Sunday, 22 March 2009

How NHS Can Do Better - More Thoughts 2

Sorry for the length of this post - there's a lot to cover.
Following this week’s report of the early deaths caused by neglect at a major hospital group in Staffordshire anything any the IT critics and bloggers can say on this subject would be inadequate. We can comment, criticise, warn, and offer ideas for improvement; but can’t do much to stop a sickening catalogue of shameful events like those in Staffordshire from happening. They were not caused by lack of training, or by lack of funds, or lack of IT, or by force majeure. These deaths and the suffering of many patients were caused by bad leadership and that alone. On TV News the other night a Labour Party Health Minister, Ben Bradshaw, showed little if any remorse for their leadership and its role in the deaths. He blamed the local health authority and other quangoes. What a creep. Now read his Wikipedia comments NHS IT: “On the subject of the National Programme for IT, a scheme dogged by cost overruns, failing public confidence, delays, and doubts over its benefit to patients,[6][7] he commented: "Our use of computer technology in the NHS is becoming the envy of the world. It is saving lives, saving time and saving money. If you talk to health and IT experts anywhere in the world they point to Britain as example of computer technology being used successfully to improve health services to the public.” This shows his lack of consideration, and an ability to live in a parallel world to rest of us who have to be treated within his NHS or have to pay for his NHS IT system. Just like Gordon Brown he is denial of the obvious.
So; what can NHS IT do better? This piece will look at non-urgent ambulance services – my term for ambulance services that are used to take out patients from home to hospital for booked treatment. As touched on previous postings; this service, at least in London is dreadful. Let me explain from personal experience.
A semi-invalid old man who needs to help to get down to street level from a 2nd floor flat to be driven various appointments, gets up at 6am to prepare for an 8:30 pick-up. The ambulance arrives at 11:00 with one driver who refuses to help him down the stairs with the words “No one told me I was to help you, it’s not my problem”. Or, the ambulance arrives late at the hospital, which means the appointment is missed and has to be rebooked for some months in the future. Or, the patient arrives on time at the front of biggest hospital in London and is 80 year old wife is left to find a wheel chair to wheel him herself to the clinic as no staff can or want to help. Or the ambulance arrives at the wrong entrance and goes away with even trying to telephone for instructions. Or should two ambulance staff turn up they drive round London spending two hours plus with old and frail patients being jostled about while they do a’ bus tour’ to various hospitals. The same occurs on the way home. So a 30 minutes consultation at mid-day can require that a patient start the day at 6am ending it at 6pm after spending upwards of 4 hours sitting in an ambulance and 8 hours in waiting rooms. Even the youngest of us would find it hard to survive this sort of treatment.
What does all this poor service do? It requires ambulances to drive on long wasteful journeys which cost extra money on wasted fuel and staff costs. For the Greenies it also adds to UK’s carbon footprint. It means appointments are missed and therefore NHS capacity is wasted adding to costs. It means that a shortage of ambulances occurs; requiring emergency crews to drive from East Coast or South Coast towns to fill the gaps. All this leads to yet more wasted time and money and bigger carbon footprints. Above all it means that patients who are in a frail condition are stressed to breaking point, probably making their conditions worse.
What’s needed to sort this mess out? Apart from some motivated management and staff, i.e. The Culture Thing mentioned before.
It needs IT systems in which ambulance bookings can be entered to ensure the full needs of each patient are logged. Currently each hospital, each ambulance station uses pen and paper to record and transcribe appointments.
It needs ambulances equipped with GPS devices for routing and location tracking.
It needs ambulance crews equipped with hand-held type pc’s for managing their service just like modern home service companies who service washing machines, or carry parcels.
It needs links for hospital doctor pa’s to have access to ambulance bookings to enter their patient’s needs.
It needs, above all, leadership willing to put their political rhetoric to one side and consult with and listen to staff and patients (not trades unions or quangoes) to ensure solutions are developed from which all can benefit.
Sadly I cannot see Gordon Brown, Alan Johnson, or Ben Bradshaw having the courage to admit their past is wrong and that a new future, not one based on NpfIT, is needed.

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