Tuesday, March 06, 2012

You don't know what you've got til its gone... #NHS

As regular readers will know, both Sue and I myself are prone to 'ooh, that'd be a good idea' moments which then, somehow, often before we've noticed, become a social media campaign. Personally I hold the medication responsible for at least a bit of the inspiration and often wonder why the creative industries don't employ more people on legal opiates to dream up campaigns. Ok, so the potential downsides are things like declaring one's desire to become a duck on twitter, but really that's a small price for any employer to pay.

So, with the #nhssavedmylife trending on twitter I thought it would be an interesting idea to try and live tweet through my bronchoscopy procedure. As many of my ideas do, this had practical downsides and I failed to actually tweet whilst the scope was being used, but it's the intention that counts.It was crap by the way. The bronchoscopy I mean. Definitely not one to put on your bucket list. Surprisingly the having a camera down your trachea bit isn't actually that awful, but the spraying of the local anaesthetic half way down to your lungs would be a worthy replacement for waterboarding, though I doubt Guantanamo would serve it up with a side order of nurses to hold your hands throughout. To be fair unlike torture centres the NHS do also offer a nice, free sedation service for those people not stupid enough to think toughing it out for a few minutes is the way to go. I'm generally a huge fan of floaty sedative drugs so it says a great deal that I chose to reject the free, legally administered by vein drug option. 

 We've had our problems over the years, me an' the NHS; lack of diagnosis, judgemental clinicians and absence of adequate services to support those with chronic conditions being top of a long list. As someone with a chronic condition falling through every possible gap in NHS provision its all too easy to get caught up in what the NHS doesn't do well and forget to notice all the things it does so brilliantly. NHS reform is undoubtedly needed, but like seemingly most of the legislation this Coalition government is trying to force upon us, there has been so little attention paid to the details that we risk dismantling all the positive parts of our systems whilst leaving the dysfunctional in place.

Yesterday, while waiting in the endoscopy suite I watched the NHS at its best. If I'd remained in the waiting room all I would have experienced was the constant, endlessly ringing phones and the tooth grinding while waiting for them to be answered. I'd have seen the officious reception staff too busy to meet anyone's eyes and the insensitive so and so eating in a waiting room full of people 'nil by mouth'.* I'd have been frustrated at the delays, the loss of my notes and did I mention those endlessly ringing phones already? They were very annoying.

But instead I went through the patient experience. The consent procedure which was repeated as my notes were yet to return from clinic 'just in case'. Even though I had a signed copy with me, it was just in case anything was missed. The repeated measuring of my blood pressure which indicated my fight or flight response was in full swing thank you very much, but despite the desire my ability to turn into a duck and fly far, far away was not.**

As I waited for and recovered from my procedure in the recovery area I saw the part of the NHS most people are never privileged enough to see. Typically an individual uses the health service heavily at the beginning and end of their life, with little contact in between save say the occasional broken bone, or visit to the GP for holiday immunisations. They can be frustrating, misleading experiences which involve lengthy waits or incomprehensible delays. Incomprehensible until you go beyond the surface areas of the NHS and get to see what's happening behind the scenes. There are areas of the NHS that would make you weep with the waste and incompetence, but conversely, an NHS unit which is well funded, staffed and managed is like watching a beautiful ballet performance.

Having experienced health care on both sides of the Atlantic, along with the subsequent bills fought over by hospital and insurance company I wondered how different would this experience be if my experience were in an insurance based co-pay environment. The fear I felt in the waiting room and reluctance to endure and unpleasant procedure would almost certainly have led to me running away and avoiding the test altogether if I had had to contribute towards the financial costs. I would definitely have gone without sedation as having it means losing income not being able to work the following day and adds substantially to the costs. I would almost certainly have refused the 'just in case' venflon put into my arm as an unjustifiable expense, more willing to take the risk of delay during an emergency than spend a few hundred pounds on something that might not need to be used, but that could save my life if it were. Perhaps I would also have felt obligated to go to the cheapest provider of the testing, regardless of whether they were equipped to deal with the kind of complications which can occur in someone with Ehlers Danlos Syndrome. I would certainly have felt a type of stress and fear that most British people raised on the incredible priviledge of the NHS cannot even begin to comprehend.

And that's the utter disaster that is the NHS bill. Its so poorly drafted, so ill defined that it doesn't address the areas of the NHS in need of reform - how we care for those with chronic conditions or the elderly. Instead it attacks the structure, forcing reluctant GP's to become both diagnostician and budget holder seeking the cheapest possible provider not the best. It fails to recognise the complex interactions required in any hospital, focusing entirely on the waiting room experience for the worried well.

It paves paradise and puts up a parking lot.

 

*Though the insensitive so and so did come with me and is probably not a permanent feature. 
** bloody drugs, promise you everything, deliver nothing. Like politicians but without the taxpayer funded duck house.

4 comments:

L00py's Craft Creations said...

Hun, so pleased you got through it in one peice, and are able to talk about that which you were dreading. Like you I know the results wont be in for a while, and I am very grateful to the NHS for the job they do, even though like yourself I fell through the cracks for 38yrs. I would dread to have to pay a medical insurance, and do realise how very lucky we are to have this system in place. I know people knock it, but its much easier to know that alot, not all, but a lot of the necessary medications are available for our treatment, than have to dread asking for treatment and justifying expensive drugs.
Now just need to deal with my latest shock for today, the refusal of a Statement for any child with EDS/HMS in the Borough of OLDHAM, if they need less than 15hrs 1-1 per week! So if they move area's they then have to wait and go through the Statement process in a new borough! Not entirely sure this is Legal, its definatly not for the protection of these children, but a cost cutting excersise, being done ONLY in Oldham.....Upset isnt the word!!!
Hugs hun, Keep up the good work, xx

Lou

Anonymous said...

So glad it's over for you, v impressive and brave to live tweet through it!

"an NHS unit which is well funded, staffed and managed is like watching a beautiful ballet performance." That's so well put. I had the privilege to see that for myself recently. I have a chronic health problem (and yes, the NHS did take years to diagnose it, but then it took fewer years than the average time to diagnose in the USA where they have a private healthcare system). A few years ago I was due to have surgery on the NHS, and for various reasons a private hospital provided it. My experience didnt' suggest to me that private providers offered greater dignity or customer service than the NHS... I had my own room, which was very nice, but it didn't offer me much dignity when nurses kept leaving the door open whilst doing intimate examinations, or wandering in and chatting with each other during said examinations.

Then there's the surgery itself. It turns out the kind of surgery I had is pretty pointless, sounds fancy but doesn't really do anything. So I went back to my local consultant. The service I had visiting my local NHS hospital, from the receptionist to the nurses, to the radiologists, to the doctors, to the medical student in the room, really couldn't have been bettered. They were respectful, understanding, on time. I'll (hopefully) have surgery later this year, which will have a decent evidence base.

It left me thinking - if you were a private provider, why would you give somebody the surgery that actually works, rather than the one where they keep having to come back for more?

Dave said...

Hi BG, I was in our local Endoscopy Clinic on tuesday having a colonoscopy. Luckily they called me in at 8.00 and I was out and home by 12.00 and tucking into some grub. You can't eat anything for 20 hours before the procedure and the stuff they get you to drink flushes you right through. I was empty. The staff were great and did a good job.

My current medical situation has seen me visit almost every clinic/department in the hospital in the last couple of years and I agree that the well run bits are a joy. However, not every department is well run. I was on a ward having tests (which resulted in an appendectomy that didn't solve the issue)and I'm afrid my treatment was appalling. It's not nice to have to shout at a nurse to get her to fit a drip (which took two minutes)and to read my notes which showed quite clearly that a drip had to be fitted. In some parts of the NHS the staff are too busy filling in forms and ticking boxes to actually do any nursing. The reforms planned by the government will make this more likely to happen, not less.
Keep up the good work BG!

James said...

After seeing GP-hospital interactions up close, I'm not sure it will be such a bad change after all.

Two years ago, my mother had a sore left foot - essentially, there was a lump growing in it, forcing two toes apart. At first, the GP suggested trying an insole and switching car to an automatic in case it was the clutch. That didn't help, so the GP asked for an appointment with an orthopaedic surgeon at the local hospital.

That's where it all went wrong. The hospital decided it knew better, and switched the appointment to see an orthotic technician instead - who installed an insole and sent my mother away again. Actually getting the appointment the GP had requested ended up costing a few hundred pounds.

If the reforms mean you actually get the treatment the NHS ordered from the NHS instead of having to pay to go private to get what the NHS says you need, it can't be a bad thing.

(My own first encounter with the NHS was very nearly fatal as well, also due to "hospital knows best" care rationing, determined to keep a tiny hospital open and delivering dangerously inadequate care rather than send patients to a proper hospital. On a remote island you could understand it - but this was London.)