Saturday, 14 January 2012

And it came to pass . . . eventually.



Sometimes recent events can trigger long forgotten memories of previous lives. Recently at ND Central one such event occurred.

Many many years ago in place that practised first world medicine a junior grunt in the middle of the night pushed an ill patient for an urgent CT scan. There were porters at this great centre of learning and nurses were not meant to push patients but as the porters earnt more per hour for a night shift than junior doctors they were allowed an uninterruptable hour for their midnight lunch and this was sacrosanct. Bugger illness we need our snap and are part of t’union.

So a junior grunt (the cheapest employee on the pay roll earning less than a 40 hour a week police office at the time for working a 100+ hour week) and a junior nurse (leaving a busy ward on take understaffed) pushed the ill patient several hundred yards and several floors up and down in lifts to the CT scanner.

In those days CT scanners cost about £ 500,000 to buy and another half million a year to run. Scans took sometimes half an hour per patient in contrast to the minutes they take to do today.

The hospital had very good radiologists and the junior grunt sat and spoke with the on call radiologist as the scanner warmed up and during the scan. Obviously a lot of the conversation was about the images we were seeing as they were slowly produced on the screen and we cannot recall the outcome of the scan but we do recall the radiologist’s comments as the scan progressed.

They told us about the costs above and said that the scanner “tubes” had a life expectancy of about 3 years (this was early CT scan days) and that given the costs to get best value they should be used 24 hours a day. Now knowing that the junior grunt was the lowest paid member of staff per hour in the hospital at night and, in those days radiologists did very little out of hours work and so were not that highly paid among consultants, the grunt asked why did they not do this?

The radiologist replied that they thought most patients would be prepared to come in in the evening in order to get scans done quicker but went onto say that they had looked into this and the consultant radiologists were prepared to do this so that they could offer a better service and reduce their waiting times for the one CT scanner they had.

The only thing stopping it being a cost efficient service was the cost of the overtime for the radiographers. The figure quoted was that they wanted 2-3 times their normal hourly rate for out of hours (17.00 - 09.00) during the week and more at weekends especially for nights. The huge cost involved on this one item of expenditure meant it was not possible.

Both of the grunts in the scan room looked at each other at this point as they could see the logic of using expensive equipment efficiently for the benefit of patients being scarificed on the absurdity of an institutionized selfish stumbling block.

Now at that time most places in Northernshire had not any CT scanners and were only dreaming of such magic but if we fast forward through the mists of time and memory to a Northernshire that now has CT scanners and even MRI scanners we come to the present and the event that triggered our little musing.

One of the team answered a family member’s phone and it was a hospital radiology department asking to speak to the family member. They left a message and asked if the family member would be prepared to come in for their scan 10 minutes earlier than their appointment.

And the time of their new appointment? 07.30 Zulu.

It has only taken over a quarter of a century to get to this stage that we had discussed in the scan room all those years ago. Who knows in a another 25 years time GPs in Northernshire may be able to request a MRI scan of a back after the lumbar spine x-ray is confined to the dustbin of history for investigation of back pain.

Now we heard someone wise in the ways of radiology talk about that idea in the same scan room how many years ago now . . . ?

Praise be to the Party for ensuring that when it comes to progress the NHS is designed to inhibit it at every turn. Come up with a good idea in the NHS and it will out committee you at every turn.

And still does.

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