A Tale of Two Worlds

A previously healthy woman notices some shooting pains down her arm and thinks nothing of this as she has had them intermittently before and they have gone off after a few days. One morning she gets up and find that her arm is not working properly in that she cannot lift her shoulder up or move her elbow but can move her wrist, hand and fingers.

Thinking that something is wrong she rings her family physician, Doc Northern MD, and is seen that afternoon. She consults with her family physician who talks to her, performs an exam and suspects that she may have a disc in her neck pushing on the nerves to her arm.

Doc Northern rings the local neurosurgeon who sees the lady the same afternoon and arranges a whole series of tests including a MRI scan of her neck. The scan reveals no disc problem but further tests on her nerves reveals that she has a condition called mononeuritis or inflammation of a nerve that affects its function. It should recover given time and help from a physiotherapist. The neurosurgeon passes his patients care on to a neurologist whom she sees the next day and he then arranges further follow up and treatment.

This is a tale from one world. Let us though the wonders of imagination now travel to another world and start the story again.

A previously healthy woman notices some shooting pains down her arm and thinks nothing of this as she has had them intermittently before and they have gone off after a few days. One morning she gets up and find that her shoulder is not working properly in that she cannot lift her shoulder up or move her elbow but can move her wrist, hand and fingers.

Thinking that something is wrong she rings her GP, Northern Doc, to ask for an “emergency” appointment but there are none. All the emergency appointments are now “open access” and not limited to emergency only consultations and so are taken by people needing contract review appointments to ensure that their GPs will get paid.

She then attends the local A&E department, something she shouldn’t do as it costs too much according to the local commissars, where she is seen by a junior doctor who tells her to go and see her GP as there is no neurosurgeon at this hospital. The A&E doctors cannot refer direct to a neurosurgeon as it is not an emergency and therefore the neurosurgeon would not get paid under Payment by Results as it is a consultant to consultant referral (rather than a GP to consultant referral which will lead to payment).

A few days later she gets to see her GP “as an emergency” (something she was loathed to do as she does not wish to abuse the health service) who talks to her, examines her and suspects that she may have a disc problem in her neck. Her GP, Northern Doc, knows she has been to A&E and not been referred to a neurosurgeon because of funding issues.

Northern Doc could refer her by Choose and Book but the local neurosurgeons do not use this system. They like to screen referrals to prioritise referrals themselves rather than see non urgent cases first if they are booked by Choose and Book. Any paper referral would take days or weeks and the only other option would be a possible emergency admission to a far distant neurosurgical centre which the patient does not want because of family commitments.

Therefore, the doctor and patient decide to go for a private referral direct to a consultant neurosurgeon a couple of days later to ensure a prompt review by an appropriate specialist and circumvent the management structure that delays health care called World Class Commissioning.

The neurosurgeon admits the patient straight away and does all the tests over a couple of days that reveal inflammation of the nerves or mononeuritis as the cause of the lady’s problems.

He refers on her onto a neurologist who tells her what the problem is that she will need follow up including specialist neurophysiotherapy which he then asks her GP to arrange (to ensure that funding for this specialist service is preserved) as his referral was from a consultant not a GP.

She is discharged and goes to see Northern Doc to ask for the physiotherapy.

Northern Doc asks his secretary (for GPs in the UK rarely have enough time to use the snail like computer system that is Choose and Book) to try and arrange a neurophysiotherapy appointment.

Northern Doc’s secretary hunts high and low but can not find the hospital where the patient was treated on the Choose and Book system as the local Choose and Book Commissars will not allow this service on their local Politburo controlled Choose and Book system.

They do allow several local tractor plants which claim to offer neurophysiotherapy but the GP knows that these physios at the tractor plant know nothing about neurology. They cannot recognize worsening paralysis in patients they treat for bad backs, in place of real orthopaedic surgeons, who are too expensive for local management commissars to allow local GPs and their patients to use them.

After a long time trying to use the new and improved Choose and Book system, which just shows what is available, not its quality, the dedicated secretary rings the hospital where the patient has been discharged from to ask if they know where to refer the patient to?

She speaks to several people who know the department exists and is eventually told to send a paper referral to the physiotherapy department who will sort it.

After 2 weeks the department phone and say because the patient does not live in the same town as the hospital they cannot have this service even though they have been treated at the same hospital and there is an alleged National Health Service.

This is the tale of two worlds. The first 3 paragraphs detail what would happen to the patient in any first world country and it does as our patients tell us their tales of illness abroad or how their (and our) relatives get treated overseas.

The susequent paragraphs (14) relate the second world's story of the "patient journey" (=management speak for treatment why use one word when 2 meaningless ones will do?) in the wonderful world that is local NHS World Class Commissioning one of the (alleged) best in the country.

If your arm did not work one morning which world would you like to live in?

Praise be to the Party for the wonderful world of World Class Commissioning the 21st century equivalent of the Youth Opportunity Program (YOP) from the 1980s. Jobs for the otherwise unemployable and an artifical bureaucracy serving no useful purpose than preserving its own existence.

Welcome to the fourth world that is medical care under the current NHS in Northernshire and this is not a made up story. We really wish that it was but it isn’t.

The patient is still waiting and getting worse with each day of World Class Commissioning in action. Perhaps they should go private but then is that not what the Party wants?

Can they afford to? No, so they continue to worsen despite paying their taxes.

And our heads are sore from banging them against the brick walls of institutionalised management incompetence.