A&E Treatment Targets

It's been an "interesting" summer (as in the Chinese curse "interesting"). One of my more forgettable moments was taking myself down to St Thomas's one Wednesday evening with what I suspected was an unwelcome return of the double pneumonia episode a couple of months earlier.

I arrived into a pretty quiet waiting area at 20:45 and was booked in almost immediately. A few minutes later, I was taken into the treatment area and into a cubicle. Routine obs were taken and after a while the new JHO - Junior House Oficer (it was week one of the great August musical chairs) learned of my previous bout. She said she'd arrange an x-ray and this was done within the hour. Pretty good ... so far!

About 23:15 JHO returns and says chest is clear so they're going to take some more blood for some tests. Blood duly extracted. I wait in cubicle.

23:45   Still sitting in cubicle
00:15   Still sitting in cubicle.
00:30   I say to my wife: "You watch; in the next fifteen minutes all sorts of stuff will happen".
00:40  JHO returns and says they're going to admit me.

Me:   Why?
JHO:  Pardon?

Me:   I've been sitting here for the past 1½ hours. Why have you suddenly decided to admit me?
JHO:  We're still waiting for results of your blood test.

Me:   Can't I wait here?
JHO: No.

Me:   Why not?
JHO:  My care pathway coordinator won't allow it.

Me:   Well how long will the results be?
JHO: About an hour or so.

Me:  Well I'll wait here then rather than take up a bed.
JHO: You can't.

Me:  Why are the results taking so long?
JHO:  Um, um, actually there was a problem with path system.

Me:   What problem?
JHO. Er, we forgot to send them to the lab.

Me:   You are not admitting me to adhere to some arbitrary four-hour target which you will exceed because you made a cock-up.
JHO:   You can't stay here.

 Me:  Then I'll go home. I live over the road less than five minutes walk and you can phone me when you have the result.
JHO:  Oh, you'll need to fill in the self-discharge papers.

Me:   OK.

Two hours later the phone next to my warm comfy bed rings.

JHO:  The results are back. You need a CT scan. You need to come back straight away.
Me:    Does that mean I have the CT scan when I get there?

JHO:  No. They don't open until nine o'clock.
Me:  Then I'll come back then. Good night.

If I'd agreed to be admitted, St Thomas's would have charged my GP's commissioning budget because they'd cocked up their management of my treatment by forgetting to send my bloods to the lab. The likely cost to the GP's budget would have been hundreds of pounds because of the way it would be coded with my advanced years and a non-related chronic disease.

As long as this goes undetected. There is no incentive on hospitals to be more efficient when treating A&E patients long as they can be admitted, even without a diagnosis, after 3h:55min. In theory the tariff allows a set number of days for particular episodes but this was an episode that could have been completely unnecessary (e.g. my first ever attack of gastric reflux - which it wasn't).

A Letter to my MP

Dear Dianne Abbott,

After much consideration, I have decided that it really is about time that you, as my MP, put my interests at the forefront of your thinking. Gone are the days when every four years or so, you could break off from your busy schedule of evening television programmes to remind us all just how great you have been at doing whatever it is that you do. I think it's about time that you put us, your constituents, at the heart of your thinking.

Recently, I got together a group of citizens and we held a "Citizens Summit" at 'The Fox Reformed' on Stoke Newington Church Street. I asked them what they would like to see from you, their MP. Their responses were interesting and I have sifted through them to find those that are neither physically impossible nor morally repugnant. There were a few left.

First of all, we want to see you at a time and place that is convenient to us. I work away from Hackney so I expect you will make reciprocal arrangements with your Newham colleague so I can visit him during my lunch hour. Also, I'm taking the mother-in-law to Prestatyn in the new year, so I would be grateful for contact details of your colleague there just in case I feel like an evening chat.

Now your website doesn't actually give details of your constituency "surgeries" (I think that's the term) but I do have a number of irritating minor ailments, so I need to know where I can make several appointments stretching through Christmas and the New year. At the same time, I wish to be reassured that should I have a short-term crisis with my brown recycling bin, you will be on hand to get things done. Now I just thought I should warn you that I may, or may not keep these appointments.

When I do visit you, it may be that I will need to speak to someone else as well. I would like you immediately to make me an appointment with that person, again at a time and on a date of my choice. Of course, I would expect you to confirm it in writing.

Finally, I am enclosing my proposals for "Payment by Results". This exciting and radical plan represents the biggest shake up in parliamentary procedure since Dennis Skinner said something constructive and no more that mildly offensive. Quite simply, MPs will be reimbursed on the basis of "outcomes" rather than at present. I suggest fifty five quid for a consultation; twenty pounds for writing a letter; let's say thirty quid for each day in excess of fifty days a year that you actually turn up at Westminster and say something .. ( I was about to say "useful" but let's not run before we walk).

Even more exciting will be the Enhanced Payments to which you will be entitled once we have completed a survey of your constituents. We will mail a number of them at random and ask them questions about what they think of you and your effectiveness as their democratic champion. I attach a sample questionnaire but suggest that you pay it little heed. It's not the one we will actually send out to people.

Finally let me offer you some soothing words about those dreadful rumours that have been circulating. Of course at this stage, nothing can be ruled out but I am happy to reiterate that at this moment in time we have no plans to introduce private contractors into the House of Commons to take over constituencies where performance may be below par. That doesn't mean to say that we won't be pushing to expand those parliamentary walk in centres. You know the ones. You turn up; they listen attentively; and then they tell you that you need to see your own MP for that particular problem. Whilst they don't actually add much value, we do think that they sound good and we'll get lots of brownie points from our friends and neighbours.

I look forward to seeing you next Saturday afternoon at about six-ish. I have this nasty rash on my front drive .....