Outcomes

The NHS is the largest employer in Europe and the 4th largest employer in the world. Yet it never ceases to amaze me that it doesn't measure whether it is achieving its prime purpose of making people better. It's good at measuring how many operations, outpatient appointments and CT scans it does but it doesn't measure whether patients leave the hospital in a better state than when they arrived.

Take my wife's shoulder. She had a spur on her sub acramial joint causing her pain. On a score of 1-10 she rated it at about a 6. For about 2 months after the op, it was a 9 and then gradually improved as the wound healed to a 6. At no point has it ever been better (pain wise) than just prior to her operation. i.e. it was a pointless operation. However, the highly respected surgeon noted that the procedure went well and will record this operaton as a success. It reminds me of a cartoon I once saw in which a surgeon commented "the operation was a success but unfortunately the patient died". Thankfully my wife didn't die, but you get the point; surgeons are often more interested in technical ability than patient outcome.

I accept that not all operations are successful, but I wonder how aware patients are of the health gain they should expect rather than just the risks of complications that accompanies the consent process. You would be excused for thinking that surgeons would be offering this impartial advice, but you'd be wrong, because surgeons like to cut and it's what they went to medical school for.

So what can be done? Well, personally I'd like to see patients offered before and after questionnaires that quantifies their health status. This isn't as hard as you think, and EQ-5D is a useful measure if you want to look (http://www.euroqol.org/home.html). All the questionnaires could then be collated centrally, entered on a database that enables comparisons of healthgain by surgeon for any given procedure. Now that would lead to an interesting discussion with your GP. Not only would we all as patients be better informed about whether we would prefer to wait for surgeon x in Andover rather than be seen by surgeon y in York, but we may also weigh up the odds and decide "nah - no thanks, I think I'll live with it". And if the NHS has to save £20bn by 2014, we do worse than to stop doing operations which don't benefit patients.

Patient Transport

Patient transport is always guaranteed to wind up the locals but the expectations people have are mindblowing.

At my hospital we have recently stopped the voluntary car service. I must stress, it's the car service which has been stopped not the patient transport provided by ambulances. The basic reason is that if you are fit enough to get in a voluntary car, you are fit enough to get in a cab and we could do with not spending £400k a year on the "volunteers" expenses.  I realise that a lot of folk are pretty annoyed with us for stopping the transport but really, is it right that we spend taxpayers money getting patients to hospital when they can get there themselves? I would have an ounce of sympathy but some of these patients ask to be picked up at the local shops!

One of my colleagues recently asked a surgeon how they manage patient transport in the private sector. Amazingly, this doesn't seem to be a problem in the private sector; patients somehow always seem to make there own way to their appointment. Strange that!

Volunteer drivers hasn't been the only transport issue making the news. A couple of dears from a local small town made front page news complaining that there is no direct bus to (wait for it) one of their local hospitals. Sorry, but I thought it was the bus companies responsibility to sort out where the buses go! I mean let's face it, bus companies have a vested interest in finding where the fare paying public want to go and if there were more than 2 people making this journey on a regular basis, then it might be worth their while.  What's sad about this story, is that my Trust has given the bus companies about £2m to run new bus journeys to the new hospital! Still, I now know what the £400k can go towards.

All in all, it's enough to drive you mad.

Welcome to my blog

My name's Dubsy and I am a proud NHS middle manager.  My wife got sick of me complaining about how the NHS works at a local and national level so I had to either get a blog or get divorced. The blog's cheaper.  Don't get me wrong, I love the NHS but my god there's a lot of crap that goes with it!

I hope that through my blog, I will be able to give an insight into how the policies spoon fed to us by our leaders are (mis)interpreted and implemented on the ground, where the press coverage misses the point and generally vent my frustration at the obstacles which are seemingly put in the way for fun.

This may be amusing, it may not, but I will always feel better for it!