Part 5(B): For Better, For Worse; For Richer, For Poorer

London’s NHS: A Personal Experience (cont'd.)
Max gets uncharacteristically verbose on a 'hot topic', in the run-up to the UK General Election

The second part of my personal, close-up look at the current state of the National Health Service in London (read Part 1 first, below).
... Picking up where we left off, my 'virtual' expert did decide I needed to get along to Barnet Hospital Fracture Clinic; and sent me a very nice letter, setting a 9.15 am appointment, for just a couple of days later. Now, although I rather flippantly observed that Chase Farm Hospital had carelessly lost its Fracture Clinic facility, I was being slightly disingenuous. This was, in fact, potentially good news; since that old clinic had been COMPLETELY SH1TE ... to borrow a medical technical term.

On previous occasions when I'd had to use it, I had regularly spent entire mornings sitting in a grubby waiting room, amidst dozens of other damaged bodies of all sorts, including: frustrated parents; bored, mewling school-kids and distressed, wailing infants. It was a frankly terrible experience for all concerned, probably the medical staff included. It was standard practice to give the same appointment time to huge numbers of patients, despite the fact that they couldn't possibly all be seen simultaneously at that same, scheduled appointment time; nor indeed, in practice, even within several hours of their appointed times; since the day's initial back-log simply grew longer and longer. Nor was this a rare or isolated occurrence/experience. It was 'the norm'. The clinic's processes appeared to have been designed without reference to the convenience of the ill and the injured; a throw-back to the bad old days, when clinical scheduling generally appeared subordinate to the golfing commitments of a veritable army of over-bearing and self-important Sir Lancelot Spratts*.

The irascible chief surgeon (Sir Lancelot Spratt, left) famously gives Kenneth More grief, after asking him "What's the bleeding time?" - clearly still intent on making his scheduled tee-off.

This was always one of the potential dangers and common faults of an immense public sector system, where services are perceived as being delivered 'free of charge', to very lucky and tiresome creatures designated as "patients" (and who need to remain very patient, indeed!); rather than to humans, who've already paid handsomely for said services through their many and varied taxes. Barnet's fracture clinic would HAVE to be an improvement on the old Enfield experience - wouldn't it? I'd find out soon enough; if only there was some way of getting myself there. I couldn't walk; I couldn't drive (although I did think seriously about trying!); I couldn't get along on my crutches to anywhere with suitable public transport links. I had no idea where on the Barnet Hospital site the Fracture Clinic was actually located; and no amount of on-line research could help me to resolve any of these quandaries. Eventually, I 'phoned the appointment line to reluctantly cancel; whereupon I was greeted by the hope-restoring message that by dialling 1, I would be put through to 'transport services'. Which hadn't occurred to me; so that's exactly what I did. After nearly 20 minutes spent on hold to a private-sector call centre - because the line was, apparently, "receiving an unprecedented volume of call traffic" (as usual, one assumes) - I finally got through to an actual person and (after answering enough scripted questions to resolve The Riddle of the Barnet Sphinx**) made all the necessary travel arrangements. Panic over!

The Barnet and Potters Bar Times quoted NHS directors, saying Barnet Hospital’s A&E had been "partially rebuilt and fully refurbished under the changeovers"; and hoping that "... the changes will provide better co-ordinated services". Although "opponents in Enfield say the trusts are removing key local services and risking patients’ lives". And here, in essence was the difficulty of turning three A&E hospitals, effectively, into two: if you live in Barnet, everything probably looks pretty great; with shiny new buildings and signage. If you live near Chase Farm or North Middlesex, however, then everything still looks pretty much completely sh1te - AND potentially fatal. 'The Authorities' have entirely failed to strike a reasonable balance in their divestment and (promised) re-investment plans, whilst imposing unpopular, enforced change.

Shiny new buildings (and signs) at Barnet - in lovely soft-focus. Such excellent PR stills; but what about those clinical services?

On the plus side, my big day out in Barnet went remarkably smoothly; but probably not very cheaply, for the NHS. I was told to be ready for collection (like a pesky parcel) 2 hours before my appointment time. So that was 7.15 am. An empty, non-emergency ambulance eventually picked me up outside my house at about 7.50 am and took me (only me; there were no other patients) to the door of Barnet's Fracture Clinic. We had a lovely, sunny drive through the Enfield and Barnet countryside, avoiding all available town routes like the plague. Once there, the very personable driver, Dave, insisted on staying with me; because, arriving at about 8.20 am, we were too early (doh! - could that be anything to do with having to be ready 2 hours before the appointment time, do you think?). Clearly transport service managers appreciate and plan for the vagaries of North London journey times, during the rush-'hour'. But Dave has strict instructions not to leave his parcels - sorry, his 'patients' - alone, sitting on benches outside their destinations, when the doors of said destinations aren't opened yet. So we chatted about Dave's earlier background, working in BT; about how he'd been "TUPE'd" across to an outsourced service provider. Also about how he'd started his current job as an ambulance driver working for an outsourced US business, contracted to the NHS; but how he had, again,  been "TUPE'd" across to a different employer, a few years ago - to a division of parcel delivery giant, DHL (with no apparent sense of irony). These service providers have, of course, all been signs of the creeping privatisation of the NHS. It is important these days, apparently, that somebody, somewhere (share-holders, or other investors) should be making a profit out of the transportation of parcels - sorry, 'patients' - at the tax-payer's expense. Could this possibly, in any way, be contributing to the NHS being in a seemingly permanent cash crisis? Surely not.

Two services on a funding collision course? (photo: E. Daily Press)

Eventually, the clinic's reluctant automatic doors opened, as in the story of Ali Baba***. Magically, I was finally "delivered" and Dave was at last free to go about his medical parcel-delivery business, elsewhere. There was now some good news delivered by the cheery clinic receptionist: despite the 45 minutes remaining until my actual appointment time, I should only have to sit in the empty waiting area for perhaps 30 minutes; since patient-parcels delivered by "Transportation Services" get seen first, as a priority. Yes, I had luckily (and unintentionally) been upgraded to a sort of first-class parcel. At 9.10am, I was duly called in to see the very personable young Doctor Aroon, with whom I spent a few minutes, going over the state of my injury and proposed treatment protocols, all in a very professional and polite manner. Then I went pretty much straight into the Plaster Room, where I was quickly equipped with a new, weight-bearing 'slipper'. The whole process had been remarkably civilised, so far. After this, a different clinic receptionist notified Transport that I was ready for collection. Informed that I would probably need to wait 40-60 minutes, I took my place back in the now-full-to-bursting waiting area, amidst dozens of other damaged bodies of all sorts, including: frustrated parents; bored, mewling school-kids and distressed, wailing infants. I absorbed myself in my newspaper's crossword and sudoku puzzles, to pass the time and to help drown out the din and the miseries all around me. I was also asked to fill in a 'Customer Questionnaire' on a shiny i-pad. I gave a very good review. I'm not sure everybody else present would have followed suit, if asked ... but maybe that's precisely why I was given the i-pad, in the first place.

Luckily, I was saved from any more of this potential hospital hell (or was it merely the waiting-room of Purgatory?) after just 20 minutes or so, by the arrival of my second driver of the day: a very nice young Romanian called Adrian. Rather than send another ambulance to collect me, "Transport" had hired a private taxi; leaking yet more public money out of the beleaguered NHS; but giving me a very pleasant and comfortable ride home.

The whole adventure had lasted 'only' about 3 hours, for me - for less than ten minutes of contact time. Which, to be fair, was still a vastly better contact experience than in my previous visits to the (formerly barely-functioning and now-closed) Chase Farm Comedy Fracture Clinic; which any school-leaver with a watch, a clip-board and half a brain-cell could have improved drastically. It had cost the NHS about 40 minutes of ambulance time and a 25-minute taxi fare. Given that things were clearly not going so well for those many lost souls I had abandoned in that distant fracture clinic waiting area; perhaps the Barnet management team could also usefully do with the services of a school-leaver with a watch and a clip-board and half a brain-cell ?

On balance, I was comparatively lucky. I seemed to have inadvertently initiated a series of 'cheats' that made my experience relatively bearable; but at some considerable financial and resource cost to the NHS. Now that particular "cat" is "out of the bag", how much will it cost if everybody were to initiate those same 'cheats', as I had inadvertently accessed? You can't prioritise EVERYBODY, can you?

It is often said that there are a lot of very dedicated (and very nice) people working very hard in the NHS. This is very obviously true. Indeed politicians (rather annoyingly) begin almost every sentence on the subject by paying lip-service, labouring this truism - and 'paying respect'. Alas, NHS staff seem to be working (after enduring the recent public sector pay freeze) within a structure with poor processes, that's leaking cash from every pore into the private sector; and, in Enfield's case at least, making significant strategic and investment decisions badly - negatively affecting the welfare of individuals and their families. My brief and unplanned exposure to its current state made a lot of this patently clear; and mine had been a comparatively lucky exposure.

The result is that the NHS has become just one more political football (along with Education, Social Care provision, Br-Exit and many others, besides) to be kicked around by opposing party ideologies. I wonder whether my Enfield experience isn't, in fact, a spectacular 'own-goal'? Can "the largest sustained drop in NHS funding as a % of GDP since the NHS was founded" really form the basis of a credible "safe in our hands" claim - and a return to government? It simply seems to go against the principles expounded by almost every voter I talk to on the subject. Predictably, no politician has included, in the many thousands of hours of their recent, pre-election media exposure, a commitment to spend less on the NHS and privatise more of its services. I wonder why. See: The NHS Roadshow Video

Can North London's NHS services survive? Perhaps; but probably only if they can avoid North Middlesex Hospital.

Luckily, my condition wasn't life-threatening. It was painful and very inconvenient; but relatively trivial - which was just as well. Taken on balance, across these two blog posts, North London's NHS appears to have been in a managerial 'car crash', kept going primarily by its staff's dedication, goodwill and life-support. It's not clear exactly who's taking appropriate action to resolve that situation, though; and various faces around Enfield's health-care bed-side don't look too optimistic about the potential future. That is despite all the positive PR 'spin' emanating from the offices of the many guilty parties.

This isn't only a London problem, though, of course; and I'm not planning on leaving town just yet, based on these experiences. Us Londoners are sticking it out; just like an earlier Nazi Blitz that caused massive devastation. Wearing their proverbial tin hats and waiting for the all-clear, which will signify that their Health Service is being fully funded again - and re-nationalised. Let's talk again here very soon - hopefully on sunnier matters. Now, where are those ladders of mine? ...

Your Addicted London Buddy,

Max ("F-H-W")

Footnotes:

* "Doctor in the House" (1954) - a British comedy film based on the novel by Richard Gordon.

** "What goes on four feet in the morning, two feet at noon, and three feet in the evening?" - a common rendition of Sophocles' version of The Riddle of the Sphinx. I certainly won't be going anywhere on two feet again, any time soon.

*** From "Ali Baba and the Forty Thieves"; a story included in many versions of "The One Thousand and One Nights".

Part 5(A): In Sickness & In Health; Until Death Us Do Part

London’s NHS: A Personal Experience - Max gets uncharacteristically verbose on a hot topic, in the run-up to the UK General Election

I recently got up close & personal with the current state of the National Health Service. Something most of us would normally prefer not to have to do. At least it provided an excuse for me to look at another aspect of London life, for you.

A rogue set of step ladders derailed me - and all my best-laid plans – by giving an unexpected, but very passable, impression of a bucking bronco, whilst I was about 4 feet up in the air, treating a garden fence. The result? “A non-displaced (pretty much the only 'good' piece of news) spiral fracture to the neck of the right foot’s 5th metatarsal”. No weight-bearing for 4-6 weeks. Brilliant! I would just have to face up to the consequences; like a man.

Since 9th December 2013, those consequences have become more complicated than previously. That's the date, etched in local infamy, when my local hospital's 24-hour A&E department was closed, to be replaced by a 12-hour Urgent Care unit. Even basic maths suggests it's only going to be half as good. The background to that change involves Tory politics, deceit, bullying (or am I just repeating myself?) and more besides. From 2004, the local constituency's prospective Conservative parliamentary candidate, Nick De Bois, led the “Hands Off Our Hospital” campaign, against proposed Blair-Brown Labour changes to services at Chase Farm Hospital. Under those proposals, our local hospital would be decimated, in order to fund the provision of better services at the two nearest other major hospital sites: Barnet and North Middlesex. The proposed cuts were a key local issue at the 2010 general election, and a contributing factor to why 'White-Knight' De Bois won the local seat, based upon his opposition. He even brought David Cameron along; who made a personal pledge to keep our A&E open. Hooray! Of course, we've all found out since then how little a personal David Cameron promise is actually worth. After their election victory, all the proposed, swingeing service cuts were then implemented, anyway - by the Tories. Was anybody really surprised? Not only was A&E axed; but so was the Maternity unit and other services. Enfield's pregnant women apparently enjoy spending an extra half hour stuck in North London's snarled-up traffic, to go several miles further away from their homes, friends and families. [Chase Farm Hospital, incidentally, isn't famous for very much; but its A&E did help save many lives after the carnage of the Potters Bar train crash - and its maternity services did give us Amy Jade Winehouse, back in September, 1983.]

The stated intention of these deceitfully-implemented cuts was “to maximise clinical effectiveness, given limited human and financial resources”. That's right: to reduce services, so as to improve them - and no, we locals weren't convinced by that argument, either. The cuts were also predicated on substantial incremental investment in local community health provision; which, of course, never materialised. One could go on at length on the subject; there's the astonishing story, for instance, of David Burrowes, Mr. De Bois’s Tory MP colleague, from next-door constituency, Enfield South. Burrowes hit the local headlines when he had the misfortune of spending many hours on a trolley, in a corridor, at the supposedly vastly-improved North Middlesex A&E, without pain-killers, whilst crippled with a bout of appendicitis. That A&E unit has since "been threatened with closure on safety grounds … the first time in the NHS’s history, amid fears that its 500 patients a day are at “serious risk” of suffering harm ... what one local MP described as 'a catalogue of failings'.” I think I can guess which “local MP”. And this, apparently, was the improved level of care for which my own local A&E department had been undemocratically and dishonestly sacrificed?(https://www.theguardian.com/society/2016/jun/14/north-middlesex-hospital-ae-faces-closure-on-safety-grounds). 

Local protests ensured the quality of local services were maintained - NOT!

In addition to such structural turmoil and failure, the NHS has found itself increasingly privatising its services out to the for-profit/corporate greed sector; and, of course, has recently been caught out in a massive, ransom-ware-driven IT mismanagement scandal. It was against THIS backdrop that I picked myself up, dusted myself off and started out for my first ever visit to Chase Farm’s "Urgent Care" (sic!) unit; limping along with aid of an old hiker’s stick. Having had the Lady Bracknell-esque "misfortune"* of breaking a metatarsal in my other foot four years earlier, almost to the day, I had a fairly good idea of the prognosis awaiting me, any way.

After about an hour of very uncomfortable waiting, I finally saw a nurse - for about 60 seconds. Though not before I’d also walked several hundred yards on my broken foot, to the most distant possible consultation room; through a veritable warren of doors and corridors. At one point, said nurse retraced their footsteps to check where the heck I had got to – and gave me ‘the eyebrow’. Clearly I wasn’t sprinting along fast enough behind them, on my broken foot. Those 60 seconds of nurse consultation were, you'll already have guessed, enough to confirm that an X-ray was required. After a further 30 minutes or so waiting for the radiography technician to turn up, a few minutes of X-raying was also enough to confirm the presence of a fracture. To break a second metatarsal in four years begins to "look like carelessness"*. Finally, after a brief additional wait, a few minutes in the plaster room were sufficient to equip me with a pair of crutches, a padded boot and a leaflet explaining the new “virtual fracture clinic” procedure; and I was out just in time for staff to start closing up the unit behind me. So, that was roughly two hours in Urgent Care for just a few minutes of contact time; which felt neither very Urgent, nor very Caring. And while I realise one can easily wait far longer than this to be seen in a 'proper' A&E department, in the absence of any emergency ambulance arrivals, there's a very strict (and very slow) take-your-turn system in operation in 'Urgent Care'. To the 'layman', it's very clear that something is not at all right in the processes that manage and dictate our interaction with our NHS; the principles of which most of us support heartily - and for which we have all paid royally. Yes, something appears to have gone very wrong indeed.

That Tory Manifesto Pledge, in Full

I reviewed the leaflet I'd been given. Apparently, if 'virtual' fracture experts decided circumstances required it, I would have to get myself along to the North Middlesex (errrm, no thanks! - see above) or Barnet Hospital Fracture Clinic, "within 3-5 days". Oh yes; that’s right. Did I not mention this? Along with our A&E service, Enfield has also, rather carelessly, lost its Fracture Clinic facility. A schoolboy error, surely - and one with obvious transport and access implications!

To Be Continued ...

Let's talk about this again here soon.

Your Addicted London Buddy,

Max ("F-H-W")

Footnotes:

* from "The Importance of Being Earnest, A Trivial Comedy for Serious People" by Oscar Wilde. First performed 14th February, 1895 - St. Valentine's Day!