05 July 2008

The patient right at the centre of care

In the video in the previous post Gordon Brown says that he wants the 'patient right at the centre of care'. Dr Grumble has no difficulty with this mantra. No difficulty whatsoever. The patient is at the centre of care. It's obvious. Very obvious. It's what Dr Grumble was taught repeatedly from his first day as a clinical medical student. But Dr Grumble feels aggrieved. He is aggrieved because it's an affront that the prime minister feels the need to tell doctors this. It's an insult that Mr Brown seems to think that doctors do not put their patients at the centre of care.

On the other hand Dr Grumble has never really thought that those other than the healthcare professionals in the NHS thought the same way about patients. Doctors never wanted those sick A&E cases piled up on trolleys in the corridor. Doctors never wanted long waiting lists with patients or their relatives phoning daily to check they had not been forgotten. It's easier and nicer for all to run a quality service with patients' needs the focus. But the managers never cared. They never saw the problem. They were never there at night. Never there at the weekend. Never there dealing with distressed relatives. Never there when the trolleys were piling up. It's the managers who failed to put the patient first. Not the doctors. Not the nurses. And not any of the other NHS professionals. And it's the managers who are still failing our patients. Not that it's their fault as individuals. Quite often their hands are tied by government edicts.

Last week one of Dr Grumble's clinics was uncontrollably disorganised. It's a medical clinic. The slots allocated for a new patient are just 20 minutes long. That's OK. Dr Grumble puts in patients that are clearly the simpler cases - cases he knows he can deal with speedily. For the more difficult cases he has other clinics with bigger slots. Enter the Wicked Witch - Choose and Book. Sounds wonderful. Works dreadfully. Unfortunately patients now have control of which slots they go into. Sounds good. Patient choice. But patients do not know how long Dr Grumble needs to deal with their particular problem. Patient choice is not at all the same as focussing on patients' needs. In the old days it was so easy. The GP wrote a thing called a letter. Dr Grumble read it and, putting the patient at the centre of his decision making, allocated the patient to the best clinic for their needs. If it wasn't convenient the patient could use a thing called a telephone and change it. But now, the government's C&B edict, the patients turn up in a Martini style - any place, anywhere, any time. Others have similar problems. It's not putting the patient at the centre. It's putting government initiatives at the centre. Mr Brown needs to learn from his own mantra.

Another example from last week shows the inflexibility of Choose and Book. What happened was this. A lady chose and booked into one of Dr Grumble's clinics. Whether it was the best clinic for her or not is immaterial because the patient had a domestic crisis and she couldn't come. So, helpfully, she phoned the receptionist to rearrange her appointment. Sensible you might think. But no. The patient had chosen and booked. Only she has the password to Choose and Book. The hospital cannot, apparently, change the appointment. That, anyway, is what Dr Grumble has been told.

Dr Grumble thinks that this poor patient who had a domestic crisis and in the midst of it all made the effort to phone the hospital is stuffed. She will probably have to start the whole process again. Dr Grumble doesn't actually know. He has, though, written a letter to her GP suggesting (and one hopes this isn't NHS sacrilege) that, yes, a referral letter is sent so that Dr Grumble can rectify this. Dr Grumble you see is no longer empowered to send her another appointment. That is just not allowed. Another edict. How's that for patient centred care? The patient is hardly likely to see this as putting her at the centre. And the poor GP will have to produce a letter. The GP will understand that Dr Grumble is not just being difficult. The hapless patient may well not.

Whoever dreamed up Choose and Book failed to realise that a hospital appointment is not quite like booking a flight. That's because the government takes advice not from health service professionals who know but from convincing management consultants who don't know but have a degree in, well, anything at all. Or maybe even nothing.

Of course, in case you don't know, Choose and Book is not much to do with giving patients what they need. It's about giving the government what it needs. And the government needs some way of getting patients to go to providers outside the NHS. It's all about back door privatisation. And the mechanism is patient choice and Choose and Book. It's not about patients. It's about government.

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