Phones and Patient Choice

Rather than bring you stories from the behind the NHS as I usually do, I thought I make a change by bringing you some stories that you may have missed this week.

Firstly, telephone numbers. Many of you may be aware that more and more NHS organisations are using non-geographic 0844 and 0845 numbers. The big issue with this numbers is the cost to use them.

Many people these days have call inclusive packages, or have to call the NHS from their mobiles. Even standard BT customers would pay hardly anything to call a local standard geographic based STD number. But the 0844/5 numbers are never included so you invariably end up paying for these numbers on top of your usual phone bill. 0844 numbers particularly attract a charging rate set by the owner, so you won't know what you are paying until you get the bill.

To top this, when ringing one of these numbers, you are usually connected to a menu system, and then placed on hold, meaning that it can many minutes before you are actually connected to a human being. I have personal experience of this. On Christmas Eve last year, I had to call my doctor surgery, and the only way I could call them was from my mobile. I was on the phone for 12 minutes, cost £1.20. Add that up over a year, and the costs can be high. And of course, when you are ill, and in no choice over having to call a doctor. Go for a test, and have to ring the number for results, then perhaps a follow up, or a repeat prescription and it just goes on adding up.

This week, the government announced that these numbers shouldn't be used for public sector services. All good and well, but they stopped short of banning them, so essentially it's business as usual for the organisations using them, and business being the operative word, as they are all making money out using these numbers. From you and I, who are already funding the services though your taxes.

The other announcement this week was that GP boundaries are to be a thing of the past. This is long overdue. The NHS barks on about patient choice all the time, but the one area that has lacked this option has always been your GP. If you have a problem with your GP, it's always been tough. This means of course that if you don't want to go to your GP for whatever reason, you're never going to the get the wonderful choices that are on offer AFTER your consultation, should you need them. Potentially this lack of choice could directly impact on your clinical care. But why shouldn't you choose where you wish to see a Primary Care Physician? For years I worked in London, and was unable to access a GP unless I took a day off work, which meant of course, I never went to the doctor. This element of choice exists in other primary care areas, I can choose a dentist, or optician where ever I like. So what's the difference?

GP's need this fundamental element of competition to ensure they keep fresh and focused and encouraged to offer new and customer driven services.

Perhaps when this change becomes effective, you might consider changing to a GP surgery that has a normal telephone number!

Lies, lies, lies and consultants...

I was attending a meeting this week for those hospitals who use the same Patient Administration System.

The system suppliers were there, and at the start of the meeting were asking for suggestions to go into the next maintenance release. This in itself is nothing odd.

However, to put this into context, you need to know that the product we are using has been deemed 'end-of-life', and as we're are looking to take a brand new, entirely different system in the coming months (OK, years... OK decades...) we would only be getting minor, bug fix releases. So as a consequence we were quite pleased that they were considering updating the existing product, and were coming up with ideas thick and fast.



Anyway the meeting moved on, and some hours later a member of the group asked if it would be possible to have a minor enhancement. What followed was staggering. The supplier stated that they would have to cost this enhancement. You might think that this is not unusual. You might even have thought that this could be included in the maintenance release that was being discussed earlier.



No, what was staggering was that firstly one hospital already had the enhancement discussed so why would it have to be costed and paid for when the work had already been done, and secondly, the supplier chose this moment to tell the group that the previously discussed maintenance release may not happen!

Left hand, right hand anyone?

About 8 months ago, we lost hot water in our office kitchen. This was because our water heater was condemned, as it had been leaking, and causing our friends in Health and Safety to write letters home to their mothers. Some time elapsed, during which, we naively assumed our water heater would be replaced. Sadly, this was not to be the case. There was some debate, it would seem, as to who exactly was going to foot the bill for the repair. Whilst all the big wigs discussed the minutia of detail regarding budgets and spreadsheets and such like, my colleagues and I still had no hot water.

About 6 weeks ago, a crisis loomed when at the height of the H1N1 virus (that's piggie 'flu in English) epidemic (sorry forgive me ignorance PAN-demic), a lady collapsed in our office with a suspected case of the aforementioned infection.

A brief discussion between myself and infection control which highlighted the need to wash our hands regularly resulted in the words "Oh, you have a problem, I'll see what I can do..."

More time elapsed. More correspondence. More cold washes. Nothing it would seem could lever the corporate might of the mighty NHS into resolving this intriguing dilemma. So whilst one part of the NHS was happy to spend money on a Zen garden, another could ill afford a water heater.

Mmmm, as if this was not frustrating enough, today was the day of the office move. Hurrah I hear you all shout. Needless to say, this brought about, it's own set of trials and tribulations. There were desks that moved and shouldn't have been. There were no live network points at the start. The removal firm insisted on moving the boxes over, before moving the desk over, so we had our files and such like, but no-where to put them!

And at the time of writing this article, no-one in my team had a working telephone, or was able to print anything. So all in all a really successful day.

This brings me back nicely to our water heater. Today of all days, they decide to turn up to replace it! On the day we move out! Thank you God. You may of course already be laughing at the irony of this. However the final humiliation of the day was when the workman admitted that he couldn't finish the job as this needed an electrician. Marvellous. So now, in the old office, we have a water heater that can't actually heat water until someone else arrives.

Is it me? Am I missing something?

Money, money, money, it's a rich man's world

Ever wondered where all your hard earned tax payers money goes? Then wonder no more dear reader, allow me to enlighten you. There's a large, and I mean really large, black hole sitting under the Department of Health in Whitehall, and all your money gets poured into there. No matter how much gets poured in, it never ever ever ever gets near the top. To illustrate this point, I discovered yesterday that one NHS Trust has spend the last 6 months recruiting 40 staff for a particular project which has just been canned, with all the fresh faced talent being given their cards. Unbelievable. It was it wasn't true it would be funny!

On a more local level, further to my last post on the trials and tribulations of moving office, I can report that the non-abundance of networking points in the new office has been equalled, or perhaps even surpassed by the arrival of the cabling company who told me that we have no capacity in our existing trunking to put all the new cables so we'll have to get some more. So what, I hear you ask. Well, aside from the extra cost, it means that the newly decorated office will have to be redecorated again to cover up all the peripheral damage that will inevitably end up being done. Life, don't talk to me about life!

First Day Back At Work

Hello all, and welcome to my new blog on life working in the NHS.

Today was my first day back at work after 2 weeks of fun and frivolity. During my brief absence 2 projects were due to go live, and we were due to move offices. Upon my return I discovered a 66% sucess rate! The 2 projects had indeed gone live; the latest release of the main hospital system, and computer printed wrist bands had both been sucessfully implemented. However, the office move had not.

This was particularly frustrating as it seemed to be held up by the IT department. Those sharp observers of you who are thinking "Hang on a cotton pickin' moment, don't you work for the IT deparment" may well be asking how can we delay ourselves in moving? Shrewd question that I had to dig to get to the bottom of. It would appear that perhaps we don't have the abundance of networking points that are deemed necessary to run a modern, forward thinking hospital IT department. There was nothing more to it. I had to survey the situation myself, and not being one to be trusted to perform such a complex task on my own, I took one of the team with me.

All was going swimmingly in my team's shiny new office as I took measurements, accounted for doors, windows, pillars and the adverse camber of the new floor until I noticed a discreapancy in the sizing on the floor plan that I was creating. I'd taken all the measurements in inches, but had written it all down in centimeters, so everything was 2.5 times smaller than it should have been! I realised that this must be the standard NHS method of measuring everything, and accounts for many anomolies discovered uniquely in this healthcare setting. Was this the foundation of waiting list calculations? Prescribing budgets? In-patient menus? Who knows. Suddenly the haze of the last 5 years became clear, and I realised that all nonsensical things in life must be measured in this way. Or perhaps my brain hadn't adjusted to being back at work yet?

I also found the project managers office had been used as a dumping ground of all the old stuff from the refurbishment, and had various assorted rubbish in it, including a desk that had been dismantled, loads of shelves, and the like. I'll let you make up your own jokes about PMs!

Anyway back to network points. It now seems that there are two schools of thought as to whether we're going to get the work done that we need by the end of the week, thus enabling a smooth transition to our new workplace next week. Those that say it will happen, and those that say it won't. My money is on... one of those two options!

On a different tack, it seems that a sister organisation of ours has it's own 'Zen' garden. I assume that if the staff sit in the garden according to strict Feng Shui principles, they will have all the necessary Yin and Yang to cure the population of all its ills. Well, Swine Flu at least... well maybe a chesty cough... oh alright then, a small boil...