Thursday, 4 June 2009

Choice in Northernshire

Choice” is a ZaNu Labour buzz word. Before the current Party was in power there was no choice ever in healthcare if you believe the Party. They did after all found the NHS and were never responsible for the lack of "choice".

Those of us on the front line know that this is complete bull as there has always been choice if you know how to exercise it and if a NHS manager does not block it. However, under the free internal “market”, there is less “choice” as “choice” is now controlled by “Choose” and Book.

For some specialities your “choice”, as a patient, is to ring a call center. Here in the UK everyone knows that call centers are staffed by those of the highest intellectual ability. Any referral letters sent by GPs to consultants are screened by people only slightly more qualified than those in the call center and when you ring for your appointment you are told your “choice”.

Your “choice” is decided for you by what we shall term “referral screeners” who work in a new creation of the Party that never existed before called Referral Management Centers. Some of these are not even medically qualified and are complimentary therapists well versed in reading letters sent from one doctor to another the consultant and understanding them as they practise such advanced medical skills as voodoo.

Now, you may be unhappy when the highly trained and qualified call centre operative tells you that the comrade “referral screener” thinks you need physiotherapy. Your GP told you that you need to see an orthopaedic surgeon because they think you need a joint replacement. You may kick off especially as you have already had physiotherapy and this fact was in the referral letter your GP sent along with the fact that it had not worked.

Of course because of the high intellect of call centre staff and unqualified “referral screeners” who think that physio is big juju medicine you then be given another “choice” which is go and see your GP and ask for another “appointment” (to ring a call center).

NHS managers, many of whom would be unemployable in any other organisation due to their overqualified ignorance, are making “choices” for you because they are so much less able than you in order to “regulate” the “market” and keep funds for the local tractor plant in which they have a vested interest. No tractor plant, no job.

Thus under the current Party there is less choice in the NHS than there has ever been. “Choice”, according to the local commissar managers in Northernshire, is limited to “your” choice of hospital only. You cannot choose which surgeon you see as they control what appointments anyone using “Choose” and Book can see. If there are no appointments for a particular surgeon – which may be because the managers choose not to let you go to a particular hospital or surgeon - you can make a “request” for an appointment to be created for you.

This is meant to be done by the local tractor plant but usually they do nothing and bounce it back to your GP’s secretary who made the “request”.

This usually results in the patient being sent back to see the GP to request another appointment until finally patients, who want to see a doctor because they are getting worse not talk to a call center operative, eventually opt for the right or Party or their “choice”. Either that or they keep you waiting and the circle repeats itself or you go private and then ask to be transferred onto an NHS waiting list after finally seeing your choice of doctor.

This is the reality of 12 years of ZaNu Labours “choice” agenda here in Northernshire. Our medical secretaries have long since had enough of using Choose and Book as it has increased their workload no end and more people are involved in the referral process than under the old paper system when we actually did have real choice. We sent our letter direct to the person we wanted our patients to see. Not via a centrally controlled Party run computer system to be read by a non medically qualified idiot sometimes called a "consultant".

Choose and Book has been an expensive failure, created more work, offering less choice and is a disaster. Joseph Stalin would have loved it as it is being used to regulate choice on a scale he could never have dreamt of. Our political leaders love it for the same reason and hail it a success. All it is is a glorified bean counter.

Today in Northernshire as in the rest of the UK we actually do have a choice. It is called an election albeit just for local councils and the European Parliament. The creation of universal suffrage has been a long struggle in the UK and it is something that enables a degree of democracy in this country. We here at ND will be voting although many feel there is not much worth voting for. Nonetheless our politicians do not listen to us as individuals or to organizations that represent us.

However, unless the tanks appear on the streets overnight, they cannot ignore an election or do so at their peril. You have little “choice” in your healthcare but thanks to the struggles of our forebears you do still have a choice at the ballot box. It will take only a few minutes of your time but it is the only thing our leaders will listen to (unless they follow the example of other democracies like Zimbabwe).

Go on exercise real choice not NHS “choice”. It may not be a general election, which many here in the UK feel is long overdue, but it may be the start of one.

Praise be to the Party’s and its choice commissars’ success in healthcare “Choices”. Thank goodness we still have a democracy - for now- use it. It is your choice not theirs.


Prisoner of Hope said...

For a(n even more) kafkaesque descent into the wonderland of Choose and Book this is what happens when you might want to "unbook" your "choice":
(Sent to me - at the time - by a colleage in Australia planning a study visit to the UK)

Sent: 14 March 2007 09:59
Subject: NHS Bureaucracy

The following is the substance of a letter I have sent to my MP - but I
would welcome others' comments.

I have been a researcher and advocate for the NHS for more than 30 years
but my current experience really leaves me flabbergasted by the
bureaucracy that is now being spawned and the series of jobsworths that
the service is now employing.

The story begins with a visit to my opticians that led to a referral for
assessment for cataract surgery. This involved the opticians sending a
note to my GP, who immediately sent a letter referring me to the Choose
and Book service. After wasting about half an hour trying to log on I
discovered (a) that Choose and Book is only accessible with Microsoft
internet browsers and (b) that the local ophthalmology service isn't
online anyway and is only accessible by a phone call to an appointments
centre at Stapleford. After about 40 minutes of unsuccessful phone
calls, I finally get through to Stapleford, only to be told that they
cannot give my an appointment because the GP has used the wrong
paperwork and the appointment will have to be resubmitted. About a week
later, I finally get another letter from Stapleford giving me a number
to call to make an appointment. My two complaints about this are met
with responses that (a) the NHS doesn't really care about people who
don't use Microsoft software and (b) that Stapleford cannot possibly
consider giving me an appointment without the right paperwork even when
all the relevant information has been supplied to me by the GP.

Anyway, I am duly offered appointments over half the East Midlands and
point out that, since I work next door to QMC there is not much reason
to go anywhere else. But it then turns out that I have to cancel the
appointment because the university wants me to make a major presentation
later in the morning, when my vision is likely to be affected by the eye
drops required for the examination. So I call the clinic and ask to
change the date. Oh, no. Despite the fact that I am on the QMC
computer, the only way I can change the date is by going back to
Stapleford...and I can't speak to the manager at QMC about this because
she's not available. So I think I will ask the PALS service for advice
on how I actually complain about this farrago. Well, it turns out that
when you phone QMC PALS you get a voicemail referring you to City and
when you phone City, you get a voicemail referring you to QMC!!!

Net results: One very dissatisfied patient who will be trying to lead a
reasonable life with increasingly defective vision for longer than
necessary. More to the point, this is my research field and I have no
idea who is now responsible for any of this. You may or may not recall
Sir Roy Griffiths's line about how, if Florence Nightingale were to
return to the NHS in the 1980s, she would be wandering around wondering
who was in charge. It seems to me that ten years of Labour government
have made this worse rather than better. I cannot for the life of me
see where the buck stops on this one. Who is actually responsible for
designing such a buck-passing system and who do I address myself to in
order to have some hope that it might get fixed?

Robert Dingwall
Professor and Director
Institute for Science and Society
University of Nottingham
Law and Social Sciences Building, University Park, Nottingham NG7 2RD,

Northern Doc said...

Thank you for posting a comment. The situation is worse in many ways. Elderly patients have turned up to the call centres listed on their letter thinking they were hospital appointments not telephone appointments to get a hospital appointment.

Patients whose only phone is a mobile find they are stung for large bills by dailing 0845 numbers from a mobile and spending over half an hour to change an appointment as mobile rates are alot higher than land line rates to these numbers.

The letters sent out from Choose and Book are confusing and often valuable nursing and medical time is spent explaining the system and the letters.

DNA rates have risen, paper consumption is increased etc etc.

We could go on but onone listens. Hope you enjoy the blog.