The two faces of the NHS - IT's contribution?
Posted by Doug Walters on 3rd January 2014
Just before Christmas, I had an operation to remove my epididymis; this was the culmination of a TWO YEAR journey in terms of this particular medical problem, during which I experienced the best and worst of the National Health System, which was particularly interesting, since I was a patient at Furness General Hospital, one of the NHS Trusts central to the recent national news headlines about the state of the NHS. My conclusion is that there are some fantastic people working in the NHS, and they tell me that there are some fantastic systems supporting surgical operations – but that there are some real issues in terms of systems which support the "front-of-house" which play a significant part in dragging the reputation of this great British institution through the mud. The lesson would seem to be that, as always, the proportion of attention to each element of the eternal triangle - cost, functionality and quality needs to be appropriate to the purpose of the system. and that doesn't seem to be the case here
A few years ago, I started to need to go to the toilet more frequently, and I had some tenderness of my testicles. Over time, both symptoms got worse, and given the prominence given to testicular cancer in men, I was very concerned; so much so that just over two years ago the situation became sufficiently acute to prompt my GP to refer me to a consultant at Furness General Hospital (FGH.)

From initial consultation to surgical procedure took two years during which time I experienced a litany of examples of professional indifference and procedural incompetence:
  • I saw the same consultant on just 3 occasions in 2 years. On all 3 occasions he was leaning back in his chair behind his desk, almost horizontal and somnolent. He gazed at my notes and never looked at my face (let alone in the eye) at any time during the 3 consultations. His attitude was supercilious and indifferent to me - he certainly had no concept of me as a patient.

  • During the first consultation he prescribed medication to control the pain and incontinence and referred me for a scan. I waited patiently but in vain for an appointment; eventually I phoned the hospital administration, and after being passed from one department to another (my call wasn’t even re-directed; I was given new phone number to call on each occasion) I was told that my case had been “lost in the system.”

  • Although assured by the radiologist that she couldn't see anything serious I still had some lingering concerns about the possibility of testicular cancer and looked forward to the next consultation to get the diagnosis. After waiting for a few months, my wife nagged me into chasing the next appointment (I must admit that I was nervously “burying my head in the sand” at this point) When I got to the bottom of the delay, it transpired that the consultant had to go back to his home country for a family crisis (totally understandable) and my file was nowhere to be found. A few days later I received a call to say that it had been found in the papers on his desk and an appointment would be made as soon as he returned.

  • When I did see the consultant again, he suggested surgery as the only alternative to my worsening condition. I tried to ask for some more information about the procedure, but got "fobbed-off" with the catch-all "there is always an element of risk and no guarantee with surgery" so I agreed, albeit with some reservations. A few weeks later I received an appointment for a pre-op assessment, which went ahead as planned and which I passed. Then things went quiet again!!!

    After a few months, my wife started to nag again, so I made an appointment with my GP and complained. At this point, I firmly believed that the scandals in the national news were only the tip of the iceberg. I asked whether I could be referred to another hospital, but was assured by my GP that she would ensure that the hospital sorted things quickly, and that the surgical competence significantly outshone the administrative and consultation capabilities demonstrated thus far.

    I agreed to stick with FGH, and sure enough from this point onwards, my experience was in complete contrast. The next day a fresh pre-op was booked, and an operation scheduled for a couple of weeks later. Again the nurses were friendly, efficient and professional.

    Once I was on the ward and in my pyjamas, I was visited by the surgeon, who was not the same as the consultant I had seen up to that point. He very thoroughly went through the options open to me: some of which were only available privately (and, although I told him that I could afford private treatment, he was careful to tell me that he didn’t do private medicine.) He explained that there was no guarantee of success, that there were other surgical procedures which could be considered, and he outlined the pros and cons of each, all in very simple, straightforward language. He also told me that the procedure I was scheduled to undergo was not very common, he had only performed it a few times, but that each occasion had been successful. His honesty, direct and quietly confident manner was reassuring and gave me a feeling of confidence. I elected to proceed.

    When I arrived in theatre, I started talking to the anaesthetist, and it was clear that he is a very experienced consultant, having worked in a number of countries. He asked what I did for a living, and on hearing that I worked in IT, he told me that the systems used in theatre are the best he has experienced, and that the general administration system (it's called Lorenzo) is the worst – clunky, bewildering for users, slow performance and full of bugs.

    At this point the anaesthetic kicked in, and the next thing I knew, I was back on the ward and recovering. The surgeon visited before I was discharged to de-brief me about what he considered to be a successful operation. One month later and I am extremely pleased with the results - still a little bit sore but considerably less so than before the operation, and I certainly find that I can sleep through the night without visiting the toilet - my wife is very happy that her sleep is less disturbed!

    What conclusion do I draw from this? I don’t know enough about the NHS to prescribe a solution for the poor administrative processes – but I am fairly confident that the theatre support systems will have been developed with the consideration for quality appropriate to systems upon which life-and-death operations depend. On the other hand, as I know only too well from my own work in the commercial world, there is a trend to eschew quality in favour of cost-reduction and speed-to-market when developing systems for other than defence and surgery-supporting systems. While I am in favour of this sentiment in the industries in which I work (services) I also firmly believe that quality must still be appropriate to the purpose. I'd suggest that welfare is a tad more important than commercial profit and just as importantly, front-of-office systems such as booking for an appointment or referral, are extremely important in the end-to-end welfare experience.

    As a result of a lack of quality in the front-of-house systems, I suffered (both physically and emotionally) for far longer than should have been the case. I don't pretend that my malady was a serious case; but what if it had been?

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