Monday, 17 May 2010

Choose and Book some more. A patient’s experience.

At the end of last year we had a little rant about the how to use C&B properly book.

Well one of us here at ND Central has had to use C&B first hand for a family member and to say that it is a crock of brown stinking useless sh*te would to be give it more credit than it could ever merit based on how well it works.

Have a look at the scans above and we shall dissect one of the most expensive pieces of useless government software ever devised and its complete and utter failure to do anything.

Remember dear reader that this software was designed to be used by doctors, some of the most intelligent people in any society and very few (if any) of them use it because it is complete and absolute crap.

If someone suggested Brillo pads as an alternative to toilet paper would you use it? Ask any UK medical secretary Brillo versus Andrex? Choose and Book versus the old paper system that worked and was so much less labour intensive and quicker?

By way of background we wanted two appointments for the family member concerned one of which we were able to book in the surgery the other we could not.

So let us look at the letter. Easy to read as we copied the text to a grammar checker and it gave a Flesch grade level of 7.4 equivalent to a college graduate or very difficult to read.

So your average demented, elderly or illiterate patient will have no problems based on the words but the concepts contained within the easy to read text might be more difficult.

Go to section 2 and see where you can make your appointment.

A call centre? Well our experience of call center’s staff whose sick notes we sign is that they are usually drug addicts or alcoholics so you know at once you are in capable hands to navigate though the complexities of “choosing” your healthcare with these experts. This is an enhanced service where if your referral has been screened by a clerk in a referral management center you will have to argue the case in order to get your, or did we mean their, choice for your appointment?

This is just our experience from the local commercial call centers. We know from our experience of swine flu that those employed by NHS call centers are a completely different caliber of operative. Far better than anyone with a medical degree as they can diagnose and prescribe in 3 hours of training something that no UK GP could.

Now section 2 also hides a very publicly hidden “cost” to the NHS “free” at the point of need agenda so beloved by the Party.

For a pensioner on a budget a mobile is good way of saving money until you start to use Choose and Book and try to use a government sponsored call center “please wait while I put you on hold as the computer is not working”. Something is usually not working in call centers and it is called the staff. Trust us some of our better staff dished the dirt when they joined us looking for better jobs.

Look at the last paragraph regarding mobile phones. How many real GPs, not politicians, have had patients ask them to make their appointment as when they try to do it on a mobile they are put on hold and charged a fortune to the point of no credit and more importantly no appointment. They are repeatedly told to ring back as no appointment slots are available.

When you can neither Choose, or Book who you going to call? Your free at the point of delivery GP and their staff of course.

No wonder pensioners are called bigots for how can they not afford to use mobile phones as they have all been to the same public schools and universities that politicians have been to and they get massive pensions and expenses as well?

Section 3 says “Your choices”. In the letter it says you can book ONE of your choices. Curious that we had asked for 4 choices of hospital (can’t “choose” your consultant though comrade) but then we are only good communist serfs so therefore 4 now equals 1 in NHS “Choice” la la land. Go to the nhshealthspacewebsite and you choose all four to see what appointments are available.

Clearly good one size fits all here comrades and remember we have the benefit of a University education and one CSE in Maths between us at ND Central so we should find this all a walk in the park.

We have access to the Internet as do just 66% of the population which means Choose and Book is true egalitarian medicine and "choice" along the lines of if you can afford to pay you can have more "choice". If you have Internet your choice is greater than those with just phones (90% of population for landlines 79% mobile phones source).

On to the second page and there is your password. This is the thing that we as GPs have seen most of with Choose and Book a whole generation of people of all ages saying “I rang up and was asked for a password but I couldn’t find it”.

In the good old days, when most people could read, the only password you needed for a referral was “Good morning/afternoon doctor”.

Now we come on to the most interesting bit. Being techies here we have been using the internet for the last 4 weeks to access an appointment. And what do we get?

“Please choose one or more of the clinics below and click “Continue to Step 2” to view all available appointments.”

Select all 4 we did as clearly as internet babes we are given more “Choice” than those using telephones and this is what we got:

Hospital 1 Approximate wait time 80 days
Hospital 2 Approximate wait unknown
Hospital 3 Approximate wait unknown.
Hospital 4 Approximate wait time 39 days

And the most important bit after all of this was the message in red:

There are currently no appointments available please try again later. Please call the C&B Appointment Line on 0845 6066 8888 for further information.

This cycle for many people is repeated time and time again and mobile phone bills increase as calls to Choose and Book are charged at a higher rate than from landlines.

The old system consisted of patient using the password and this simple system:

“Good morning doctor. I think I have a hernia can I see a surgeon?”

“Certainly. I will examine you, confirm you have one and who would you like to see?”

“Who would you recommend as I would not like a call centre smack head to decide? I would rather to talk to a professional. I would like to see Mr X who did my friends and he thought highly of him, can I see him?”

“Of course, Mr X is very good, I will dictate a letter which our secretaries will type and send off to the hospital and you will receive an appointment through the post. Let us know if you hear nothing in 4 weeks”.
(Text in quotes 117 words vs 300 for C&B Call Guidelines core from the C&B text above).

If you examine just the text of the Choose and Book Appointment request letter there are 216 words. That does not include the appointment or the instruction of how to make a choose and book appointment

Now someone once said that The Ten Commandments required a mere 300 words and the American Declaration of Independence 1,300 words. However, the EU regulations regarding the export of duck eggs require 26,900 words.

So what used to be a simple system has evolved into a monstrous system that fails to deliver. Our family member is still waiting after 4 weeks to be given an appointment. Does that mean that when they get one it will only take 14 weeks until treatment? Or has the waiting not yet begun because they have been denied an appointment by the Party and its all wise commissars?

Look on Choose and Book websites and this scenario of no appointments does not exist.

Remember we know the system where would you suggest we go next?

We did manage to book one appointment in the GPs office for the patient concerned and chose a date that would mean no time off work to take our family member to their appointment. Our choice was respected as a few days later a letter arrived from the hospital concerned with another appointment date and time. We now have to lose half a days work as the appointment has been changed to another day with no explanation as to why.

More massaging of the 18 week wait target by giving a dummy appointment which does not exist? 18 week wait target met box ticked when actual wait longer? Cancel the non existent appointment and send a real one. No gamesmanship here comrade patients just genuine “world class Choice”.

Praise be to the Party for giving us something we never needed “Choice” = none and the ability to “Book” not an appointment.

Choose and Book is a lasting legacy to the centralized, institutionalized incompetence and inability in UK healthcare. If anyone wants to save money shut it down and efficiency saving would be instant as staff time wasted using C&B could be more usefully deployed by doing something useful for patients.


Anonymous said...

I used choose and book and got an appointment that suited me, first time, around my worklife. I got to book it online and didnt even have to contact the call centre. But i am guessing this is not a comment you were hoping to hear. I guess it greatly depends on your area and how good and efficent the doctors and clinicians are. Its not always the system thats to blame. Its usually the users behind it!!!

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