14 March 2017

The night I lost patience with the NHS


It’s often said that not all problems in the NHS are about money. I’ll give you an example of that from my own experience last night.

One of my sons injured his foot playing rugby on Sunday. When it didn’t get better overnight, my wife took him to a doctor yesterday afternoon, at about half past three. The doctor said he appeared to have torn some tendon or ligament in his foot.

Before determining a precise treatment, the doctor needed to confirm that no bone had come away when the ligament tore, for which we would need to get an X-ray done. He said it was a reasonably serious injury so we should take him to an A&E department rather than putting it off.

We are a one-car household, and my wife had an unavoidable commitment for a few hours after they saw the doctor. So I ended up driving our son to the A&E, arriving about 11.20pm.

We waited in the relevant section. An announcement came over the speakers saying they were busy and it might be up to three hours between arrival and being seen. That was about what I had expected, so I focused on reading my book and occasional tweeting.

After around an hour, a doctor saw us. We explained why we were there and showed her the notes the GP had given us. She gave my son some crutches and we were sent to the X-ray section. The X-ray was done. The X-ray man thought some bone had indeed torn off.

We had been told to return to the doctor when we were done. I guess that might have required around one to two minutes more, with the doctor confirming to us that the X-rays would be sent to our GP and that we could go. Or perhaps the injury would turn out to be more serious than thought, and something would need to be done then and there.

Anyway, we went back and sat outside the doctor’s office and waited. Time went by. One further hour. Two further hours.

Then an announcement was made that the expected time between arrival and being seen was now between four and a half and six hours, and if you were seeing a specialist it might be longer.

Obviously, a foot injury wasn’t a particularly high clinical priority. Some of the other children in the waiting room could have had all kinds of nasty problems — poisoning, heart disorders, cancer. If things were as busy as that, we oughtn’t to stay, holding others up.

It was already 2.30am and a further three hours’ wait would take that to 5.30am. So we gave up and left.

We might, of course, have been next in the queue and been seen within five minutes. But there was no system of communication — no Argos-style list on the wall saying where one was in the queue or how long one might expect to wait. So we had no way of knowing how much longer we would be waiting – and we gave up.

I gave someone my son’s wrist-tag so he could be removed from the queue. Then there was the question of what to do with the crutches. I didn’t know whether we had been given them just for moving around within the hospital, much as one might be given one of those green hospital gowns.

I suspect we were intended to keep them, but there was no way for me to find that out, and no way for me to find out how I should return them if not, and we didn’t want to be stealing hospital equipment that others might need. So we ended up leaving them behind in the waiting room.

I have no idea what happened to the X-rays. I have no way to discover if they have arrived at my GP, other than to book a new appointment. I don’t imagine phoning up the secretary will get me anywhere other than a request to make an appointment. And if I book an appointment and the X-rays aren’t there, that will mean I’ve used up a half a workday. So I’ll probably have to get the X-rays done again, before trying to go to my GP.

What, then, is the point of my tale? I have no complaints about waiting at A&E. The waiting time seemed reasonable to me. I have no complaint that my son’s (albeit non-trivial) foot injury was not a clinical priority – of course it should not have been. I have no complaint that I ended up wasting many hours. I’m not really making a complaint about me at all.

My point is that this episode has resulted in quite a lot of NHS resources being wasted. The time spent processing me at the A&E was wasted. The time of the X-ray staff, and the X-ray machine time, was wasted. The time of the doctor who spoke to us and gave us the crutches was wasted.

These things were all wasted avoidably, through communications failure. A simple electronic system of communicating to those waiting at A&E where they were in the queue (even if that position might change if someone more urgent arrives) would have meant my leaving much earlier – or waiting until I was seen.

If someone had told me whether we should take the crutches out of the hospital, giving them to us would not have been a waste. If there were some way for me to tell if my X-rays have gone to my GP, I would not be arranging to have them done again.

Such communication is not a matter of extra money. It is about grasping that decisions by patients – Do I stay in the queue? Do I arrange another x-ray? Do I take the crutches away? – are a fundamental part of the medical process.

You may think I had no choice but to leave; you may welcome my decision to give up my place in the queue to those in more need; you may think I made a perfectly rational assessment of the costs and benefits to me and others of staying another three hours or leaving; or you may think I am at fault for the waste of resources and that I should have stayed.

Regardless of the oughts, the blunt reality is that patients do get to make decisions that lead to resources being wasted, and any efficient system needs anticipate what those patient choices are likely to be.

I have been in other medical systems that recognised the key role of the patient in medical care many decades ago (eg in New Zealand). The NHS doubtless believes it aspires to something similar. It fails, and in doing so costs itself resources unnecessarily.

Andrew Lilico is an economist and political writer