Drip by drip

In my current role, I am for the first time responsible for maintaining a fairly sizeable building and surrounding land that isn't my home. Looking after 'bogs and drains', fixing dripping taps and redecorating is time-consuming, fiddly and, not to put too fine a point on it, dull. Even worse, occasionally I have to deal with the Scarlet Pimpernel of English tradesmen - builders ("They seek him here ... "). It is ever so easy to do something more interesting, more intellectually challenging and involves finding or making money rather than spending it. Maintenance can so easily be deferred, ("if it ain't broke. don't fix it") especially when the same work will cost double the price that would be charged for"domestic" customers. But I buckle down and do it, reminding myself that the building is a huge financial asset and the cost of repairs will eventually come to those who wait.

Then there is the question of the appearance of the place. It may not need painting to maintain structural integrity, but high-use buildings soon start to look shoddy and tired. Aesthetic priorities are almost certain to be ignored when the finance director comes a'prowling to balance his books. These matters always come down to "balance".

What does frustate me greatly though, is the lavish expenditure on capital projects. When a new building is constructed, there is plenty of money for landscaping and stocking the gardens. There is no minimalist cost approach to fixtures and fittings so it seems fair to assume that these things are of merit. After all, there is plenty of second-hand furniture and office equipment around from whatever was closed to make way for the new build. Yet it seems that only new stuff will do. Clearly, "balance" doesn't quite extend this far. There is no money for flat screen displays for the waiting rooms in most of the estate; yet all the new build gets them.

"Ah, but that's Capital" say the wise people. "Ah" say I. In a commercial world, a company's freehold is a significant part of its capital and an important one to keep in good nick.

Look around next time you're visiting your local health facility. The state of deterioration is a straight-line function of the years that have passed since it was built. It needn't be so but bogs and drains just aren't the sort of thing that gets the local MP to cut ribbons or Chief Executive's their OBEs.

How Many?

For a year or more, the Department of Health has been touting Choose and Book as a good thing. In many ways they are correct. As a patient, I too would be impressed that, on being told that I am being referred to a consultant for a specialist opinion or for specialist treatment, I could "leave the surgery with an out-patient hospital appointment convenient to me". This post isn't about the merits or otherwise of "Choose and Book". It will happen and it's all our responsibility to make it work. To help us to do this, our local "lords and masters" have published a handy booklet for us to give to those whom we refer using the new system. It's jolly nice, informative and comprehensive. It will be a great help to patients. We are supposed to give one to each person whom we refer. For us, that's over 4,000 booklets each year. How many did they send us?

Ten.

Can't get any more: out of stock... No idea when there'll be any more... Not sure who ordered them... Try again in a month or so.

Can You See Me?

General practitioners (or GPs as we say in England) are some of the most advanced users of software to support them in their day-to-day clinics. Many practices use their computer-based medical record as the primary source of information about the patient sitting in front of them. An ingenious system of coding every sort of ailment, disease and unfortunate event that can befall man means that all sorts of useful data can be extracted and used to help better manage each patient's health. In fact they're so good, that our lords and masters want us to do more and more with them, mostly more good stuff. As with so many good things, there is a trade-off. Your doctor can't be looking at you if he is busy typing in his consultation notes and looking at patients is still an important part of any consultation.

My son had to visit his new GP for the first time recently. On being summoned, he entered the consulting room and held out his hand to shake that of the doctor. The doctor never looked up from the screen on which he was reading my son's summary. Instead he asked: "how are you?". Luckily my son was in one piece. Nothing was hanging off, exuding pus or bleeding over the floor so he didn't look as foolish as my son felt.

We should all remember that it is as important to look as to listen. Body language can tell much about the person that the words won't reveal on their own. If a patient limps in and sits down with a grimace, it wouldn't take much medical skill to see that there is something amiss, even if it isn't what the patient has come to talk about.

Then there is the question of plain good manners.

More of the Similar

Yesterday we reviewed with a number of your performance directors and choice leads, the best means of assuring readiness is genuine and reaffirmed the expectation that this is captured in a written form, practice by practice.

or ...

We met yesterday to decide how to make sure that you were all ready, and to agree what written evidence we will ask you to submit to prove it.

You couldn't make this up

Extract from a report by a Strategic Health Authority into progress made in implementing "Choose and Book". Ready?

"The key concern is that the added resources funding implementation teams expire this March, while local communities need to move from 2% electronic booking to the December target of 90%. Communities are at various stages of identifying funds to continue implementation, but credible plans for managing the trajectory have not yet been submitted."

For those of you who aren't quite into "healthspeak" I add this translation:

"We've almost run out of the extra money we were given to do the work although we still have a great deal of the project to do. We're looking for more funding to enable us to plan and complete the project but haven't found any as yet."

I think I will go and sit in the corner for a while ...