Sorry to have been quiet, folks.
Last week late on Tuesday night I found myself having a sprain-like pain in my shoulder, which then spread and spread to the point where it was clear even to a crusty old doctor-avoider like myself that something was Not Right.
So we called the emergency number – and watched the modern NHS unfolding.
First an advance NHS First Response man arrived, within five or so minutes of my first calling. He lived in the nearby village but nonetheless was here at what seemed like an amazing speed and started taking key medical information and making blood pressure and other immediate tests.
A few minutes later two people from the excellent Southern Central Ambulance Service came along, well on track to meet their government targets of arriving within 19 minutes. They took more tests, using handy kit to send the results directly from their machines to the main hosital in Oxford – this allowed the hosital to be ready for me when I arrived.
Thus, off I went in the ambulance into the lonely night.
On arrival at the hospital at 0100 or so on Wednesday morning I passed a lugubrious sleepless night undergoing a series of blood and other tests which together suggested that I was not having a heart attack. To break the tedium between tests (and to put myself in the right frame of mind for plenty of gore) I watched Kill Bill Vol 2 on my iPad:
The next day dragged into fitful sleep and more tests, culminating in a CAT scan. This showed the problem: a lung blood clot and some added pneumonia for luck.
Eeek. More pills/jabs.
Sorted! I slept all night and woke up feeling transformed, pain virtually gone.
The consultant (who happened to be Polish and was mucho impressed to hear me attempting to talk in Polish) promptly proclaimed me well enough to go home, so home I went.
I have been back to the hospital each day since Thursday for another injection and blood test, and now move on to a long stay on daily doses of warfarin to help keep my blood thin and beautiful.
It seems likely that I fell prey to an errant blood clot caused by inactivity on our long flight back from Orlando a few weeks back. Message to world: buy those naff-looking ‘compression socks’ for long flights! They work by squeezing your outer foot so that more blood goes into the deeper veins in your foot and keeps things moving along there, to reduce clotting risk.
In other words, this was one of these happy (enough) situations where you’re getting v sick quite fast, but likewise can get unsick just as fast once the problem is identified and treated with the wonderful products invented for us by Big Pharma.
First and foremost, I got fast and effective treatment. No forms to fill in or bills to pay. Done. My hearty thanks to all concerned.
Second, prompted by this bracing experience I have been mulling over the problems of ‘reforming the NHS’, looking at the way it works from the viewpoint of an ill person steeped in civil service management.
In one banal way of looking at it, the NHS is a huge quasi-shop. It has ‘customers’ who need ‘products’, so the key issue must be getting those products to the right customers with as few transaction costs as possible, right? Mainly an information management and delivery-process problem, albeit a damn big one?
The analogy promptly breaks down. In the NHS’s case, the customers do not know what products they want, or the quantities they need. So as well as the formidable problem of having to hand all sorts of different products, the NHS mega-shop needs to run all sorts of checks to find out precisely what each customer needs and be incredibly careful in delivering just the right dose to the right customer at the right time.
It doesn’t matter if you get a few grams more or less rice or cornflakes in your shopping bag – it may matter a lot if your drug dose is out by even a small proportion, or if they give Mr Jones’s drugs to the wrong Mr Jones. So the need for precision and checking adds exponentially to transaction costs in a medical context.
I asked how they managed my records. It turns out that when I am admitted into hospital a paper file is opened on my case which then follows me around the hospital, growing at each stage of the treatment as this and that is recorded by those responsible. But as well as that there is an electronic file on computers, containing results of blood and other tests as monitored by the machines concerned.
This sounds and probably is old-fashioned and ‘inefficient’. It is clear how ‘information decay’ caused eg by our deadly enemy the EU Working Time Directive can set in.
However, given that what we are dealing with is so complicated, and given that we can not stop the whole system for even a minute to create space in which to reorganise things, it is not easy to see how to move from one way of doing things to another. The more so if we want to set up an NHS-wide system (as opposed to, say, computerising everything within one hospital in a way which may or may not be comnpatible with how other hospitals/GPs do it).
I could imagine a sci-fi set-up where each patient entering hospital has a small computer chip implanted which then reads and transmits data from/to neighbouring machines. Each treatment step would then be recorded electronically on the chip, thereby creating a single source of patient record linked to central computers accessible by one’s GP for data back-up. What could go wrong?
No doubt plenty. Hence thrashing around at unbelievable expense for NHS-wide solutions to data management which seem to end in one noisy calamity after another:
But the National Audit Office (NAO) warns today (WED) that the £2.3 billion spent so far on computerising detailed care records “does not represent value for money”.
There are also “no grounds for confidence” that the situation will be any different with the remaining £4.7 billion, it concludes…
I was also struck, watching the wards, by the sheer volume of stuff which needs to be moved around a large hospital every day: bedding, injection needles, supplies of drugs, paper towels, meals, water, revolting cardboard bed-pans, tubes, files, cotton-wool, sterilising fluids, and goodness knows what else. Just as an army marches on its stomach, the NHS depends on its extended supply-lines, most of which are largely invisible to the patients themselves.
Add to all that is the fact that it is not a National Health Service but an International Health Service, employing people from all across the planet. Every conceivable diversity target is ticked and ticked again.
Myriad issues arise from that fact as to expectations of professionism and attitudes to work and discipline. Keeping standards up in the ‘caring’ non-discriminatory, non-judgemental culture where it is very difficult to sanction under-performers (lest some or other key function starts to fray in the protracted process) must be a horrendous job.
Yes, more competition can and will surely help at different parts of the system. Ruling out change for ideological reasons is ridiculous. Yes, there must be staggering waste and dysfunctionality in any system as large as this. Yes, it may be better to break down the ‘national’ health service into more manageable sizes. Or not – centralisation and de-centralisation each have pros and cons.
Yes, there is a lot more which might be done with clever IT to allow self-diagnosis and faster information-flow. Yes, we shouldn’t be where we are now: France does not have an NHS and is not obviously dropping dead.
But we are where we are now with the NHS, and moving somewhere different, better and quickly is probably not possible in theory or practice.
While all that’s rumbling on, I leave you with the wise words of Jackson Browne: