Back on the NHS theme again. I had not anticipated that I would have much, or anything, to say about it until I had met with the good folk at University College Hospital (UCH) on the 10th of December, but a couple of things happened today that I could not resist writing about.
After a lot about the failings of the local NHS, it is a real pleasure to be able to relate some good news about how it can work well. One relates to Medway Hospital, the other to the good sense and planning at UCH.
You may recall that the MRI scan I had to look at my prostate revealed another potential problem which led to an endosocopy the other week. The bits that were removed during this duly went off to the pathology department at Medway Hospital with the usual assurance that results would be available in "about 2 weeks".
Forgive me, but after waiting 4 weeks last time, I did not have a lot of faith in the 2 week estimate. But no, I got home yesterday to find a message from the surgeon asking me to call him back. Tried, he was busy "in theatre". Love that expression; conjures pictures of surgeons and amateur dramatics..............mind you, there are an awful lot of surgeons who enjoy a drama!
This afternoon, the 'phone rang (or, strictly speaking, warbled a bit) and there was the good professor on the other end. He had actually taken the time to telephone in order to tell me that the histology report revealed nothing sinister. You may recall that I quoted my experiences in the endoscopy suite as a study in excellence the other week; well, this phone call confirmed my view. Well done Medway Hospital, or at least, well done Professor Wegstapel.
The other good thing arrived in the post; it was an MRI appointment UCH which has been booked for the 13th of December (a saturday).
One of my criticisms of Medway hospital was that everything was done in series i.e. seen by someone, they refer you for an investigation, you go back to them, they refer you for something else etc etc etc. Weeks in between each stage. Nothing like that at UCH, they understand what will be needed and book you in advance. What would have stretched to 2, 3 or 4 weeks locally will happen in 3 days at one of the big London Hospitals!
A topical music clip for a change. For those of you who do not live in the UK, and for anyone who is not really into politics, this may be a bit obscure. Believe it or not, the man singing was actually a Minister in the British Government until 4 day ago..........
https://www.youtube.com/watch?v=DDd_deMoUpc
Friday, 7 November 2014
Monday, 3 November 2014
Newspapers can be useful......
In my house, newspapers have many uses which their electronic e-versions could never hope to match. Amongst other things, they are used to:
You may also recall an earlier blog post in which I speculated about whether there were people who might want to apply their skills and / or knowledge to help others who were encountering difficulties with public services. Within a day of that post, I met someone in need of just that kind of help.
Allow me to leave you in suspense for a few minutes longer and tell you a story. It is a story so breathtakingly daft that it defies belief, but I can assure you that it is true. I shall refer to the main character as S to preserve her anonymity for the time being.
S is a single mother of two, one child being of school age, the other still firmly in the pre-school stage. She is registered partially sighted and, as a consequence, cannot persuade the DVLA (for my non UK readers, this is the bunch of bureaucrats who give, or take away, driving licences. They are based in Walesland, a semi-autnomous principality somewhere in the West) to let her apply for a licence to drive a motor vehicle.
S used to have a job, to my mind and those of many others, a very important and skilled job, in which she has qualifications. She was part of a small and very select team of people who look after every whim of some very, very important guests. In short, she worked at the stable yard my horse lives in. Unfortunately, when she broke up with her husband, who used to drive her to and from work, she had to leave the job as there is no direct public transport from her younger son's childcare to the stables. She cycles, but it is an 11 mile trip with two HUGE hills inbetween; there is no way she could make it to work on time, or have the energy to work once she got there.
Being resourceful and determined that she should not languish on state benefits, S applied for something called the Access to Work Grant. This is a discretionary benefit to help people with disabilities get into, or back into, work. Great idea...............unfortunately not matched by reality.
Without boring you with the details, all that was needed was a taxi from the place she drops her younger child at 07:30 to work, which starts at 08:00, and the same in reverse at 16:30. The (un) civil servant she has been dealing with agreed that the AtoW Grant would be just the thing, but not from childcare to work. His genius solution was that she should walk 2 miles to the nearest station, catch a train to Swanley some 15 miles away, get off and wait, catch a train to Bearsted (15 miles back again) where he would provide the Grant for a taxi for the last 6 miles. This would get her to work at 10:00 -ish if she is lucky. Bonkers, or what?
I had a brainwave.
There is a by-election in Medway which is a little interesting. It is so contentious that the main political parties are falling over themselves to fill the place with their idea of the Great and Good (the author here dissociates himself from all political parties, all of whom are equally corrupt in his eyes) and to compete wildly with each other over who could be the most benevolent, hardest, nastiest or just plain maddest depending on what they are talking about at the time.
How would all these Islington (a nouveau riche part of London, the equivalent of a bat's cave for politicians) luvvies react if someone put a real person, who is a real victim of their system, right under their noses? How could this be achieved?
Answer: in by-elections, each party, with the possible exception of the Monster Raving Loony Party, has armies of people combing the local papers looking to see what the strange locals are on about. How about getting S's story into the local paper?
A quick check with S that she was ok with it (she was) and I dropped an email to the MM (remember them?) with a summary of S's story. No response.
Waited patiently (not my style)
A few days went by
Nothing
Sent another email regretting that they were not interested in the story
11 minutes went by
Bingo! Did I think that S would agree to be interviewed? Photographed? Too d**n right she would!
S and the MM now have each other's contact details. Let's hope that the power of the press can be harnessed, even in this small way, to do some good. I will keep you posted.
And now tonight's song. I heard this band on tv the other day and they blew me away. I hope that you enjoy them as much as I did
https://www.youtube.com/watch?v=1Lif-UZJjxA
- Provide a removable and disposable lining for the chicken coops
- Dry out wet wellies and shoes
- Light the fire in winter
- (this may strike some of you as a bit odd) Act as a conduit for the news and opinions of the day i.e. they are read.
You may also recall an earlier blog post in which I speculated about whether there were people who might want to apply their skills and / or knowledge to help others who were encountering difficulties with public services. Within a day of that post, I met someone in need of just that kind of help.
Allow me to leave you in suspense for a few minutes longer and tell you a story. It is a story so breathtakingly daft that it defies belief, but I can assure you that it is true. I shall refer to the main character as S to preserve her anonymity for the time being.
S is a single mother of two, one child being of school age, the other still firmly in the pre-school stage. She is registered partially sighted and, as a consequence, cannot persuade the DVLA (for my non UK readers, this is the bunch of bureaucrats who give, or take away, driving licences. They are based in Walesland, a semi-autnomous principality somewhere in the West) to let her apply for a licence to drive a motor vehicle.
S used to have a job, to my mind and those of many others, a very important and skilled job, in which she has qualifications. She was part of a small and very select team of people who look after every whim of some very, very important guests. In short, she worked at the stable yard my horse lives in. Unfortunately, when she broke up with her husband, who used to drive her to and from work, she had to leave the job as there is no direct public transport from her younger son's childcare to the stables. She cycles, but it is an 11 mile trip with two HUGE hills inbetween; there is no way she could make it to work on time, or have the energy to work once she got there.
Being resourceful and determined that she should not languish on state benefits, S applied for something called the Access to Work Grant. This is a discretionary benefit to help people with disabilities get into, or back into, work. Great idea...............unfortunately not matched by reality.
Without boring you with the details, all that was needed was a taxi from the place she drops her younger child at 07:30 to work, which starts at 08:00, and the same in reverse at 16:30. The (un) civil servant she has been dealing with agreed that the AtoW Grant would be just the thing, but not from childcare to work. His genius solution was that she should walk 2 miles to the nearest station, catch a train to Swanley some 15 miles away, get off and wait, catch a train to Bearsted (15 miles back again) where he would provide the Grant for a taxi for the last 6 miles. This would get her to work at 10:00 -ish if she is lucky. Bonkers, or what?
I had a brainwave.
There is a by-election in Medway which is a little interesting. It is so contentious that the main political parties are falling over themselves to fill the place with their idea of the Great and Good (the author here dissociates himself from all political parties, all of whom are equally corrupt in his eyes) and to compete wildly with each other over who could be the most benevolent, hardest, nastiest or just plain maddest depending on what they are talking about at the time.
How would all these Islington (a nouveau riche part of London, the equivalent of a bat's cave for politicians) luvvies react if someone put a real person, who is a real victim of their system, right under their noses? How could this be achieved?
Answer: in by-elections, each party, with the possible exception of the Monster Raving Loony Party, has armies of people combing the local papers looking to see what the strange locals are on about. How about getting S's story into the local paper?
A quick check with S that she was ok with it (she was) and I dropped an email to the MM (remember them?) with a summary of S's story. No response.
Waited patiently (not my style)
A few days went by
Nothing
Sent another email regretting that they were not interested in the story
11 minutes went by
Bingo! Did I think that S would agree to be interviewed? Photographed? Too d**n right she would!
S and the MM now have each other's contact details. Let's hope that the power of the press can be harnessed, even in this small way, to do some good. I will keep you posted.
And now tonight's song. I heard this band on tv the other day and they blew me away. I hope that you enjoy them as much as I did
https://www.youtube.com/watch?v=1Lif-UZJjxA
Wednesday, 29 October 2014
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......
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......
Tuesday, 28 October 2014
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
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
Friday, 24 October 2014
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
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
Thursday, 23 October 2014
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.
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.
Wednesday, 22 October 2014
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