Feature

Losing their patients?

Everybody is talking about the quality of health services — but nobody’s asking the people who know, says Arthur Clarke

This is a true account of something which happened a few days ago. Will it make people — especially health workers — stop and think?

The ambulance man knocked loudly but vainly on the door: vainly, because the patient whom he sought to take to hospital was next door. The patient was waiting when the ambulance arrived and waiting when it left. The patient was waiting because he was told that the ambulance might call at 10 o’clock, or thereabouts, for the 11 o’clock appointment. He was ready, even though it was only 9 o’clock.

The poor old patient sits, ready to be carried out when the ambulance men arrive. He’d like a cup of tea and some pain-killers, but these are not permitted until after the appointment. Ten o’clock comes: no ambulance seems to have arrived — leave it a little longer. Ten-twenty: the worried patient phones the hospital. He discovers that the ambulance has called but they aren’t aware that it called next door. He asks whether, when they did not receive a reply from the patient, they could have telephoned him? No, the hospital says, this is not possible because ambulance telephones are for limited purposes and are able only to phone the hospital unit to report that they have not collected the patient.

This leads to a further question: couldn’t the hospital, knowing that the patient had not been picked up, have phoned the patient to find out if anything was wrong? After all, he might be on the floor, fallen off something, in a bad state. Well, it didn’t happen.

He asks if an ambulance will now call and is told not today, everything is off now.

So what we have is this: an ambulance and staff have wasted their time; wasted phone-calls; presumably wasted time of the doctor; NHS resources wasted. To a small degree, perhaps, but no doubt they could be multiplied many times. And it is so unnecessary, and hard on the patient.

The story doesn’t end there. Two days later a letter arrives following some conversation on the phone. It turns out that the doctor thinks all is well and that there is no need to see the patient. So if the ambulance had picked up the patient, if the patient had gone to the hospital it would have been a waste in any case. The doctor didn’t need to see the patient anyway.

So here’s the problem: whose responsibility is this wasteful episode? The ambulance men? They do as they are told. They might have tried next door, knocked on the windows and should, of course, have a phone to call the patient when they get no reply. Hospital staff? Can’t tell — too many people involved. The doctor? His late decision raises the question: why could this decision not have been made much earlier and then there would be no worry, no trouble, no pain, no pointless ambulance call? The episode would not have taken place.

Of course, this is a small instance. Nothing great in it, except that there may be hundreds — even thousands — of other similar wastes of time throughout the country every year. The NHS should get down to brass tacks to look at some of these small examples to find out what goes wrong and why. In the meantime, patients should not be patient. The problem is, of course, the Authorities and Bureaucrats don’t have it in mind. The problem is that the patients lack vitality, are tired and wan and often are very old.