Monday, 7 May 2007

It's your choice

It is remarkable to think just how quickly the Internet has become an apparently essential part of our lives. One area where I now find it indispensable is booking flights. If you fancy a weekend away, you just click on your favourite web site, and if the flights to Barcelona seem too expensive, or at the wrong time of day, you can choose to fly from another airport or on another day. It’s all so delightfully quick and foolproof, and I can only imagine that it was after such a happy experience that some bright spark at the Department of Health dreamed up the madness that is Choose and Book.

I suppose that if you have a totally obsessional personality, and your GP has diagnosed you with, for example, a hernia, you may wish to research all the available surgeons, find out which of them has the lowest recurrence rate, and then ask to be referred to him (or her). But that, of course, is not something that Choose and Book can offer; for a start you can’t be referred to a named consultant anymore - so if you really want to be seen by Mr Spratt, that’s tough nuts, you just have to get a referral to his hospital and hope for the best. But that’s not the end of things; suppose you merely wish to be seen at a particular hospital, perhaps simply because that’s the only hospital within thirty miles of your home, or because that’s the hospital which has all your records of your previous care, well you had better hope that the hospital isn’t too popular with the rest of the general public, because if it is, you may well find that it is no longer a choice, because since nowhere is allowed to have a waiting list of more than thirteen weeks, once the appointments have been filled, your favoured hospital just vanishes from the computer screen.

This hardly seems a recipe for giving patients what they want, and if the system doesn’t work for patients with straightforward acute problems – hernia, haemorrhoids, and so on – what happens about those with chronic diseases, and especially those with chronic dermatological disorders such as eczema and psoriasis? Well, the brave new target-driven NHS designed by management consultants find this group of patients a bit of an inconvenience, and since they don’t fit neatly into their deluded plans, they take the easy way out and simply ignore them. The latest wheeze from these masters of the NHS is to penalize consultants who see more than a very minimal number of follow up cases, and follow ups, I may remind you, are those cases which by their nature are the most complex and challenging, and which cannot simply be seen once and sent on their way.

So, under totally artificial pressures from our managers, we send patients with challenging long-term problems back to their GPs, but always with the proviso that if the problem flares up or becomes more troublesome, they should ask to be referred back. And what happens when they do just that? Yes, you’ve guessed it, they fall into the Choose and Book trap. They cannot be sent back to the consultant of their choice, the consultant who knows their case with all its idiosyncrasies, the consultant who they trust, because the Department of Health cannot abide the concept of anyone providing a personal touch. Worse than that, there is no guarantee that they will even be able to get back to the hospital of their choice, with all their past notes and investigations, and the better the reputation of the department, the more unlikely they are to be able to get back there.

If Choose and Book has anything to do with patient choice, or even patient care, I seem to have missed something

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