The Best and Worst of the NHS in One Day

NHS_LogoI don’t know the statistics on this but I suspect that many of us don’t have dealings with the National Health Service on a regular basis. As a direct result of that lack of interaction, I’m sure that the majority of the UK population, like me, rely on what they see or read in the media. So if I were asked to summarise the general impression I get from the television, radio, newspapers and internet reports I’d be forced to conclude that it’s in a mess.

So with that pre-conceived opinion already in mind, I had reason this week to spend a whole day experiencing the NHS at first hand. That being the case I thought I’d take the opportunity, as I have a blog, to highlight the good and bad bits. As the title of this entry suggests, there were some events during the day that were decidedly not good but on balance I’d say that the NHS eventually won the day.

My one-day NHS experience began at 9.30 am when my 11 year-old son called me from school. He had mentioned that he had a pain in his testicles on the way to school that morning but I’d assessed it as likely to be the result of a playground-type injury or an accident he’d had at home bumping into something. Now the pain had apparently increased considerably and having been sent to the school office by his class teacher the staff there had advised him to ring me.

Having spoken briefly to him on the phone I decided that he needed a doctor’s appointment. I then knew I had to go through the torturous process of getting him one at our surgery. Gone are the days when you can just call-in or ring up for an appointment: Your need for an ‘urgent’ appointment now has to be vetted by the day’s duty doctor even if the patient is a child. This is done by you registering your request with the reception staff, either in person or by phone, then waiting for the aforementioned duty doctor to call you back within the hour to verify that your symptoms justify an ‘on the day’ slot. If you fail this test you have to make a routine appointment sometime during the next two weeks if there’s one left of course. The obvious conclusion to be drawn from this process is that during the following two weeks you will either get worse and thus pass the test on a second attempt or get better and cancel the non-urgent appointment you hopefully made, or die!

Now I appreciate that GPs are under pressure and they apparently all have more patients than they can cope with but with systems like this in place is it any surprise that casualties are overflowing with patients who shouldn’t be there? As it happens I did pass the doctor’s necessity test but if I hadn’t, as a worried parent, I would have taken my son straight to casualty whether the symptoms justified it or not!

So the first available appointment was at 1.20 pm. Our doctor immediately concluded that my son might have testicular torsion but wanted to speak to a paediatric consultant in order to confirm her diagnosis and if necessary to arrange the immediate treatment he needed. To her credit she spent more than 30 minutes on the phone just trying to speak to a consultant. Sitting outside her office we overheard her increasing frustration as she tried at least three hospitals, had the consultants there paged but got no response. So after a frustrating half an hour or so, she gave us a letter to take to casualty. True irony – we would have gone there earlier if we’d been refused a surgery appointment!

We were advised that St. George’s Tooting would be the best hospital to go to and we duly got there about 2.30 pm. Under 18’s were given priority for booking in and we were soon shown to the paediatric part of their A&E. I know there’s a saying that you’re getting old when the policemen start to look young but the doctor (in her defence she might have been a medical student) who made the triage decision regarding my son looked as though she should have been studying for her GCSEs. Whatever her age and qualifications, she clearly knew less about testicular torsion than our GP and didn’t place us anywhere near the top of the list as it was nearly three hours later about 5.30 pm before we saw the A&E paediatric duty doctor.

When we did finally get seen the paediatrician’s ‘bedside manner’ was excellent. He put my son at ease even though he was asking the same questions that an 11 year-old was struggling to understand why he had to answer for the third time that day! After a full examination, a consultant was called and it was decided my son needed surgery to explore the problem.

Not only were we now faced with the shock of finding out that our son needed surgery but if testicular torsion was the problem we were told that the condition can ‘kill off’ a testicle in 6-7 hours! Suddenly we were faced with the possibility that a 3.5 hour delay in getting a doctor’s appointment, an inability for our GP to speak to a consultant and a 3 hour wait in A&E might have seriously affected our son’s health.

It is only right to point out that from that moment on everything happened at a pace. By 7 pm our son was being operated on and we found out that it wasn’t testicular torsion but a problem with his hydatid of Morgagni. That had been removed and he would make a full recovery in due course. Despite being told there were no beds the hospital found one for his post-operative recovery. Once his blood pressure and heart rate had stabilised we managed to persuade the paediatric ward doctor to discharge our son around 11 pm despite the hospital’s usual policy of not releasing young patients that late in the day.

So, as I wrote at the beginning of this rather long entry, the NHS eventually ‘came out on top’. We couldn’t have asked more of our GP and once we saw a fully-trained paediatrician things moved at a pace and we can’t fault the service we got. The first logjam appears to me to be doctor’s surgeries that can’t cope with the number of patients who want to see a doctor. As a direct result of this casualties are full of patients who should really be seeing their GP and a triage process (inadequate in some cases) has necessarily been introduced. I know nobody with any influence over the NHS funding or staffing will read this but it has made me feel better pointing that out!

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