“Everybody, soon or late, sits down to a banquet of consequences” Robert Louis Stevenson.
I know what its like when you’re the front door of a system that could and you feel, should, operate better. It’s frustrating – sandwiched between good practice and a rigid procedure and pretty powerless to intervene. I can understand it, been there, got the beaten-down tee shirt. Hence, this blog comes with a big spoonful of acknowledging that it’s rare that an individual does one thing that causes the problem.
Today Isaac had a neurology appointment, 33 miles from home at 10:10. Having got up at 6:00 to feed him his breakfast earlier than usual, then bath him, because travel too soon after feed causes reflux we left at 0815 arriving, through traffic purgatory, at 9:40. Arriving at the outpatients reception at 9:55 we thought we were well in time for his appointment. Which he was called through for at 11:10. We then left at 12:00 meaning his lunch was delayed and I had to take a full day’s leave from work rather than half a day as I would have only got in at 14:00.
See, that paragraph above will be similar to a lot of complaint letters to trusts, I guess. ‘The previous patient was more complex than we thought’, ‘we were short staffed’, ‘we were late starting due to an emergency case’ all of which are individually perfectly acceptable on occasion and all of which we have heard in what is over 100 hospital clinic appointments in 3.5years (and double that in the community services). There are times when we all have the day from hell and something gives. We’ve experienced ‘the consultant isn’t even in today, I don’t know why you got this appointment sent out’, or when we’ve seen someone ‘sorry, there’s only ‘the boss’ can give an opinion on Isaac and he’s not in’ to all manner of other things that exasperate and you swallow down.
It annoys me, but the annoyance is my issue, not the system’s. However, situations like this morning the most affected person is Isaac and that’s when the annoyance really, really rises. So some people grab a pen and etch a fiery letter into a pad and send it to the customer care departments. Who then reply. Who then pass it to someone further along the chain (definitely), who then apologises again (definitely) and takes the letter to a meeting where it’s discussed (definitely), reviewed (hopefully) and someone actually recognises the effect that stuff kicking out of sync at 10:10 on a Monday morning meant Isaac had an hour sat in a hot chair uncomfortable and bored (now that’s taking empathy…still hopeful) and then someone, somewhere in the systems that we as a family don’t see maybe thinks about whether this appointment represented an outlier on a spreadsheet and can be normalised and not acted on or whether it’s a terrible experience that we need to ensure doesn’t happen again.
I’m not cynical, I hope. I have met people in the NHS at all levels that would say that this sort of thing should not happen, and must be improved. What I fear is that I don’t intend to complain about today, but by not am I acquiescing with the poor appointment slot planning ? Must I bring it up to point it out?
My whole outlook is that I have met very few people involved in Isaac’s care who don’t either embody every aspect of good quality care or aspire to achieve it. Systems however, don’t have a face and can either quietly make a huge positive difference or quietly continue to fail ; I know it is so much more complex than I present it in terms of commissioning, in terms of prioritisation, in terms of the nature of the appointments in neurology meaning there will be more dialogue and discussion, but if i’m presenting it ‘it felt like a delay and was uncomfortable’ then I think I speak on behalf of a 3 year old, who can’t even tell the flipping time, level of reasoning. You’re ‘working out’ doesn’t carry points as much as your answer does.
I dearly wish that we can go the rest of 2014, let alone longer, without similar experiences as today but with Isaac’s care being across 3 hospitals and in the region of 6 disciplines I guess if I was a gambling man i’d be leaving my money in my pocket.
I hope i’ve not sounded really negative, like I say we accept it so so many times, but I guess I just felt motivated to remind readers of the ripple that swells out from a late running clinic. Every effort to stop this should be made, and i’ll sleep easy when I believe that it really is being made.