While you’re at it, Wes…

The hullabaloo over Labour’s plans to reform the health service has been predictable, if rather depressing.

Wes Streeting and Sir Keir Starmer are clearly looking for ways to modernise the system and make it more patient-friendly in the 2020s and 2030s. Of course, that’s no substitute for further investment in wages and infrastructure, but given the likely economic constraints a Labour administration will inherit, they are thinking laterally.

The hard-left opposition to New New Labour hates the word ‘reform’, as they see it as a code for ‘privatisation’. But the Corbynistas have been left a little bit discombobulated, because one of the Shadow Health Secretary’s eye-catching plans is effectively nationalisation: making family doctors direct employees of the state. (More than half are currently still self-employed contractors — a legacy of winning the medical profession’s buy-in for socialised medicine in the late 1940s.)

Another proposal — greater self-referral to consultants — has also provoked a lot of anxiety.

Sir Keir Starmer made an unfortunate blunder in suggesting that individuals with ‘internal bleeding’ could bypass their GP. In fact, he was talking about people finding blood in their urine or stool — a situation where a GP needs the patient to take a test before diagnosis and further action. Why not allow people to go straight to the test, argues the Labour Leader? It would mean one appointment with the doctor when the results are through, rather than two.

At this point, let me tell you about Mrs W’s shoulder.

She was informed some years ago by a consultant that she would eventually need an operation. At the time, he gave her a steroid injection which produced a minor miracle. For a long while, it helped her enough to get by, but eventually the pain, discomfort and immobility built up significantly. She knew it was time for the op.

So she asks for an appointment with a GP. It’s three weeks away and it’s on the phone.

She talks to the GP on the phone. They say they want to examine the shoulder in person (something it might have been logical to assume in the first place). Can she come in right away? Errr… no. She’s working. Oh, well the next appointment is two weeks from now.

She sees the GP face to face a fortnight later.

Can she go back to the consultant who advised the op? Errr…. no. It’s not possible to refer until she’s tried a course of physiotherapy.

She is referred for the physiotherapy and waits.

Several weeks later, she embarks on a course of treatment which isn’t going to treat the underlying problem. She knows this because she was told by the consultant that an operation was required.

Eventually, when she’s done a number of physio sessions, she has to get an appointment with the GP again. Who refers her to the consultant who had seen her in the first place.

This is not only madness from the patient’s point of view. It is a hopeless mismanagement of the resources of the NHS.

Of course, there’s a danger of people using Dr Google to self-diagnose stuff and waste the time of a consultant. If we do extend self-referral, there will have to be clear rules and guidelines. But why can’t someone with depression decide they need to see a mental health professional? Isn’t a woman entitled to bypass a GP when she knows she has a gynaecological complaint?

No question, there will be all kinds of complications and caveats. But I refuse to accept this should be some kind of taboo subject and that we have to accept the way things are, simply because they have always been that way. Respect to Starmer and Streeting for getting it out in the open.

So while we’re talking of things that could change within the NHS, what about the experience of patients at A&E?

Of course, the hospitals are overloaded with cases of Covid, flu, Strep A and whatever right now. There is chronic bed-blocking, caused by under-investment in social care. We need more doctors and nurses on duty. There’s a knock-on effect on ambulances, which are held outside the infirmaries. All of these things are to do with money and resources.

But there’s plenty of other stuff which impacts the patient experience. And it has nothing to do with money and everything to do with systems, processes and working arrangements.

A basic rule of A&E is that no patient or their relatives has the remotest idea what is going on. Once someone is triaged, they wait.

Sometimes they’re given a vague idea of when a doctor might eventually emerge. (Usually hours away because of the resource issues described above). And they sit. And then someone comes along and asks the patient to follow.

Ah, perhaps we’re off to see the doctor?

No one says.

Actually, we’re taking some blood. Which is obvious to the person taking the blood, but not to the patient.

And then we sit.

Someone comes along and takes blood pressure.

A couple of hours later, the chance finally comes to see a doctor. It’s a big breakthrough. After which, you’re told to go and sit again. Perhaps in the same place, perhaps somewhere else.

Have you got a diagnosis? Who knows?

Are you going to stay in overnight? Anyone’s guess.

An hour or two later, you ask a passing member of staff what’s going on. They don’t know. But they’ll ask.

It seems we’re waiting for the blood tests. Once the doctor has seen them, you’ll be able to go home.

So… err… when do you think the doctor will see them? Ah, well that’s impossible to know.

Will the patient be staying in? Well, that depends on what the doctor says about the blood test.

The last time I took Mrs W to A&E, we were eventually parked in a cubicle in a locked corridor used by occupational therapists, amid piles of Zimmer frames. We were waiting for the results of additional blood tests. And we were forgotten.

When I say forgotten, I mean literally. Someone poked their head around the door at one point and said: ‘And what are you doing here?’

To which our response should have been: ‘Well, you tell us, mate.’

Mrs W decided eventually to discharge herself at a point where someone was coming past the cubicles literally noting the names of the occupants of the locked corridor. They didn’t even know who they’d put there.

The fundamental point here is that everything about this system is alienating to the patient and their family. They are left in complete ignorance of the process, which causes unnecessary stress and anxiety. It’s not just that delivering a proper system and communication with the public would cost little money. It would undoubtedly save money, as it’s not possible to imagine anything more inefficient than the current model.

What about an app that tracked progress through the hospital, for instance? Something that told you who you’d seen, what they’d noted and what was going to happen next? It could be accessed by the patient. Seen by the patient’s partner or child or parent. Read by the doctors, nurses and ancillary staff.

That’s a reform that has nothing to do with ownership — public or private — but would make a world of difference to patient experience.

So come on Wes, let’s get our thinking caps on.