An NHS experience today.....

Brodiej · July 2011

My girlf found something and had some pain so went to see her GP who referred her to Whittington for tests etc. Bizarrely they do this via fax machine! Yes, that technology which died around 5 years ago! Anyway, she was told to wait for a call to confirm an appointment which never came. After 3-4 weeks of calling and each respective establishment saying "we sent it" and "we didn't receive it" she finally got the appointment through for today....a good month after the initial referral. When we arrived, we were told it'd be an hour wait even with a pre-booked appointment, but were surprised when the call came after 25 mins to see someone. Having seen the specialist, it was off to the imaging department for tests and results...more waiting. We came out at 2.47....which even with all the waiting, i thought was pretty good going. Its annoying at the time, but less than 3 hours from seeing a specialist to getting results is pretty good. Thank you NHS. A few questions comments in general though.... 1. Why do patients details who have moved from another trust (by moving home) never get passed on to the new one. All the history is lost. Its so important but its not done. I have more history on my nectar card. 2. Why on earth are they still using fax machines to talk to each other (GP to trust)? I couldn't believe the shenanigans that was caused by it. There really is no justification.....it even costs more! What would the result be if something could have been caught within 3-4 weeks that wasn't? 3. The NHS appears to fly by the seat of its pants. People who do what they do (doctors / nurses) do a great job when the patients finally turn up in front of them. They appear to be let down by the managers and support functions that go round the houses to make it all happen. As an observer, it just seemed so disorganised and crazy....is it really? or is it just a world that can only ever appear that way to an onlooker. Its not like anyone elses place of work is it. We had a good experience in the end, but i had an overwhelming feeling that it was a complete lottery...and we had a good outcome luckily, i'm sure others haven't. Any other experiences from anyone?

miss annie · July 2011

I've had only positive experiences with the NHS, although admittedly I only go to the doctors about once every two years if that and have been admitted to hospital (UCH) once. On that occasion it was two weeks from the diagnosis at A&E to the operation which I thought was pretty impressive. My doctor - Moneeb at the Hornsey Rise Practice - is splendid too.

krappyrubsnif · July 2011

If you are interested, I can give you a very recent and graphic comparison between the 'care' provided by the Italian health service and the NHS. I can absolutely assure you that the NHS wins hands down. That was partly at Whittington.

Brodiej · July 2011

@krappyrubsnif....absolutely, tell me more. Touch wood i've never really had to use the NHS so today was my first opportunity to form opinions (and even then, it wasn't me using it!). I found it fascinating, although a little weird too. I'm glad i came away with a pretty positive viewpoint.

krappyrubsnif · July 2011

Brodiej, it's too big a subject to go into here in detail. But two points stand out for me: if you're admitted, I believe the nursing care is simply fantastic in the NHS - well trained nurses who treat you with professionalism, compassion, respect, and privacy.

Secondly, I also have the impression that in the NHS they really do try to work as a team and do joined-up care: the doctors, the nurses, the physios, the occupational therapists, all work together and know what ought to be happening. When it works, it's fantastic and they can have you in and out of there like greased lightning.

Of course it doesn't always work, sometimes they lose notes, make mistakes, forget appointments.......and if you're old and vulnerable it can be dire. But on the whole, the NHS is fantastic.

Ali · July 2011

I have also noticed a very poor use of technology and quite often not so great locums at the GP level. The whole idea of getting GPs to control the budgets through how they commission to “make it better” for patients seems bit crazy to me. Although I guess the real idea is to pick the better GP Practices to lead the consortia and either drag up the not so good ones or close them down. My experience of the NHS is generally very positive especially at the hospital end although they are absolutely hopeless at keeping to appointment times and take far too long to confirm the next appointment etc when there is no reason ( as far as I can see although there must be some sort of prioritisation system going on in the background to manage the scare resources they have) ) why it can’t be done on the spot.

Miro · July 2011

Funnily enough this is something I worked on in a previous job...

The movement of records between trusts and the online booking of appointments, etc. were two key parts of the last governments big NHS IT Programme called variously Connecting for Health or the National Programme for IT.

It was huge and complex and incredibly expensive to do right (currently each trust has its own IT setup, often several setups to do the same job). It's also, as far as I'm aware, been cut back to the bone in recent "efficiency" drives. Big IT projects are an easy target.

The specific service you're looking for for appointment booking is called ChooseAndBook (http://www.chooseandbook.nhs.uk/). It's available (afaik) to all trusts and GPs to use, but whether or not they opt to use it is another matter - something to bring up with your GP perhaps? They have a lot of freedom in these matters, and most are simply not that interested in technology (or the Hospital may not support it).

With regard to electronic patient records, check out http://www.nhscarerecords.nhs.uk/ which is this initiative. In theory it does exactly what you suggest - and also makes your records available to you on demand. I'm not sure about how successful this has been though.

Hope that helps!

miro

Ali · July 2011

I guess with each trust having it’s own system must make it very expensive when they try to merge or reorganise them. I guess it is easier for the GPs not to move forward very quickly as there is no pressure for them to do so fro m the government, they do also have a pretty strong closed shop union and always need to be bought off by the government with oodles of cash.

rainbow_carnage · July 2011

Doctors use fax machines because you're not allowed to e-mail patient details. I work on the research side. We're not even supposed to use initials when referring to patients over e-mail.

I've had largely positive experiences with the NHS, but it very much depends on who is treating you. A few years ago, I went to UCH for a chest x-ray. The technician asked me where I lived. I said Finsbury Park. He said that there's a large Algerian population in the area, which put me at greater risk of TB. He had a consultant look at the x-ray right then and there to make sure I was OK. I was in and out with a diagnosis in 20 minutes.

In contrast, last summer I had pneumonia. The same hospital lost the x-ray, so it wasn't properly diagnosed for four weeks.

Ali · July 2011

Seems like someone in the South West has written a 13 page policy document on sending medical faxes. <https://www.igt.connectingforhealth.nhs.uk/KnowledgeBase/KB\Devon_sample fax policy.pdf> I wonder how long it took and how many reviews it went through and how many times something like this has been written in other Health Authorities ? Having quick read it just re enforces that GPs should be forced to use the Health Computer system and the secure network that will surround it. I would think the politicians haven’t got a cats chance of getting any swift change in the NHS. It is still generally very good at the Hospital end and that is down to the very good motivated people that deliver the service. I hope the government doesn’t screw that up because of its ideology around this . I think the comments on here are a bit of pat on the back for Blair/Brown etc.

Brodiej · July 2011

£13 billion on a computer system that never even made it to roll-out is not a pat on the back.

sincers · July 2011

yeah, ditto, I'm struggling with that one. The banks seem to manage keeping (for the most part) very delicate data very secure. I'm not sure the value in accessing my flu jabs and MRI scans and what the big risk is compared with financial data. Sorry to go against the grain with the reforms, but there is no incentive for GPs to change the system. If anything they are making the NHS inefficient and dangerous. Look at the system know as the Quality and Outcomes Framework, which for example, hugely incentivizes GPS to prescribe statins to bloody everyone and then explain to my Grandad why he now can't lift his arms above his head because of the pain and weakness caused.

Ali · July 2011

Apparently is was the 63rd Birthday for the NHS yesterday. < http://www.dh.gov.uk/en/Aboutus/Features/DH_128062>; Click through to see the message form Ozzie Osborne Don’t believe everything that is in the Telegraph The systems update seem to be on still going on so I doubt they have really lost £13B http://www.connectingforhealth.nhs.uk/ My comments weren’t about the lack of capability in the NHS to run a project but more about providing enough cash to the NHS to let people do their jobs properly. It has changed (at least locally) beyond all belief over the last ten years because it is resourced properly. It won't stay that way

Ali · July 2011

The evidence is starting to appear: <http://www.bbc.co.uk/news/health-14034835>;

Mirandola · July 2011

@sincers, It's not about flu jabs. Imagine having HIV, or a history of mental illness, or records showing that you had been a victim of domestic violence, or were seeking fertility treatment, or had had an abortion. And then imagine them falling into the wrong hands.

Ali · July 2011

But a fax must be quite in secure and so is the post

sincers · July 2011

I know other ailments are available and I understand the sensitivities around that kind of data, but I don't see that as a reason not to implements an intelligent & efficient IT system to manage it. What's in the way are ancient are GPs and NHS practices compounded by the sheer scale of the task.

miss annie · July 2011

Not easy to hack a fax machine and in my experience they check that the person that should be picking up the fax is waiting at the other end as they send it through.

Mirandola · July 2011

@sincers. It's not a reason not to, but it does make it difficult.

Ali · July 2011

Is it not that the type of appointment is decided by the GP, then he goes into the system for that consultant and just books it straight in front of you when your there, if is something that needs professional triage at the hospital it just goes into that persons work queue. All transactions are logged by which user made them. Ie full audit trail For the records etc there is only one record which is accessible to both ends we don’t have multiple records. If they are “owned” by the GP he just allows access to the records to the triage named user or consultant for the purposes of the referral. I suspect that the designers of the systems have been forced into trying replicate the current Spanish customs of the NHS epically at the GP end and they are in effect private businesses and it’s not in their contracts ! I suspect Faxes in reality are really quite insecure as there are bound to be a complete lack on controls at the far end and certainly no audit trail of who has seen them

Brodiej · July 2011

Every time i've visited my GP, they've left the notes of their previous patients on their desk for anyone to see. If everyones so cautious about confidentiality and security, they could start by sticking the paperwork back in a folder.

becky · July 2011

UCH regularly use email with me so they seem to have got over any security issues. I can correspond with a specialist nurse about visits and test results. If I'm at the GP and need some extra information to help make a decision, UCH will happily send it over by email after a quick phone call. I guess others in the NHS might have a problem with it, but I suspect the persistence of fax is more to do with an inability to make wholesale technological changes in procedures, rather than any belief that it is impossible to make simple electronic processes secure.

Siolae · July 2011

My previous GP surgery accepted faxed repeat prescription requests but not emailed. My current surgery only accepts hand delivered prescription requests which is bloody inconvenient. In terms of confidentiality however I have a minor cautionary tale. Several years ago I worked in social services at a time when a new database was being set up as a means of ensuring all the various agencies which become involved with clients could share information. Seemed sensible enough when you think of the number of people who fall through the cracks in the system. Whilst being trained to use this system I stuck in my own details (name and date of birth) and, to my astonishment, up popped some of my medical records! At no point had I been asked / warned that my records were going to be entered on this system, nor was there any need for them to be there. However they were easily accessible to the several thousand various people who had access to this system.

sincers · July 2011

...and then what happenend?

andy · July 2011

This is how wikileaks happened. Massive consolidation of databases to encourage sharing among agencies meant that reasonably junior analysts could see all sorts of stuff for the first time. One of them put it on some cd's and voila.

Ian · July 2011

I lost energy with the number of meetings I was in in Government where the "big idea" was to "put everything in one place" so we could "share data across the whole of Government". This was "because that's what the public want". I always used to be the one saying "no they don't, that's what we want". That said, happy with everyone to know my medical records, might come in handy if one of you comes over me in the street after a major accident as you will know what blood type I am etc. But that's because there is nothing in my records I'm bothered about.

Ali · July 2011

Been looking into the NHS Choices web site. Lots of good stuff about your rights that you will never get told at the GP Have look at <http://www.nhs.uk/choiceintheNHS/Yourchoices/hospitalchoice/Pages/Choosingahospital.aspx>; If you are referred say to the Whit and your unhappy about the wait go here <http://www.nhs.uk/ServiceDirectories/Pages/ServiceSearch.aspx?ServiceType=Hospital>; For what ever the condition is you can find out what the average wait is at each hospital and the numbers are based on info the chose and book system and was very accurate about wait times at the Whit. So with the right to choose you can speed things up if your worried about the early. At the 157 Practice I had a recent referral to the Whit which I tried to change using Choose and Book. The problem is that you need a password which is supposed to be sent to you in the referral letter from the surgery but the problem is that 157 Practice don’t send out the referral letter with the password as they say it is confusing. When I eventually got a copy it was quite clear what was going on. I got confused because the first letter I got was the referral saying you need the password. No wonder simple booking systems like this don’t work for the patent if the clowns at the GP practice don’t use the process properly! I really don’t understand why the Coalition want to give all the money to the GPs as I am yet to come across a practice who are any good as the basics in a consistent manner.

julieshrive · July 2011

It doesn't work because it is controlled by PCT who are rationing ignoring evidence of impending heart problems . The GPs have the passwords who do as they are told via their contracts . Apparently they don't have to follow their medical oaths so my GP 5 years ago said when questioned about this.That was before the cardiac arrestnever having seen a cardiologist. The Choices website is No choice they use postcodes which PCTs don't use so the information is invalid.Nobody wants to know. And if you live on a boundary like most in Stroud Green ????!!God help us.

Ali · July 2011

I found it was very accurate for the Whit from waht I already knew when I put in N4 and it shows all the Hospitals. If you not geeting a choice then surelay they are breaking the law. Are the any GPS out there who can explain? The pasword is not the GPs but yours the patient

Cookie · August 2011

Whilst I do not want not want to put you guys down with negative NHS experiences, and yes they do happen. Can I tell you my day today as a nurse in an NHS hospital? I had not even started my shift before a patient shouted abuse at me. The next patient, physically assaulted me by bending my thumb backwards which hurt like hell, when I tried to deter him from destroying a piece of hospital equipment, which he did as it happens.He then threatened to ' punch me in the fucking face'. Thank's to my colleagues, he did not get that far.
I have always loved my job, but are we nurses expected to accept the violence now?

Brodiej · August 2011

Hi Cookie. Absolutely not. If anything, assault should be sentenced twofold (doubled prison time / doubled fines) if taken out on hospital staff. You are there to help them, and they choose to fight you. Perhaps even blacklist people from future treatment for a period. A growing number of people in society are slowly but surely becoming disgusting and unacceptable. Time for some hardline tactics i think. I'd refuse to treat them whatever the circumstances.

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