a study in excellence.

I knew in advance that the Colorectal consultant was coming in especially to carry out the procedure, so had no doubts about his abilities, either clinical or interpersonal and was fully confident in both. The nursing staff were an unknown.

 

Ø  My partner and I were greeted very cordially by a nurse who introduced herself without prompting and showed us to a consulting room. Following a brief discussion about when she should return to collect me, my partner left.

 

Ø  Clerked in efficiently, BP etc. checked, introduced to the nurses who would be accompanying me into the procedure room, and led to a private cubicle to change.

 

Ø  Informed when the consultant arrived.

 

Ø  In the procedure room, made comfortable, entonox provided for use on demand and pillows placed to allow me a clear view of the screen.

 

Ø  Running commentary from the consultant which was both interesting and informative. He was joined by a colleague, who was also introduced to me, who provided advice when required.

 

Ø  Returned to cubicle and informed that my partner had arrived. Consultant arrived and gave me a summary of how he thought things had gone, along with his recommendation for surveillance; shook my hand before leaving.

 

Ø  Changed, clerked out and left. Elapsed time 1.5 hours of which 55 minutes was direct clinical intervention.

 

Ø  In the meantime, my partner had been informed about progress and how long she might have to wait.

 

Ø  I was listened to, treated with dignity and respect and stayed in the unit for the minimum time necessary. I would like to think that this is standard treatment for all.

 

8.         Conclusion

I was not the average “patient” using the services of Medway Hospital and managed to negotiate a reasonably timely path through its services by virtue of knowledge, influence and refusing to accept the unacceptable. It was not an easy journey even for me as an informed, assertive and persistent customer, negotiating systems that appeared disconnected and uninterested. I have no doubt that the managers and some of the clinical staff are glad that I have been referred on.

I have no complaint about how I was treated or the generally high clinical standards that I experienced, but I would like to feel that this feedback is taken seriously by the Board and used as part of its drive to improve services for all.

 

 

 

 

Phil Woods 23.10.14.

Happy Diwali

Happy Diwali to you all

https://www.youtube.com/watch?v=kQ1gbGAuSNs

An amazing experience!

After a 2 day build up, I can truthfully say that today's visit to Medway Hospital was an amazing experience. Over the last 2+ months a lot of my experiences have been amazing, but "not in a good way, if you see what I mean" to quote a character from W1A.

Today was amazing in several good ways!

If you have been following this blog, you might have picked up that I am probably not the most compliant "patient" from the hospital's point of view and have not been slow in telling both you, and anyone else who cares to listen, what I think. Some has been good-ish, some not too good, and some downright appalling. Clearly, some one, or two, or three at the hospital has been listening...........

If the service I received today is repeated for everyone else using the same facility, perhaps Medway Maritime Hospital has a chance. There remains in the back of my mind though the cynical thought that I have been treated rather better than anyone else for a number of reasons, most of which you will probably have deduced from earlier posts.

If the manager who contacted me is reading this, the answer to "(is) there is anything I can do?" is an emphatic YES. Please reassure me that all people going through the endoscopy suite get treated just as well.



Arrival
I will not bore everyone with the details, but I was greeted properly, each new player introduced themselves properly, I was given proper choices and information, my privacy and dignity were respected............I could go on. The introduction to the unit was exactly what every person who uses the NHS has a right to expect.

On to the trolley
Private space to get changed into the obligatory hospital gown. Provided with a plastic bucket to put my clothes in which was a smaller version of the one my horse has in his stable for water (that did bring a smile). Put bucket on tray at bottom of trolley so it went everywhere with me; good idea!

The main event
Two nurses introduced themselves and wheeled me in. Greeted by the surgeon very cordially (I got on very well with him when we met the other week) . Provided with Entonox and away we went........

I will not give any gory details..........the squeamish amongst you are safe!

Surgeon was using a screen to see what he was doing, so I asked one of the nurses for an extra pillow to prop my head up and watched the show, with a great running commentary from the surgeon. I hope that you never need to have an endoscopy, but if you do it is really quite mind blowing to see yourself from the inside and the patterns of the capillaries are just fantastic; a truly psychedelic experience!

(The Entonox was not really necessary, but I took a few blasts just for the hell of getting mildly stoned courtesy of the NHS!).

Job done. Back to a cubicle, offered tea and toast (refused politely), got dressed. I was just about to leave the cubicle when the surgeon appeared, had a quick chat, shook my hand and took his leave.

Met partner in reception (she reported having been greeted very warmly on arrival), went home. In at 13:30, out by 15:00!

I am at a bit of a loss to understand why their standard sedation method leaves people unable to function for 24 hours and unable to leave the department for hours when they have light, user controlled, sedation available. I have a theory, but perhaps that is for the "collected thoughts" post which is yet to come.

The cynical thoughts I wrote about earlier? I have a feeling that several things might have happened behind the scenes, amongst which are:

• The "Chaps" (Consultants) had been talking to each other and decided that they would take no chances with this one; he is potential trouble, seems well connected and knows what he is talking about.
• The manager who contacted me gave some instructions to the unit staff to be on their very best behaviour

That is very likely to be the end of my association with Medway Hospital, at least until a few follow up scans etc next year. I have no doubt that there are a few people heaving sighs of relief, but I really hope that they reflect on this blog and the summary that I will compile for the CQC and Trust Board. In the spirit of sharing I shall, of course, publish it here first.

University College Hospital, London, next stop on the treatment front when the appointment comes through. We shall see whether they provide a contrast...............

Meanwhile, tattoo next Monday. Really quite excited about that.


Now the songs. Bit of a problem today as I had thought that I might be a bit "out of it" while the action was taking place and picked songs appropriate to that. Never mind, they are fun listening, so I offer them anyway, along with one that seemed appropriate-ish to today as it turned out.

https://www.youtube.com/watch?v=_x_03jORq7Y

https://www.youtube.com/watch?v=l9zcLAUp5E0

 

https://www.youtube.com/watch?v=kbr4qNnffi8

Not a lot happening, and a lot happening........

No real update on the story today, but blog writing is becoming a bit addictive.........hopefully safer than cigarettes!

Two letters arrived from the hospital, both copies: one from the Professor to the consultant at UCH in London referring me as requested (he got it slightly wrong, but nothing I cannot rectify when I meet with the chap); the other a letter to my GP from the Gut man telling him that he would be taking a closer look.................

Neat way of leading back to endoscopy preparation. Only clear fluid from lunch today (8 and a bit hours ago as I write) until I get home tomorrow afternoon. Fortunately, "clear fluid" may have its compensations as both beer and whisky are clear and I could find nothing in the leaflet that might lead me to believe that alcohol is proscribed.

All I shall add is that not eating for 24 hours+ is going to be hard, and that the Industrial Drain Cleaner tastes pretty bad. I will leave the rest for you to block out of your imagination.

Finding a suitable song that I knew was not easy; I think that this one partly works, but may not appeal to many...........

https://www.youtube.com/watch?v=CGqwy_DQnS4

If that was a bit too much for you, here's a more whimsical song from the Velvets:

https://www.youtube.com/watch?v=H5je_eK0V1w

The Oncologist

Hotfoot from a Board meeting at a prestigious (so I am told) National Newspaper, I trekked on down to Medway Hospital for a meeting with the Oncologist..................

Lest you get carried away thinking that you are reading the ravings of a left wing journalist, I should explain that the Board meeting was that of a small but perfectly formed Community Interest Company. It meets at the offices of the newspaper through the kind assistance of the newspapers Social Affairs Editor who is a valued adviser to the Board.

The story so far had probably not filled you with confidence about the services offered by Medway Hospital. Before you read further, let me reassure you that should you ever be unlucky enough to need the services of an oncologist, I very much doubt that they come better than this chap. Safe to read on now.............

A personal email from a hospital consultant offering to see you on the next working day is an occurrence so rare it rivals successfully striking a match on an unset jelly for improbablity. Having received such an offer, how could I not meet the person behind the invitation? It would have been impolite in the extreme which might be a good enough reason, but my curiosity was the main motivation for accepting the invitation.

He had even told me where the "Galton Day Unit" could be found: on the right of the main Hospital entrance. Should have been easy. I walked from the other side of the hospital and stopped at one of their tiny hospital maps which has every department listed in alphabetical order:


Endoscopy                             Green 1 (I shall bear that in mind for Wednesday!)
Eye Unit                                 Blue 2
General Office                       Blue 2

Hang on a minute...............no Galton Day Unit!!!!

So I looked to see which building was to the right of the main entrance: The Macmillan Cancer Care . Centre. Aha, that must be it.

Walked around the corner, notcice directing me to "Elderly and Mental Health" left over from the 1920s..............walked a bit further.............entrance to what I think was a mental health unit..............walked a bit further, a doorway over which there was a sign announcing proudly that this was the Macmillan Cancer Care Centre which includes the Galton Day Unit.......phew!

Best decor I have seen so far in the most modern building I have yet seen on the site, even if the entrance is tucked away near the works department. Something tells me that the "we try to keep cancer quiet so as not to scare people" mentality is alive and well in Medway.

On the dot of 5, a smiling young man came into the waiting room and called my name. Being well trained, I got off the chair and followed him. This was the oncologist! He smiled, he greeted me cordially, he listened, he explained things as if he were talking to an equal, in short he was everything you could hope for in a consultant. I won't bore you with details, but we had  a "groovy" time talking about scans (I finally got to see the MRI scan of the relevant bits; will definitely apply for a copy of that under Access to health Records!), the state of my prostate, the state of the health service, my views on what treatment I should have etc.

I could not resist trying to find out what had provoked such a sudden offer, and may have dropped the odd hint about understanding that I might somehow be not the most popular client they had seen for a while and that people might have been talking to each other. His charming evasions, laugh and close inspection of the floor every time anything like that came up said it all, although of course he denied anything of the sort.

Such a pity that the hospital does not offer the treatment that I want; I would have had no trouble trusting a department run by this chap.

With luck, that is the end of the cancer journey at Medway Hospital; off to London for the next bit. A whole new set of people to get to know............and blog about I expect.

Just have the endoscopy to get out of the way and I should be back to the 21st century!

Meanwhile, a footnote: the manager from Medway Hospital emailed me again this morning. Apart from getting my name wrong, she "appreciate(s) and respect(s) my decision not to discuss my treatment". To be fair, she did go on to offer her assistance if I wanted it. Full marks to her for trying, she is the only representative of the hospital who has made any effort to respond to a blog which must be pretty painful to read for managers of a hospital in special measures.

My only plea for assistance if you are reading this brave manager is please take the things I have pointed out seriously and do something about them: tell the Director of Nursing, the Medical Director, the acting Chief Exec about the blog, ask them to read it. This is not a work of fiction, it was all real and has even been sanitised in some parts so as not to scare readers too much.  I got through it by fighting, being bloody minded and knowing which buttons to press; the vast majority of your customers are not equipped to do what I have done. Over to you.............

And now today's song.............
https://www.youtube.com/watch?v=0UCDmsWcNfE

Had to share this.............

No plans to post an entry today, but this is worth sharing.

I love playing with language and (this is a bit sad) enjoy the pedantry of correcting bad grammar, pronunciation etc. So opening the "preparation pack" and reading some of its contents was a joy. There were three pieces of paper generated by the hospital that were of particular entertainment value:

A "pre-procedure questionnaire" which asked some wonderful questions, such as "do we have your details correct?" The details on this sheet consisted of my name (they got that wrong!) and hospital number. They had left things like address and NHS number blank. Given that both are on the hospital record system, this seemed a little slipshod. Other questions included: "Do you have a Hospital Acquired Infection?" I was tempted to answer that I do not, but may have by the time they have finished with me on Wednesday.............

The second was a leaflet which gave instructions for the industrial drain cleaner contained in the pack (you get the idea). Curiously, the section on eating, drinking and taking the drain cleaner did not match the leaflet that the manufacturers included with their product. Who should I believe? I opted for safety and will obey the drug company's leaflet.

The same hospital leaflet told me that, whilst the procedure was being carried out, a nurse would be with me to "provide reassurance"! After my encounter on Friday, I think that I will give that one a miss.

The third document was priceless. This was the appointment letter which told me that "The Trust aims to treat all patient's within........" A pedant's dream and the dream of all pedants. I love the Kent apostrophe: if in doubt, stick one in!

It's (see, an apostrophe!) the main body of the letter that really did it though:

"On the day of your procedure you may drink WATER only until two hours before your appointment time"

Bearing in mind that I am not supposed to eat anything for 24 hours beforehand, I initially took this as an invitation to indulge in a slap up meal anytime after 11:30. I already had the vision of a rare steak washed down with some Berry Brothers' claret as being the ideal way of taking my mind off what was to come. Then, despite reading what they wrote, I realised what they meant...............

The last paragraph was just plain weird. It warned that if you have sedation you should not drive home. Fair enough if you go with the heavy end of the sedation spectrum and do not know about Entonox. This was followed by a curious exhortation: "If you live alone (no comma) please ensure someone is with you overnight". Presumably people who live alone are expected to drag someone in off the street for the night? Possible perhaps, but would they want to be "with you"? The mind boggles!

Lastly, one of my pet hates about hospitals. I doubt that Medway is any different from the rest, but their letters and staff have the nasty habit of referring to people as "patients". I keep trying to tell them that this word should not be used to refer to me as a noun and that the adjective is entirely inappropriate when talking about me. I think they have understood the second part...............

With very little in the way of sarcasm, today's song:

https://www.youtube.com/watch?v=8h-oGEr-d7g

Endoscopy preparation

It is ok, this is not a graphic description of the preparation.................just another experience of Medway Hospital staff and where the hospital is "at" in its thinking.

I have an endoscopy coming up on Wednesday. Perhaps not the best way of phrasing it, but I went to the Lord Freud school of English! (for those without ready access to UK news, worth looking up some of the press coverage over the last few days if you want to understand that one).

As usual, notice of the date was a rush. A telephone call from the waiting list co-ordinator on Friday to tell me that I had been booked in for Wednesday and needed to collect the "preparation pack". Not hard to guess what is in that one! I asked her to pop it in the post, but given that fitting me in was obviously a last minute decision (albeit by a clinician I like and trust), she told me that I had to go to the Hospital to collect it as I needed to have it 2 days before the procedure. the pack would be left at the endocopy suite for me to collect.

Duly trolled down to the hospital (15 mile round trip) and found the endoscopy suite. Pressed the bell whilst reading a notice which said "only press once, we may be busy with your relative". Waited......nothing. Looked through the glass in the door and saw someone making their lunch.

Pressed again...............waited.................nothing

Called home to get the number of the woman who had called me earlier. Was just taking it down when someone with the code went in. "Doorstepped" her.............

Past a couple of rooms to be confronted with a counter behind which sat 3 people in green overalls. Was challenged as to what I was doing there and responded that I was there to pick up a pack for my endoscopy. One of them searched the pile: no pack with my name on it. Left her to sort that one out and made a general enquiry........

I had been told that I would have intra-venous sedation on the day and that I should not drive for 24 hours aferwards. I asked the people in green overalls what the real effects were and, off the record, how long before I would be able to drive? Two out of three looked at me as if I had just asked them to cut off one of their own limbs...............persisted..........still met with horror. One then "invited" me to talk to her in a meeting room.

This did not go well............

Sat me down and proceeded to give me a lecture about what patients should expect. She did not tell me her name and I only found out  that she was a nurse when she reacted very badly to my insistence that I am a person not a "patient".  She explained that to her we are all patients......it went a bit downhill for a bit!

I then challenged the bit about sedation again. This time, she came up with the "new" form of sedation that they had just introduced as an option: Entonox, better known as "gas and air". This has been a staple for midwives helping people through childbirth for more years than I can count and has been known about for 200 years, but it is new to Medway's endoscopy suite!! My flabber was well and truly ghasted!

It turns out that I can drive an hour after using Entonox, rather than 24 hours using their usual drug cocktail. Needless to say, I know which I will be choosing on Wednesday. Sorry folks, it means that you might have space for someone else on wednesday's list as I will not be hanging about recovering.

Pack found and went to navigate my way out. What I saw on the way out horrified me.

To leave the unit, I had to walk past a small room, the door of which was open leaving the contents in direct line of sight. Propped up on a trolley was a woman who was obviously recovering from sedation, still in her hospital gown.

Now call me old fashioned, but privacy and dignity were big even when I worked as a nursing auxiliary and I know the person who developed the South East Regional Privacy and Dignity Audit very well. To see someone left in full view of anyone passing in the 21st century was the worst bit of practice I have ever seen. If my friend from the CQC is reading this, I think that a rapid intervention is essential; this is practice from the dark ages.

If the manager from the hospital who contacted me is still reading the blog: I reckon you have about 5 days before all hell breaks loose from the outside world and I give fair warning that if it happens to me I will not rest until I have had a hand in shutting the place down. It was a disgrace.

The song:

https://www.youtube.com/watch?v=cGXU7268Z50

A surprise and an idea

The surprise is not really exciting so I will start with the idea.......

Regular readers may recall that I wrote about whether I should go for the nuclear option under the title "Dilemma" the other day. An anonymous reader left a comment (my first!) advising me to go for it and observing that I was lucky to have a nuclear option, most people do not.

The comment set me thinking and has produced the germ of an idea. There will inevitably be a number of people who feel that they need to take a degree of control in similar situations, but do not have the knowledge, contacts or sheer bloody mindedness to do it. There must also be quite a few people like me about i.e with knowledge, access to contacts and bloody minded in the extreme (some politely refer to this as being an iconoclast!).

What would happen if there was a network of people like me who are prepared to help others take control, particularly over the delivery of public services which, theoretically, are there to serve us, not the other way around?

(By complete coincidence, I then bumped into someone I know who had exactly the kind of problem that I am talking about...........you may read more about her in later posts if she decides that she really wants to "go for it". )

Will people want to join a network like that?

I am meeting with some fellow iconoclasts on Monday; if we get time, I shall see what they think and let you know.

Now the surprise.......

This blog is linked to an email account which I rarely check. For reasons unknown, I took a look at it today and found a fascinating email from a middle manager at Medway Hospital. It was written on the 16th and invited me to "talk through my experiences and where you currently are in your pathway". Good to know that someone from the hospital has been reading the blog and had obviously taken it seriously enough to get in touch.

To regular readers, my response was predictable: thanks, but no thanks, although I will be happy to share a concise summary with the hospital's Board at the same time that I share it with you and send it to the delightful woman at the CQC.

As for where I am in my "pathway", I think that I have a pretty good idea about that one given that I have (mostly) had to determine progress through it by being precisely the kind of consumer of services that the NHS hates: one who has a good idea of how the system works and how to make it work for them.

I now have only two things left that will require visiting Medway Hospital: a meeting with the Oncologist tomorrow (I am curious about why he delayed the meeting and feel it would be impolite not to see him) and an endoscopy on wednesday. Even something as routine as an endoscopy has proved an interesting challenge at Medway. To save you from getting bored, I shall put that one up as a separate post; that way you can either choose to go for the "marathon" by reading both, or you can skip yet another tale of poor customer service............

Nearly forgot the song.....

Not sure whether I have posted this one before. Even if I have, it is worth listening to again.....and again......and again

https://www.youtube.com/watch?v=6FOUqQt3Kg0

A real turn up!

If you read yesterday's post, you may remember that today was the day for the "nuclear" option. I had planned to go into action at 14:00 prompt, but first tried a few emails to see if I could provoke any action:

An email to the specialist nurse asking her to pursue the appointment with the Oncologist

An email to the Professor asking that he refer me direct to the Institute of Urology in London (they do the modern treatments)

An email to my GP enquiring as to whether he could make a referral to the IoU

A phone call to the Oncologist's secretary asking what had happened to my referral


Meanwhile, having heard nothing by 14:00, I established a new Twit identity to protect myself from retaliation and started to draft a blog entry detailing the issues so far. The plan was to "point" the local newspaper at it and to give the local politicians, CQC and CCG a chance to look if they wanted. The aim was to get the newspaper involved on the back of a very contentious by-election and drag the rest along to score points, defend, attack or whatever else they wanted to do. I was literally 10 minutes away from completing the blog post and hitting the "publish" button, when........

2 out of 4 yeilded results! Naturally, the Oncologist's secretary did not call back, and I did not expect the GP to respond, but the specialist nurse came back to tell me that the Oncologist did not want to do anything until the general surgeons had finished with me (?another month). More remarkable, the Professor's secretary sent me an email to say that he had faxed a referral to the IoU!!

The best kind of war: victory without a shot being fired..............

Now, at long last, my treatment will be in the hands of people who know what they are doing and have (I hope) an efficient system to support them.

And now a song about something just as improbable:
https://www.youtube.com/watch?v=_v2exWrsGOc

Late news: email from the Onclogist inviting me to meet him on Monday........after his normal clinic has finished! Not sure what provoked that, but something worked. No need really, but would be impolite to turn his offer down.

Dilemma

Day 83 what against the 62 day target and still not even a sniff of an appointment with the Oncologist. Time to make a decision...............

There are three options that I can see:

• Give in, let the NHS and /or nature takes its course. 
• Keep doing what I have been doing 
• Go for the "nuclear" option

I have just spent an hour sitting on a log at the top of the hill to try thinking this one through; not sure it worked, so I am afraid that I am using this post as a vehicle to reflect.

The NHS expects people to be acquiescent and have faith that it will act in their best interests. A fallacy which is peddled by NHS managers, clinicians and politicians alike. It is an organisation which is driven by the need to protect its own interests and those of a select few within it (mostly doctors); it has very little interest in people except unless it gets found out. If I was a "good little patient" and had allowed it to proceed at its own pace, I would probably still be waiting for a diagnosis, let alone anything else. But (done it again, now started a sentence with "but" twice in a lifetime!) I am not a patient "patient". I have pushed, threatened and generally made a nuisance of myself in an effort to get a moribund organisation to do what it is meant to. Then I tripped up.

My mistake was to trust a consultant when he told me that I would be seen by the next one in the long line within a fortnight. I sat back and waited...........and waited...........and waited.......Nothing!

I am not sure that I have the strength to keep fighting. The NHS has made it pretty clear that neither the organisation nor its clinicians give a damn about us population units. I have no faith that it will actually cure me, so is it worth the fight? Should I just sit back and let the NHS turn me into tree fertilizer by default?

The alternative is to use every bit of ammunition I have in one last glorious "over the top" moment. I can certainly get to a lot of people who would scare the living daylights out of a little trust like Medway. I have no qualms about doing potentially irreperable damage to their reputation, which is amongst the lowest in the country to start with.

I went to ask the trees. Spent an hour sitting on a log at the top of the hill as darkness descended and the wind increased.

Passive acquiescence in the hope that the NHS will do what it is supposed to do, keep fighting as I have been for the last 2 or 3 months, or just go for maximum damage to provoke action?

I know I should sleep on it before either publishing this, or making a final decision, but I have given up being indecisive.

If no letter arrives in tomorrow's post, the nuclear option it will be................................ One final go, but this time I will not be nice and will not care who in the NHS gets upset or hurt by the fallout.

 
A song especially for Medway Hospital and its contents.......
https://www.youtube.com/watch?v=4QbUSjnhv6M

Ever had one of those dreams?

I expect you have......the one where you are trying to get somewhere, but the thing you are aiming for just keeps moving away from you, or you are sent into a new maze. Guess what? Just happened!

If you have been following this blog, you may remember that there are a whole load of options potentially available on the treatment front. Not sure whether I have written in detail before though. Apologies in advance if this gets a bit OTT.

Five options were put to me:

• Do nothing, just keep an "eye" on the tumour. Rejected as too dangerous
• Surgery. Rejected due to very high risk of collateral damage (you don't want to know!)
• Radiotherapy. Possible and orthodox, but still a high risk of collateral damage
• Bracytherapy (a more targeted version of radiotherapy). Possible, but also has a high risk of collateral damage
• Cryotherapy, a form of highly selective freezing. Definite possibility as much less potential collateral damage
• HIFU (High Intensity Focussed Ultrasound). As cryotherapy

I did a bit of research on academic papers and found a sixth: Photodynamic Therapy. Similar to the last two, but uses light instead of cold or sound waves

The way I figured it, the last three offered the best chance of "preserving structures" i.e. whole bunches of rather important nerves and arteries, and have good reported outcomes, so these were the ones to push for. Knew I would have a battle on my hands to get there as it would mean getting referred on to one of the London hospitals, but seemed winable. My educated guess of how it would go is roughly as follows:

• Meet Oncologist and go through the non surgical options.
• Tell him that I was not really interested in any form of radiotherapy and persuade him to refer me on.
• Battle with the local Clinical Commissioning Group to get the referral approved
• Go to London, get treated

Potentially hard work getting the CCG to approve and might require calling in a few favours from NHS contacts, but ultimately smooth (if a little painful for the CCG). Worth it!

Then I saw a programme on Channel 4.........

Channel 4 has a wonderful reputation for being socially aware. This means that they can put on programmes which are basically reality tv for those who think that "Bake off" and "Benefits Street" are beneath them. Tonight's offering was a programme on treating cancer, meeting people who had just been diagnosed, watching their treatment and then recording either their joy at cure, or in the case of one chap, his incredibly postive response to hearing that there was nothing more that they could do. And one of the people had? You have guessed it, prostate cancer! They showed how wonderful one of their "new" treatments is (HIFU). And which hospital was it? Yes, the very one that I had hoped I would be referred to.

Upshot of C4's socially responsible reality show is that there will now be thousands of people queuing at the door and a waiting list running into months or years...................if you want crap timing for a television channel to try to win an audience through watching other people's suffering, you really could not make this one up.

Hope to despair in one easy step!

I had hoped that this blog would have a very limited life; now looks like the blog and me might be in the wrong sort of race thanks to C4

Sorry, depressing blog post today. Good therapy for me, but probably not much fun for you as the reader. An upbeat song to compensate:

https://www.youtube.com/watch?v=RJaca9UIqcw

A quote, a film and a short song; that's all!

“For small creatures such as we, the vastness is bearable only through love.”   
 Carl Sagan

https://www.youtube.com/watch?v=Ll7GvNKOK9k

https://www.youtube.com/watch?v=h9b0Vp8nTVs&index=2&list=PLlWgG3taDEP6gJemlcK0d4PNMmcYz9hbd

Waiting for the post

If you have followed this blog from the beginning, you will know that a good part of the reasoning behind it was as therapy for me. A place to rant about cancer, the NHS, things in general. I know that it sometimes sounds a bit "off the wall", but I suppose that is one of the inevitable effects of writing in real time. Thank you for getting this far, but please feel free to put me back in my box if I start to get out of hand; there is a comment option, a Twit option (@phil_woods) or just plain old email!

I am not sure whether you get access to the stats that come with the blog and, if you do, I doubt that you would have bothered to take a look. They set out how many times this has been read, what country the readers are in etc. I expected the UK and Australia (g'day to you), but there have been a few surprises.................the USA, Republic of Ireland (I think I can guess who you are!), Germany and, just once, Russia! Given that I do not know anyone who lives permanently in any of those, it is quite a thrill to have had an international audience. Just this once, I shall use a word that was in use when I was young and seems to have crept back into the lexicon of the younger generation: Cool!

I hope that none of you ends up in a similar situation, but this bit might be useful just in case.

• Being diagnosed and told (albeit through a clinic code) that I had cancer was a shock and left me raving for a day or two, but has no real effect on me day to day.
• The occasional discomfort of diagnostic procedures is no problem, just a matter of focussing my mind elsewhere
• Waiting in poorly maintained rooms and sharing the odd bit of banter with fellow NHS consumers (I hate the word "patient"!) is irritating and a waste of time, but it is what you expect from a service with first world clinicians working in a third world environment.
• Waiting for the next letter inviting you to be seen, prodded or tested is the real killer. You dare not commit to anything for fear of receiving a letter which tells you to be somewhere else at the same time; whenever I see our friendly postman, Lawrence, on his round I am tempted to stop him and ask whether there is any mail for me rather than wait for him to get to the end of his round (which happens to be here); as soon as a postal delivery arrives, I am off like a greyhound in hot pursuit of a bunny to the postbox at the end of the drive...................

Today, I am waiting for two letters: one which invites me for an endoscopy and one which invites me to a meeting with the oncologist. Will both arrive? Just one? None? Did one or both get lost in the sorting office? I will let you know after 1:30.

Meanwhile some songs. These are a bit on the "romantic" side, but are some of my favourite classics along with one I found this morning...................

https://www.youtube.com/watch?v=0iPtG_O8w8g

https://www.youtube.com/watch?v=JySmOoCsZG0

https://www.youtube.com/watch?v=4DuWOMqc9-M&list=AL94UKMTqg-9BTCc5E4xHD-1ayh1fmfuiO

https://www.youtube.com/watch?v=FirBvR1HmKI&list=AL94UKMTqg-9BTCc5E4xHD-1ayh1fmfuiO&index=3

Late news: nothing in the post! Ho hum, it is only day 80  i.e. national target +18 .......mustn't be too ambitious, this is the NHS in Medway after all...........

People are strange..............

No NHS today, so just some thoughts about people's reaction to cancer..........

As you may have gathered, the fact that I have cancer is not exactly a secret. If it was, I would hardly be writing about it on the internet for anyone and everyone to read (well, the select few of you who have found your way here). That being said, I have not exactly been running into the street shouting about it either!

As people find out, or I tell them, some of the reactions are very interesting. People who know me well ask how I am feeling about it and put up with me as normal; a couple are interested in the detail of my slow progression through the NHS (as you will have noticed over the last few weeks, I can bore for England on that one!), lots offer support if I need it or do something they know will make me feel good. But (I was taight never to start a sentence with "but", been waiting years for the chance), there is a fourth group who are fascinating: it seems to induce a kind of benign paralysis witha whole load of assumptions.

Regardless of the very public campaigns like Race for Life (breast), Movember (prostate), Tie Day (bowel) and some high profile support from people like the Prince of Wales (a friend has a very entertaining story about him, hand shaking and alcoholic fortification), cancer still remains a taboo subject which scares the pants off people. When confronted with it, they have no idea how to react either to the word or the person who has it. If I had broken a leg, or had appendicitis, I suspect they would have no problem, but cancer????

The only explanation I can offer is about immediacy. If something scares you, but is remote, you can park it in the "too difficult" corner of your brain. It sits there, you know it is there, but you do not need to bring it out and look at it. As soon as someone you know says they have cancer, up pop all the repressed fears................... This seems to give rise to a number of odd, but understandable reactions: become protective ("should you be carrying those chairs?"), repeated enquiries about your health (I have no symptoms!) or subtle distancing, only talking to my partner (how is he?) as if I might be contageous. Oddly, exactly the same way that people often act towards people with disabilities..........................something I have been battling for years.

Phil - osophy done.

Two lighter notes:
Booked an appointment for the tattoo! Monday the 27th

The most amazing band that I saw on tv last night. I had never heard of them before and cannot think why not. Here is one of the songs they performed:

https://www.youtube.com/watch?v=ZXMzQNjBSwk

Time wasting: a Medway obsession

Another morning wiped out for no reason because of the NHS!

You may recall that I was told that I have to have an endoscopy following the discovery of s "blip" in an MRI scan. Simple procedure..............

I was summoned to meet the general surgeon and duly toddled along, on time, this morning to a little cottage hospital about 6 miles in the opposite direction from Medway. 10:40 was the allotted time, so I made sure that I was there by 10:30.

First problem: reception could not find any notes for me (they were not needed, so I explained that one and was let through)

10:30 took seat in waiting room. Clean and quiet, quite a change from Medway Maritime!

10:40 nothing

10:50 nothing

11:00 nothing

11:10 nothing

11:15 contemplated just giving up and going home

11:20 summoned just as I was on the point of getting up to leave
Hint to hospitals: how about sending people a text if your clinic is running behind?

Met very nice surgeon after excluding the obligatory medical student. He explained what an endoscopy was and what their plan of campaign would be. No real revelations and the "outcome" was that he said he would book me in "sometime in the next fortnight". Call me impatient, but "I have booked you in for next........day" would have been a lot more efficient. Even better would have been a letter explaining what he told me face to face and confirming an endoscopy appointment without having to waste an entire morning going to Sitttingbourne. Funnily enough, the consultant agreed with me!!


Still no word from the oncologist......................

I have held off using this link for a long time, but I think that the time has come for a song whose refrain sums up the Medway NHS experience..........you might want to turn the sound up!

https://www.youtube.com/watch?v=ISy0Hl0SBfg

Day off from the NHS

Nothing to report today, so here is some film of one of the modern blues greats:

https://www.youtube.com/watch?v=pgMDJoTh-QM

Wasting time and money

The straight line thinking of the NHS strikes again!

Picture the scene:

• A Radiologist looks at an MRI scan and spots something in your guts that could be a problem or could be nothing

• (S)he tells the urological surgeon who commissioned the scan

                                                 Most of a working week passes.............

• The surgeon tells the client that he will need to be seen by the gut team before his prostate can be dealt with........he makes a referral to the gut people saying "please take a look (colonoscopy) and deal with if necessary"

                                                     A week passes..........

• The gut team have a team meeting and decide that they should take a look........

So far, a lot of time has been wasted and nothing has happened. Now call me naive, but I expected the next step to be a call which said something to the effect of "sorry about the delay, have space in endoscopy list, please come in and let's do it" . Late, but hey ho, this is the NHS. Nope! Another possibility that had not even crossed my mind:

'phone call to say "please come to Sittingbourne on Friday so that the consultant can talk to you". No mention of actually doing anything, just another meeting to decide whether anything should be done.

He already has the scans, the info about me, the radiologist's opinion and the opinion of his colleague, but still has to see me, decide on his terms and then, perhaps, put me on the list for the procedure, the absence of which has brought everything else to a stop.

The serious point of this is that the NHS is now scared of its own shadow and refuses point blank to doanything that does not follow a step by step process. It does not matter if the "patient"  has to put their entire life on hold, or dies waiting for them to make their minds up, as long as the process is followed.

I hate to think what the wasted time has cost the NHS so far. My money, your money! Then they bleat about not having enough funding.......................I give in!

Now some young people's music for a change (i.e. post 1971). The first two are very young, the third are a band who probably still wear short trousers when not on stage..............

 https://www.youtube.com/watch?v=xCiQXsvPr1M

https://www.youtube.com/watch?v=XMy0x7nlxl0

https://www.youtube.com/watch?v=gZb8nEemK2k

Going with the flow

Today's title is a particularly bad pun I am afraid, but I did not post an entry on Punday, so it had to come eventually.

Since the initial hiccup with the first Specialist Nurse ("62 day target? I believe you, but I will have to look that up"), the second one is worth her weight in gold. The Great Man decided that I needed a "flow test" at our meeting yesterday; this could have been done on the spot if only I had drunk a few pints of water before seeing him. Given that this is the NHS, I felt it wiser to go with an empty bladder for two reasons:

• I was likely to be stuck in a waiting room (albeit with access to what turned out to be the only functioning wc in the vicinity) for half an hour. 40 minutes as it turned out, but I was booked into the last clinic slot so I don't begrudge that one.
• My experience of the lavatorial facilities at the hospital which are not in highly specialist areas indicated that what is left of my health and wellbeing might depend on not needing to use one.

Specialist Nurse said she would be seeing a couple of people this morning, so if I could drop in she would be able to get the flow test and associated ultrasound done. Just ask for her at reception.......

Brilliant! Told one of the 5 (!) nurses hanging around the reception desk why I was there, but did not give my name. She told me who I was! I was not only expected, but she had been asked to look out for me and (get me to) perform the first part: peeing into a sophisticated bucket while a machine in the next room did its bit.

Specialist Nurse appeared a few minutes later, into treatment room, ultrasound done (think the machine probably belongs in a museum........I had forgotten about cathode ray tube screens), and out for a friendly chat within 5 minutes. Let's hope that cloning technology moves on quickly enough to produce exact copies of her.

Went home and was part way through writing an email to the oncologist to save a lot of unnecessary time when we get to meet, when the 'phone rang................

At the moment, there are only three realistic possibilities if the 'phone rings during the day: the Hospital with an appointment time (good practice), my friend and work colleague, or telesales. No, there was a fourth that I had never even considered: it was the CQC!!!!! Not just the CQC, but the Local Inspector who is monitoring Medway Maritime Hospital. She said she might take a look at the blog; if so, you may wish to look away now.........

Still here? Very brave! Last chance.............

For those not familiar with the CQC (explanation of what they do is in a previous post....pay attention!), the Local Inspectors have one of the worst jobs in the country which is guaranteed to ensure that their blood pressure is off the scale for most of the day.

What a fantastic woman. In the midst of overseeing performance figures, juggling difficult meetings with (doubtless) difficult people and generally carrying the can for a hospital in "Special Measures", she had picked up my comment and decided that calling me was a priority. Won't go into details, but we had a really great discussion and I promised to send her a concise summary of the Good Bits and Not So Good Bits once all this is over (perhaps a couple of new acronyms for the CQC to pass to the NHS, NHSIA, PHE, etc.: the GB and NSGB scores for hospitals?). Another candidate for cloning.

Now, dear reader, the reward for all your hard work getting this far. If you listen carefully, you may hear the instrument listed as "Asses Jawbone":
https://www.youtube.com/watch?v=Q1mCYgjhnGg