Sunday, 26 January 2014

OPINION - What should we expect as NHS patients?

Starting with a blank piece of paper I put down the most important things I require and, where applicable, what I consider to be acceptable timescales. I concentrated on my needs as a hospital outpatient with a chronic illness/multiple chronic conditions because this is a situation of which I have recent, first hand knowledge. (I've excluded GP's, as I very rarely see them, and I'm hoping that hospital stays are few and far between).

Before reading the list below you might like to have a go yourself and then see where we agree or what additional items you've come up with. I've ended up with 12 key items. Here they are, in no particular order :
    1. Easy to book appointments/tests/procedures and carried out within a reasonable or appropriate time frame (4 weeks)
    2. Consultants that make you feel welcome and are prepared to spend sufficient time to answer your questions
    3. Consultants who communicate at the appropriate level of detail. (Communication includes the ability to listen and "hear" what is being said)
    4. Consultants who take joint decisions with the patient. (You are the expert in YOUR health, they are the experts in their chosen fields and provide the knowledge to inform decisions)
    5. Good co-ordination between multiple consultants if more than one condition is being managed and a named lead consultant
    6. Ability to make suggestions to / ask questions of / get responses from consultants by email
    7. Follow-up letters sent out promptly
    8. Test results communicated promptly (or appointments organised to go through results as soon as they are available)
    9. Appointments that start on time or if they are delayed good communication as to why they are running late and the likely delay
    10. Provision of a disease/condition specific help line with prompt response time (within 24 hours)
    11. Routine appointments over the 'phone or by Skype (to save on hospital trips and consultant's time)
    12. Electronic, transferable, whole life health records with electronic patient access
      11) and 12) are more long term aims and probably the remit of the NHS as a whole rather than an individual hospital. If there are any blindingly obvious omissions please let me know. You can tweet me at @crohnoid
      My original list (now slightly modified)
      ...and how does my treatment measure up?
      St.Thomas' new Outpatients' Department
      Having established the list (and the two aspirations) I thought I'd see how my current treatment measures up against each of them.

      1) Appointments are easy to book either on the 'phone or in person. Not all departments are consistent in their approach to routine, six monthly appointments. Some give you the appointment letter there and then; others won't book further than six weeks ahead so I always make a note in my calendar of when I need to make sure I'm on the six week radar. So far (in three years) I haven't had any problems. The longest wait of all was getting a slot to see the Dietician - but I was warned that the demand on that Department is particularly heavy and, for me, it's not exactly a matter of life and death.

      2), 3) and 4) The communication with the various consultants has always been excellent. I've never felt I'm being hurried out the door. We always have a full and frank discussion at a level of detail I can cope with.

      5) Co-ordination works well. Letters and emails are always copied between the three main consultants and there is a MDM (Multi Disciplinary Meeting) were patients with multiple conditions are discussed.

      6) I've always received prompt responses to my emails. If I have a question that I think may have implications across disciplines then I copy it accordingly.

      7) I did have one particular issue with follow-up letters from one particular department but a simple email to the Head of Department sorted that out. It's all resolved now and we're back on track.

      8) OK so far.

      9) Mostly pretty good. My last Haematology appointment started 15 minutes early! There have been occasions where the clinics are running late but nobody kept the patient patients informed. The new Outpatients Dept. at St.Thomas' has large screens all around the waiting area and these carry messages if any clinics are running more than 30 minutes late.

      10) I've only had reason to contact the IBD and Stoma helplines. Both have replied very quickly. When I had a problem with my stoma I was able to go and see one of the nurses that lunchtime.

      11) This is more an aspiration than something I think will happen in the very near future. I don't know at what level the decision can be taken to implement it - individual consultant; Department; Hospital Trust; or from the NHS on high.

      12) I thought this was going to happen a few years back but the plan faltered rather badly (NHSIT Project). The system works within the Guys/St.Thomas' (GSTT) itself but they do not have access to my previous records. I've taken it upon myself to collate this information but don't know if there is any opportunity for getting the key records added to my GSTT file. (Something to ask at my next appointment)


      I'm very impressed with the treatment I receive from the NHS at GSTT. If I had to give them a score, judged on the first ten items, it would be 9 out of 10. I have had the odd hiccup along the way but by taking an active role in managing my treatment they have quickly been sorted out and never caused a problem.