Glad it urned out well in the end. I think your experiences are fairly typical, although I have seen some great efficiencies achieved through the use of community diagnostic centres that keep you away from hospital sites for procedures such as scans. But then the problem comes with poor communication between the bits of the NHS who are then responsible for the next steps. The 'scope of practice' issues that require 'decision escalation' definitely need review.
A further issue I've seen is the NHS estate. At a local hospital the other day only one set of lifts was working. So patients on beds who needed to be moved around needed to be taken on long journeys around the building and waited in queues just to get in the lift. This meant porters were delayed. They told me this was quite common and caused significant backlogs throughout the hospital. Hospital management are reluctant to invest in the building as they have been promised a significant re-build; in the meantime people just have to cope with the challenges of poor infrastructure.
The changes needed are compounded by the scale and complexity of the NHS and often the 'reforms' we introduce add to the muddle instead of streamlining. I'm not sure we spend enough time and energy understanding the patient journey and making the small, logical changes that would make that even a bit better for the next time.
Whilst the idea of community diagnostic centres is great at the moment they are massively underutilised. Mainly through a failure of ICBs to manage referral pathways. One local to me sits largely unused most of the day. GPs still “prefer” to refer people to the acute hospital for scans where there is a significant wait.
The company that built the diagnostic centre invested based on a claim from the ICB that referrals would follow although, bizarrely, this was never put into a contract. The upshot being we have people waiting AND unused capacity.
Sam it was your initial article about your experience in hospital that impressed me so much and I have followed you ever since. How you can be so dispassionate while so ill is quite stunning. Keep well and keep us informed, your substack with your father is a must read.
Last week my dad was hospitalised with severe kidney damage after a week of being unwell and repeatedly told it was just a side effect of his cancer treatment. It was only thanks to one diligent referral - who ordered a blood test at the eleventh hour - that the problem was caught at all.
So much of what you describe is identical to that week in hospital.
The contradictory updates from surgical teams about whether and when surgery might happen. The endless waiting without knowing if or when doctors would appear. The rotation of nursing teams that made every handover feel like starting from scratch.
I was struck by how many nurses were working three 12-hour shifts under 37-hour contracts - long, draining days that left little room for continuity and led to duplication. Every new team needed the same story retold.
But what stood out most was how little information flowed - not just to patients, but across the hospital itself. The nurses on my dad’s ward couldn’t see when theatre was ready or what had changed in his care plan. One evening, at 5pm, the surgeon and anaesthetist told us the operation would happen that night. By 11pm, the ward team still hadn’t heard back from theatre. I hounded the poor nurses to check with theatre every hour and then went home assuming it was postponed to the morning. Then, just before midnight, I got a call: he’d been taken in after all.
Everyone was working flat out, yet the system leaked time and trust through poor coordination and transparency.
Every ward, theatre, and diagnostic unit should operate from a single live dashboard so everyone works from the same information, cutting duplication and freeing nurses to nurse. Each ward should have a named coordinator responsible for realtime communication and clear oversight, supported by standardised handovers at fixed times to ensure continuity. Bedside staff and families should be able to see live care plans, ending the confusion of multiple versions of events. And every discharge should feed structured feedback on communication and coordination back into the system, so the NHS can learn from its daily friction as well as its successes.
I assume most of this should exist in policy but the gap of what patients experience of the NHS is so huge. These changes wouldn’t require another taskforce or ten year plan. They’d require connecting what already exists and making information more accessible.
The NHS clearly has world class clinicians working inside 20th-century systems. In my experience what fails patients isn’t their effort, it’s the fog between the different siloes.
Your system exists. We would like to have one but an it may happen, but only because our Theatre System is end of life - not because of any strategic goal. Previously when we asked for one the answer was no money. Capital investment is a mess.
Sorry to hear about your experience. It was very interesting to read your comments on efficiencies and I agreed with your analysis in IFG report. There is so much more to the NHS than hospitals and GPs though. I am on board of NHS trust that provides community based physical health care, mental health care, and prison healthcare. The first of these receive very little public comment and analysis as they are next to invisible to those who don’t use them but vital to those who depend on them. Our second area of work - in so far as it involves inpatient care - suffers similar problems to the acute physical sector e.g a view that there are plenty of beds and underfunded in capital terms (with the added challenges of staff subjected to violence and racism by patients). The third, prison healthcare, is much affected by the crisis in HMPPS, overcrowding, appalling estate, and the proportion of people in prison with poor mental health / neurodivergence / learning difficulties. There are many brilliant people working unlauded in these semi-hidden areas of the NHS and millions receiving care of a type that rarely receives attention from the commentariat as a whole.
Great article Sam, hope you're feeling rather better. My uncle had an emergency hip replacement last year (in a modern Kent hospital) which appeared to go well. My overall experience, especially trying to deal with it remotely, was similar in that how far you could get was pretty reliant on being confident enough to know the system and not give up. It also became clear that the bed managers (not a role I had come across before) were under huge pressure to keep things moving. This proved helpful when I needed information from A&E - the bed manager was the best person at knowing where my uncle actually was at any given moment, but it was less good when he was seriously ill with sepsis and one called me from his ward, didn't announce themselves, and asked if he had somewhere to be discharged to. I thought I was speaking to a nurse and confusion ensued - I thought that meant he was improving. I'm not convinced about information exchange generally. My uncle subsequently died, and the timings made it clear that the only place he could have picked up his infection was at what used to be the cottage hospital where he had been recouperating. The bereavement office of the main hospital phoned to ask for feedback. I'm not sure they were expecting any ! I mentioned that he must have picked up the infection at the cottage hospital - shouldn't they be informed. 'It's a different trust' came the response. I could make a complaint. I was more interested that someone knew the cottage hospital had a potentially serious infection issue. There appeared to be no obvious mechanism for that information to be shared at all, even though it could have been critical information for the other hospital. Eventually they thought it could be passed on as a 'learning point'. But no sense that it might be important or even urgent information that might be useful to someone else. This is where I think people in the NHS get locked into process and it leaves no room for common sense - much like your nurse who just did some more blood tests because she was told to. I've done some coaching in the NHS and I've seen examples of people being trained to take more intiative to deliver better results - not to follow rigid instructions but to focus on the desired outcome. Of course there is an important part for process to play but people still need to understand why they're doing what they're doing and be prepared to do something different if it makes more sense. There's a mindset thing there which needs to be challenged.
Nobody is in the hospital because they want to be so the whole experience of finding yourself in an emergency situation surrounded by others similarly mentally distressed brings added unwanted stress. I too am glad you have managed to get through this and hope the best for you. I rely on your insights to help me make sense of how the "system" works.
Over the last five years, I've unfortunately been dealing with serious but not life threatening health issues and consequently the NHS from GP to 3 different hospitals in London. Depending on the issue and the department involved, I've had both amazing world class treatment but at other times suffered from enormous waiting times and one inexplicable failure of the system.
Realising that I'm only one data point I've had really positive experience with Synnovis. Earlier in my health journey getting a blood test meant showing up in phlebotomy, taking a number from a dispenser and waiting. At one hospital, that could mean a wait of an hour or more in a very crowded waiting room, sometimes with standing room only. These days, my GP will give me a form for a blood test and I go home, log on to my account on the Synnovis website, select a day and time for the test with options for the next day at the test site of my choice, make my selection and when I show up at the allotted time I'm seen within minutes. I've had this experience many times now and was surprised to read your difficulty in getting a blood test.
The other really useful to me improvement in the NHS over the years I've been involved as a patient is Guys/St Thomas MyChart which not only has information about upcoming and past appointments, information about drugs, and information about the meaning of blood test results but also has the actual radiologist reports from CT scans and MRI scans as well as other tests given as well as write-ups from doctors of the results of doctor visits. Along with ChatGPT, this information has allowed me to better understand my health situation, do further research and be better able to make decisions which hitherto I would have been clueless about.
One issue you didn't mention that frequently strikes me when I'm sitting in waiting rooms for various departments is the number of people (like myself) with grey hair. We are living longer but not necessarily healthier lives and in any case the general breakdown of body systems as we age and the post world war baby boom seems to have put a great demand on the already struggling system.
Given the number of nurses and doctors I've dealt with over the past few years. I'm amazed that they almost to a person manage to maintain a positive attitude with their patients given the stresses of their job complicated by the inefficiencies of the system they work under.
MyChart is commonly used in the US. It allows patients to schedule and track all their appointments, and is a repository for doctor and hospital visit followups and test results.
It does feel to me like some app updates would help immensely. I've been waiting 10 months for some minor diagnostic tests. I then got a letter, informing me that my appointment was on a Monday... which I received on Tuesday. I then got a text message asking me if I wanted to rebook the appointment, to which I replied "Yes"... and never heard anything again.
Having a cancellation for an operation then receiving an appointment, but turns out for a post operative review. More than once….. the reality is a service made “efficient” to save for”cash releasing savings” and “quality improvement plans.” Cuts in plain language.
Glad you’re on the mend. Please learn the lesson! Don’t leave it too long next time.
As I was reading I couldn’t stop thinking of the parallels with education. Almost every point you could transpose across. The same mistakes have been made and continue to be made in education.
I also think the point about communication and information is particularly crucial. I have discharged myself from hospital in the past because the lack of information was causing me to combust. I got to the point where I thought I’d rather die at home. Bit dramatic, I know. But if I’d had some sense of how things would progress, I’d have been so much more able to manage things.
Sorry to hear about all the embuggerances, Sam. I would like to echo and amplify your call to improve NHS communication, which as you say could be done relatively cheaply and with a disproportionate impact on patient experience - and avoid serious anxiety.
My own much more trivial example will take some time to go through, for which I apologise, but feels worth quickly looking at as it shows the stopgap measures the bureaucracy has to employ - without considering the impact on patients.
It involved a referral from my GP to a clinic for a reasonably significant test. After a few weeks, I got a letter (and only a letter), announcing in bold text that “You have an appointment”. It went on to say “An appointment has been booked for you [at the hospital] as shown below”, followed by a date almost two years later, at 20 past midnight on a Sunday morning.
This seemed… annoying and deeply weird, but was pretty categoric. Only in the small print in the next section (About your appointment), in very convoluted language, did it eventually explain that “this is not your genuine appointment”, and I would receive a call or letter inviting me to my appointment “in due course”.
To rub salt in, it then said that I was forbidden to contact “the coordinator” to ask anything about the appointment - but if I hadn’t heard anything from them in six months (my responsibility) only then could I contact them.
This letter illustrates several points about the relationship between the NHS and the public.
Firstly, that there is no pressure on it to be open and honest with us. It’s clear they had no idea when a place would be available, but instead of saying this, they made up a completely fictitious appointment (as a placeholder on their own systems?), and felt that would be good enough for now.
Then there’s the issue of misleading the vulnerable. Many people getting this letter would take it seriously, and write down that ludicrous date and time in their calendars. The small print bit was confusing and irrational and didn’t look as categoric as the main bit. Who could send this letter without being aware of that?
Finally, there’s the ability to know you’re still being thought of. No contact with “the coordinator” was allowed. Unless you were painstaking enough to record that 6 months had passed and remembered you were now able to get in touch. You are reliant on waiting patiently for news (by post!). I can’t think of any other service that keeps its clients in the dark like this.
I fully understand the pressures the NHS (in all its siloed forms) is under. But if there was a Communication Unit that just looked at ways to keep people better informed (and through all the channels most people have available) - get Rory Sutherland and the Behavioural Sciences lot involved for clues (like the impact of bus-stop ETA boards on satisfaction with the bus services) - the relationship between the NHS and the public would be much healthier.
This happened to me too, 3.35am appointment at St Georges London. I went to GP and they went to phlebotomists, who opeate a different computer system. They brought out a nurse, she consulted someone else and then told me to ignore it. Why all this time wasting?
Some time in the early 1990s, my then boss told me that the best indicator of a successful health care system was the number of doctors per bed. He added that there were were two ways to change that ratio, and that the wrong one would likely be chosen.
Thank you for writing your article on the patient journey. I hope it gets noted at a high service level.
I am grateful here in Sheffield to be able to travel on the day for blood tests to two hospitals or a drive-in for phlebotomy services. It can take some time (1-2 hours in total door to door) and is not so easy for those who struggle to travel but I think it works very well. The nurses at the GPs will do bloods for some patients if needed. Blood results are often on the nhs app within 24/48 hours and the GP surgery is in touch quickly if any follow up is needed. So if I think I need my bloods doing I phone up, leave a message and a doctor either okays it (eg routine cholesterol) or calls back to discuss. We can get an appointment by phone and usually face to face on the day if we phone at 8 or 11am. I think this is great. I am sorry for those who cannot get this level of health care.
In your article though I was surprised that your GP sent you to A&E rather than sending you directly to hospital specialist services. It a no brainer for someone who is sick and who has your medical history and would likely bypass two levels of triage. I can only think that laziness or pressure of work (but that isn’t a good enough reason) stopped your GP from doing this. It would be interesting to find out what happened here.
Glad to hear you're on the mend. Sounds like you've been through the mill. Totally agree with what you've said & reflects our own experiences. Only our own persistence has prevented a bigger problem or possibly death. I often say to my husband & 95 yr old mum - what happens if you don't have the capacity (and money) to deal with these issues. Take care of yourself.
Thanks for the article - depressing but important to talk about. The only bit that grated was the final sentiment about not having to bankrupt yourself and the implication that we need to be ‘grateful’ for the NHS.
Yes, the US has such a system. However no country in Europe does, and surely we can learn lessons from how they run (and maybe pay for) healthcare.
If we constantly refer to US, it perpetuates the impression that we have only two options: either to stick with our failing system or to bankrupt ourself US-style.
It is strange that people obsess about the EU on trade / EU / single market issues but completely ignore it on healthcare where it has lots of lessons to teach us.
We don’t need to be grateful for the NHS. As you’ve illustrated, it’s a shocking mess with poor outcomes. Dozens of European examples are better.
Figures published in 2018 which do not account for the ongoing downward trends, the responses to Covid and the post covid recuperation.....if any! The mentality of the administrateurs has become that beds cost money and as such need to be cut.
Firstly: glad to hear you'll be okay; sorry to hear about all the waits. (My father has had a lot of interaction with the NHS in the last six months, and as a retired NHS member on the information side of things, would no doubt have a lot of detailed feedback on the care he's been receiving... but I think the most frustrating aspects have been around waiting for transport to be available.)
In terms of beds, do you know whether the problem is a physical lack of wards/beds, or a lack of staff to manage them? Obviously building new wards takes time and money - but if the problem is "we don't have enough staff to give gold standard care in all the wards we physically have, so some have been mothballed" I wonder whether there are ways of using mothballed wards as "this isn't great, but it's both more comfortable and more efficient than having patients waiting for 12 hours on chairs". I'm assuming if it were that simple, it would already have been thought of and implemented, but I'd still be interested in knowing where the bottlenecks are.
My mother recently had a short stay in hospital after an emergency admission. She was ready to go home on the Friday but they wouldn’t discharge her until a commode had been delivered. The problem, we eventually discovered, was they “are only delivered on Thursdays”. Had she not had a proactive and well-resourced family, she would have been blocking a bed for 6 days completely unnecessarily.
Glad it urned out well in the end. I think your experiences are fairly typical, although I have seen some great efficiencies achieved through the use of community diagnostic centres that keep you away from hospital sites for procedures such as scans. But then the problem comes with poor communication between the bits of the NHS who are then responsible for the next steps. The 'scope of practice' issues that require 'decision escalation' definitely need review.
A further issue I've seen is the NHS estate. At a local hospital the other day only one set of lifts was working. So patients on beds who needed to be moved around needed to be taken on long journeys around the building and waited in queues just to get in the lift. This meant porters were delayed. They told me this was quite common and caused significant backlogs throughout the hospital. Hospital management are reluctant to invest in the building as they have been promised a significant re-build; in the meantime people just have to cope with the challenges of poor infrastructure.
The changes needed are compounded by the scale and complexity of the NHS and often the 'reforms' we introduce add to the muddle instead of streamlining. I'm not sure we spend enough time and energy understanding the patient journey and making the small, logical changes that would make that even a bit better for the next time.
Whilst the idea of community diagnostic centres is great at the moment they are massively underutilised. Mainly through a failure of ICBs to manage referral pathways. One local to me sits largely unused most of the day. GPs still “prefer” to refer people to the acute hospital for scans where there is a significant wait.
The company that built the diagnostic centre invested based on a claim from the ICB that referrals would follow although, bizarrely, this was never put into a contract. The upshot being we have people waiting AND unused capacity.
This story is not unique to my locality
Sam it was your initial article about your experience in hospital that impressed me so much and I have followed you ever since. How you can be so dispassionate while so ill is quite stunning. Keep well and keep us informed, your substack with your father is a must read.
Last week my dad was hospitalised with severe kidney damage after a week of being unwell and repeatedly told it was just a side effect of his cancer treatment. It was only thanks to one diligent referral - who ordered a blood test at the eleventh hour - that the problem was caught at all.
So much of what you describe is identical to that week in hospital.
The contradictory updates from surgical teams about whether and when surgery might happen. The endless waiting without knowing if or when doctors would appear. The rotation of nursing teams that made every handover feel like starting from scratch.
I was struck by how many nurses were working three 12-hour shifts under 37-hour contracts - long, draining days that left little room for continuity and led to duplication. Every new team needed the same story retold.
But what stood out most was how little information flowed - not just to patients, but across the hospital itself. The nurses on my dad’s ward couldn’t see when theatre was ready or what had changed in his care plan. One evening, at 5pm, the surgeon and anaesthetist told us the operation would happen that night. By 11pm, the ward team still hadn’t heard back from theatre. I hounded the poor nurses to check with theatre every hour and then went home assuming it was postponed to the morning. Then, just before midnight, I got a call: he’d been taken in after all.
Everyone was working flat out, yet the system leaked time and trust through poor coordination and transparency.
Every ward, theatre, and diagnostic unit should operate from a single live dashboard so everyone works from the same information, cutting duplication and freeing nurses to nurse. Each ward should have a named coordinator responsible for realtime communication and clear oversight, supported by standardised handovers at fixed times to ensure continuity. Bedside staff and families should be able to see live care plans, ending the confusion of multiple versions of events. And every discharge should feed structured feedback on communication and coordination back into the system, so the NHS can learn from its daily friction as well as its successes.
I assume most of this should exist in policy but the gap of what patients experience of the NHS is so huge. These changes wouldn’t require another taskforce or ten year plan. They’d require connecting what already exists and making information more accessible.
The NHS clearly has world class clinicians working inside 20th-century systems. In my experience what fails patients isn’t their effort, it’s the fog between the different siloes.
Your system exists. We would like to have one but an it may happen, but only because our Theatre System is end of life - not because of any strategic goal. Previously when we asked for one the answer was no money. Capital investment is a mess.
Sorry to hear about your experience. It was very interesting to read your comments on efficiencies and I agreed with your analysis in IFG report. There is so much more to the NHS than hospitals and GPs though. I am on board of NHS trust that provides community based physical health care, mental health care, and prison healthcare. The first of these receive very little public comment and analysis as they are next to invisible to those who don’t use them but vital to those who depend on them. Our second area of work - in so far as it involves inpatient care - suffers similar problems to the acute physical sector e.g a view that there are plenty of beds and underfunded in capital terms (with the added challenges of staff subjected to violence and racism by patients). The third, prison healthcare, is much affected by the crisis in HMPPS, overcrowding, appalling estate, and the proportion of people in prison with poor mental health / neurodivergence / learning difficulties. There are many brilliant people working unlauded in these semi-hidden areas of the NHS and millions receiving care of a type that rarely receives attention from the commentariat as a whole.
Great article Sam, hope you're feeling rather better. My uncle had an emergency hip replacement last year (in a modern Kent hospital) which appeared to go well. My overall experience, especially trying to deal with it remotely, was similar in that how far you could get was pretty reliant on being confident enough to know the system and not give up. It also became clear that the bed managers (not a role I had come across before) were under huge pressure to keep things moving. This proved helpful when I needed information from A&E - the bed manager was the best person at knowing where my uncle actually was at any given moment, but it was less good when he was seriously ill with sepsis and one called me from his ward, didn't announce themselves, and asked if he had somewhere to be discharged to. I thought I was speaking to a nurse and confusion ensued - I thought that meant he was improving. I'm not convinced about information exchange generally. My uncle subsequently died, and the timings made it clear that the only place he could have picked up his infection was at what used to be the cottage hospital where he had been recouperating. The bereavement office of the main hospital phoned to ask for feedback. I'm not sure they were expecting any ! I mentioned that he must have picked up the infection at the cottage hospital - shouldn't they be informed. 'It's a different trust' came the response. I could make a complaint. I was more interested that someone knew the cottage hospital had a potentially serious infection issue. There appeared to be no obvious mechanism for that information to be shared at all, even though it could have been critical information for the other hospital. Eventually they thought it could be passed on as a 'learning point'. But no sense that it might be important or even urgent information that might be useful to someone else. This is where I think people in the NHS get locked into process and it leaves no room for common sense - much like your nurse who just did some more blood tests because she was told to. I've done some coaching in the NHS and I've seen examples of people being trained to take more intiative to deliver better results - not to follow rigid instructions but to focus on the desired outcome. Of course there is an important part for process to play but people still need to understand why they're doing what they're doing and be prepared to do something different if it makes more sense. There's a mindset thing there which needs to be challenged.
Nobody is in the hospital because they want to be so the whole experience of finding yourself in an emergency situation surrounded by others similarly mentally distressed brings added unwanted stress. I too am glad you have managed to get through this and hope the best for you. I rely on your insights to help me make sense of how the "system" works.
Over the last five years, I've unfortunately been dealing with serious but not life threatening health issues and consequently the NHS from GP to 3 different hospitals in London. Depending on the issue and the department involved, I've had both amazing world class treatment but at other times suffered from enormous waiting times and one inexplicable failure of the system.
Realising that I'm only one data point I've had really positive experience with Synnovis. Earlier in my health journey getting a blood test meant showing up in phlebotomy, taking a number from a dispenser and waiting. At one hospital, that could mean a wait of an hour or more in a very crowded waiting room, sometimes with standing room only. These days, my GP will give me a form for a blood test and I go home, log on to my account on the Synnovis website, select a day and time for the test with options for the next day at the test site of my choice, make my selection and when I show up at the allotted time I'm seen within minutes. I've had this experience many times now and was surprised to read your difficulty in getting a blood test.
The other really useful to me improvement in the NHS over the years I've been involved as a patient is Guys/St Thomas MyChart which not only has information about upcoming and past appointments, information about drugs, and information about the meaning of blood test results but also has the actual radiologist reports from CT scans and MRI scans as well as other tests given as well as write-ups from doctors of the results of doctor visits. Along with ChatGPT, this information has allowed me to better understand my health situation, do further research and be better able to make decisions which hitherto I would have been clueless about.
One issue you didn't mention that frequently strikes me when I'm sitting in waiting rooms for various departments is the number of people (like myself) with grey hair. We are living longer but not necessarily healthier lives and in any case the general breakdown of body systems as we age and the post world war baby boom seems to have put a great demand on the already struggling system.
Given the number of nurses and doctors I've dealt with over the past few years. I'm amazed that they almost to a person manage to maintain a positive attitude with their patients given the stresses of their job complicated by the inefficiencies of the system they work under.
MyChart is commonly used in the US. It allows patients to schedule and track all their appointments, and is a repository for doctor and hospital visit followups and test results.
Yes and MyChart also covers different trusts: I've got Guys and UCLH on mine (though they don't necessarily speak to each other)
It does feel to me like some app updates would help immensely. I've been waiting 10 months for some minor diagnostic tests. I then got a letter, informing me that my appointment was on a Monday... which I received on Tuesday. I then got a text message asking me if I wanted to rebook the appointment, to which I replied "Yes"... and never heard anything again.
Having a cancellation for an operation then receiving an appointment, but turns out for a post operative review. More than once….. the reality is a service made “efficient” to save for”cash releasing savings” and “quality improvement plans.” Cuts in plain language.
Glad you’re on the mend. Please learn the lesson! Don’t leave it too long next time.
As I was reading I couldn’t stop thinking of the parallels with education. Almost every point you could transpose across. The same mistakes have been made and continue to be made in education.
I also think the point about communication and information is particularly crucial. I have discharged myself from hospital in the past because the lack of information was causing me to combust. I got to the point where I thought I’d rather die at home. Bit dramatic, I know. But if I’d had some sense of how things would progress, I’d have been so much more able to manage things.
Sorry to hear about all the embuggerances, Sam. I would like to echo and amplify your call to improve NHS communication, which as you say could be done relatively cheaply and with a disproportionate impact on patient experience - and avoid serious anxiety.
My own much more trivial example will take some time to go through, for which I apologise, but feels worth quickly looking at as it shows the stopgap measures the bureaucracy has to employ - without considering the impact on patients.
It involved a referral from my GP to a clinic for a reasonably significant test. After a few weeks, I got a letter (and only a letter), announcing in bold text that “You have an appointment”. It went on to say “An appointment has been booked for you [at the hospital] as shown below”, followed by a date almost two years later, at 20 past midnight on a Sunday morning.
This seemed… annoying and deeply weird, but was pretty categoric. Only in the small print in the next section (About your appointment), in very convoluted language, did it eventually explain that “this is not your genuine appointment”, and I would receive a call or letter inviting me to my appointment “in due course”.
To rub salt in, it then said that I was forbidden to contact “the coordinator” to ask anything about the appointment - but if I hadn’t heard anything from them in six months (my responsibility) only then could I contact them.
This letter illustrates several points about the relationship between the NHS and the public.
Firstly, that there is no pressure on it to be open and honest with us. It’s clear they had no idea when a place would be available, but instead of saying this, they made up a completely fictitious appointment (as a placeholder on their own systems?), and felt that would be good enough for now.
Then there’s the issue of misleading the vulnerable. Many people getting this letter would take it seriously, and write down that ludicrous date and time in their calendars. The small print bit was confusing and irrational and didn’t look as categoric as the main bit. Who could send this letter without being aware of that?
Finally, there’s the ability to know you’re still being thought of. No contact with “the coordinator” was allowed. Unless you were painstaking enough to record that 6 months had passed and remembered you were now able to get in touch. You are reliant on waiting patiently for news (by post!). I can’t think of any other service that keeps its clients in the dark like this.
I fully understand the pressures the NHS (in all its siloed forms) is under. But if there was a Communication Unit that just looked at ways to keep people better informed (and through all the channels most people have available) - get Rory Sutherland and the Behavioural Sciences lot involved for clues (like the impact of bus-stop ETA boards on satisfaction with the bus services) - the relationship between the NHS and the public would be much healthier.
This happened to me too, 3.35am appointment at St Georges London. I went to GP and they went to phlebotomists, who opeate a different computer system. They brought out a nurse, she consulted someone else and then told me to ignore it. Why all this time wasting?
"I went to GP and they went to phlebotomists, who opeate a different computer system."
Seems odd that, within a single hospital system, the phlebotomist and the GPs are working within different computer systems.
I thought so too, but guess the phlebotomists were contractors as described in Sam’s piece.
Some time in the early 1990s, my then boss told me that the best indicator of a successful health care system was the number of doctors per bed. He added that there were were two ways to change that ratio, and that the wrong one would likely be chosen.
Thank you for writing your article on the patient journey. I hope it gets noted at a high service level.
I am grateful here in Sheffield to be able to travel on the day for blood tests to two hospitals or a drive-in for phlebotomy services. It can take some time (1-2 hours in total door to door) and is not so easy for those who struggle to travel but I think it works very well. The nurses at the GPs will do bloods for some patients if needed. Blood results are often on the nhs app within 24/48 hours and the GP surgery is in touch quickly if any follow up is needed. So if I think I need my bloods doing I phone up, leave a message and a doctor either okays it (eg routine cholesterol) or calls back to discuss. We can get an appointment by phone and usually face to face on the day if we phone at 8 or 11am. I think this is great. I am sorry for those who cannot get this level of health care.
In your article though I was surprised that your GP sent you to A&E rather than sending you directly to hospital specialist services. It a no brainer for someone who is sick and who has your medical history and would likely bypass two levels of triage. I can only think that laziness or pressure of work (but that isn’t a good enough reason) stopped your GP from doing this. It would be interesting to find out what happened here.
I hope the rest of your treatment goes well.
Glad to hear you're on the mend. Sounds like you've been through the mill. Totally agree with what you've said & reflects our own experiences. Only our own persistence has prevented a bigger problem or possibly death. I often say to my husband & 95 yr old mum - what happens if you don't have the capacity (and money) to deal with these issues. Take care of yourself.
Thanks for the article - depressing but important to talk about. The only bit that grated was the final sentiment about not having to bankrupt yourself and the implication that we need to be ‘grateful’ for the NHS.
Yes, the US has such a system. However no country in Europe does, and surely we can learn lessons from how they run (and maybe pay for) healthcare.
If we constantly refer to US, it perpetuates the impression that we have only two options: either to stick with our failing system or to bankrupt ourself US-style.
It is strange that people obsess about the EU on trade / EU / single market issues but completely ignore it on healthcare where it has lots of lessons to teach us.
We don’t need to be grateful for the NHS. As you’ve illustrated, it’s a shocking mess with poor outcomes. Dozens of European examples are better.
Many health systems on this side of the Channel are begining to resemble the NHS. they might not be the best source for "miracle solutions".
The quickest of glances at the second graph in this article suggests otherwise….
Figures published in 2018 which do not account for the ongoing downward trends, the responses to Covid and the post covid recuperation.....if any! The mentality of the administrateurs has become that beds cost money and as such need to be cut.
Firstly: glad to hear you'll be okay; sorry to hear about all the waits. (My father has had a lot of interaction with the NHS in the last six months, and as a retired NHS member on the information side of things, would no doubt have a lot of detailed feedback on the care he's been receiving... but I think the most frustrating aspects have been around waiting for transport to be available.)
In terms of beds, do you know whether the problem is a physical lack of wards/beds, or a lack of staff to manage them? Obviously building new wards takes time and money - but if the problem is "we don't have enough staff to give gold standard care in all the wards we physically have, so some have been mothballed" I wonder whether there are ways of using mothballed wards as "this isn't great, but it's both more comfortable and more efficient than having patients waiting for 12 hours on chairs". I'm assuming if it were that simple, it would already have been thought of and implemented, but I'd still be interested in knowing where the bottlenecks are.
Glad to hear you’ve been patched up. 👍🏼 Also exactly our experience.
My mother recently had a short stay in hospital after an emergency admission. She was ready to go home on the Friday but they wouldn’t discharge her until a commode had been delivered. The problem, we eventually discovered, was they “are only delivered on Thursdays”. Had she not had a proactive and well-resourced family, she would have been blocking a bed for 6 days completely unnecessarily.