Tuesday, September 25, 2007

Head Banging Reality

Patient pathway protocol in action

Who's crackers? Him or us? Listening to Brown yesterday, I scoffed, shouted, and nearly swerved off the road, as per. Surely he can't really think we disenchanted Tory voters will fall for the flag, a bit of crime posturing, and vague talk of patient choice. Can he?

Ten years of control freakery and huge splurges of our cash have left our public services entangled in a dense bureaucratic mangrove swamp. Police who can't police, schools that can't teach, and health services that we can't access.

Yet all he could offer yesterday was more of the same: on his direct orders hospital wards are to be steam-cleaned, police hit squads are to target problem areas he has selected, teachers are to teach one-to-one as he's decided, ten new "eco-towns" will go up where he wants, twenty fresh divisions are to be sent to the Eastern front, etc, etc.

Where does the real world come in?

As Gordo spoke, we were once again en route to visit my 92 year old father-in-law, who is currently in a big NHS hospital. There, not only does the left hand not know what the right hand is doing, the right hand doesn't even know what the right hand is doing.

Without going into the grim details, Mrs T's Dad is now going to need continuing 24/7 nursing care. But as far as the Big Hospital is concerned, he's become a bed blocker: they've done what they can medically (which does not, btw, run to helping him eat and drink- hence a repeated need to put him on a drip), and now they want him out. Since we all agree that home nursing is no longer a runner, we've entered the scary realm of residential care.

But as luck would have it, there's a superb new care home very close to where he lives. It was built and is run by a charitable trust, the local authority block books a large number of the places, and two of them are currently vacant. My father-in-law is very keen to get one- it gets excellent local reviews- and we are very keen to arrange it.

Which is why we are currently attempting to hack our way through a monstrous tangled knot of bureaucratic non-joined-up "protocols". They are Big Government's alternative to having some actual person in charge.

First there's the Doctor. Does he agree the patient needs continuing residential care? We don't really know because despite visiting at all hours of the day, the Big Doctor somehow always manages to come round when we're not there. So we're thrown back on a revolving cast of junior doctors, who are quite happy to talk about the medical side, but not the more difficult subject of after-care.

The revolving cast of nurses are quite happy to show us the ring-bound patient file - and dispense many useful things like sticky bar-code labels to identify his false teeth - but they need to get the Big Doctor to sign off the blue docket. Which somehow never gets done.

"Can I just take it to The Doctor now? He must be around the hospital somewhere." No, there's no protocol permitting that. Anyway, hints the nurse, being too pushy might derail the whole process. Strong suspicion that the nurses are too timid to ask the Big Doctor, probably not helped by the fact that English is rarely their first language.

Then there's the social outplacement department. I don't think that's their actual name, but their job is to get bed blockers off the premises and onto someone else's hands. Like maybe this care home.

When you eventually track them down to their windowless offices, hidden deep in the bowels, you meet a succession of overweight ladies with clipboards. They are highly empathetic, but sadly, virtually useless. Their key role is almost certainly to persuade you that home nursing is an option after all.

But it isn't. We must fight on.

Well, you say, what about simply paying for a place? Yes, that's certainly a possibility, and it's doubtless what the system would like. But apart from the eye-watering £25-40 grand pa cost (after a lifetime of paying his taxes and fighting for his country, he himself has few funds), there are no "self-fund" vacancies at this home. The market supply has been curtailed by the LA's block booking, and the only vacancies are LA funded (albeit with some sliding scale contribution from the resident).

So we're stuck in the mangrove swamp, desperately hacking away.

At some stage Gordo will doubtless issue another order of the day to guarantee our right to something that sounds like it might be what we need.

But we all know the reality. When the order finally makes its way down to the wards and care homes, it will simply be another variety of mangrove complete with its own impenetrable offshoots of protocols and blue dockets.

PS That old Monty Python sketch is right on the money in terms of protocol driven healthcare. Except of course, these days doctors' white coats have been made illegal by the commissars, and you'll never see a nurse looking like a nurse any more- your modern nurse dresses in Kwik Fit mechanics overalls.

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