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The tail is still wagging the dog in the health service

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It started with a hole in the pavement - quite a big hole, and the paving stones surrounding it weren’t level. So we had - depending on your attitude - either a hazard or the makings of an assault course.

The lady down the road phoned the council twice and the man next door wrote to them. They said the paving irregularity did not yet meet the severity required to warrant action. There were potholers visiting at weekends, so goodness knows what constituted a proper ‘paving irregularity’.

Anyhow, on the other side of us is a nice elderly lady who reminds me a lot of Margaret Rutherford. She was walking home one evening a couple of weeks ago and she tripped on the paving irregularity breaking her arm in two places and her nose and cutting herself badly enough to need stitches to her head and arm.

Needless to say, the pavement was mended the next day - I believe this is called disposing of the evidence - but this lady is not the suing type. In fact, despite the best intentions of a health service care pathway, she is not any sort of type.

I could give you a litany of examples of poor care and medical misjudgement she has experienced over the past two weeks: the five nurses who were asked to get her a tetanus jab but were never seen again; the doctor who tried to discharge her while she was still on oxygen; and, the care plan that automatically signed her up for meals on wheels, an Age Concern visitor and contact with a health professional who brought her leaflets about care-home packages for the over-75s.

‘It’s dishonest to talk about patient-centred care when large parts of what we do is done to fit in with hospital systems, bureaucracy or the interests of the consultant’

All this for a woman who will be taking a hiking holiday in Peru in August and, in her 78th year, continues to be a tour guide for walking holidays in the south of England, among many other things. But I don’t want to depress you. I do, however, want to talk about patient-centred care in 2009.

My neighbour had a metal plate put in her arm, which is due for review this week. She phoned up to make her appointment and was told that she cannot come to the local hospital because the consultant dealing with her case won’t be there. She said she would wait until he would be there, but was told: ‘No, he doesn’t like coming here. He is based 35 miles away - you’ll have to go there.’
‘Oh dear,’ she said. ‘Well, I can get a lift up there next Friday.’

‘He doesn’t work Fridays. He’s a consultant you know. But we would be willing to pay your bus fare.’

Politicians talk about choice. Managers talk about customer service but still the tail is wagging the dog.

It’s fundamentally dishonest to talk about patient-centred care - let alone patient choice - when large parts of what we do are done to fit in with the bureaucracy, the hospital systems or the best interests of the consultant. My neighbour shrugs and says her arm will heal but she doesn’t trust or respect her health carers or her hospital - and it’s hard to blame her.

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