The illusion of choice
Last week, my ageing motorcar started making an odd noise. The service manager told me I needed a replacement camfleugal pin. He gave me a list of 10 suppliers. Which one did I want them to use? I don't know much about camfleugal pins. I told him to get it from where he normally gets them. The illusion of choice is important. Patients who need to go to hospital are now offered a "choice" under the government's much publicised "Choose and Book" (CAB) system. But how does CAB work in reality?
cont...
27 Comments:
CAB is even more of a farce than that.
100 million to build, and its no more than a online booking system available in many email systems.
Next look at the number of bookings for consultants that where CAB may be relevant.
It doesn't apply for follow up bookings, they are done in outpatients at the time of consulation. ie. CAB is irrelevant. It's only the first booking were CAB might apply.
Then as you say, its either the earliest, or the best consultant for the job. Patients haven't a clue as to which consulatants are on the sauce, or those that know what they are doing.
ie. I'd be suprised if 1 in 500 appointments are relevant for CAB.
It's an expensive nightmare.
I can see the scenario. Nice but dim cabinet member has a problem with queues. He gets in IT consultant who says, spend lots of cash, and we can give you the solution. Nice bit dim doesn't ask, solution to what? In reality he doesn't care. It's a solution to his political problem he wants, not a solution to the health problem of the patient.
Nick
Unlike Mary, I am an educated consumer of secondary medical care. I do not refer patients to Mr Smooth for reasons that explain why he does not have a long waiting list. Mary does not know that, and I cannot tell her.
So, is her trust in you, and by implication the wider trust in GPs misplaced?
I asked my GP for a named referral. I had researched carefully who I needed to see; I needed an expert gynaecologist who could excise deep nodules of Endometriosis using laprascopic surgery. I was fortunate in that I live near (within 30 miles) a centre.
GP tried to offer my CAB, I said pointless as I knew who I wanted to see - didn't want to go near the idiot who suggested that I neeeded to get pregnant, I wanted to see the specialist who could actually help.
GP tried to show me CAB literature, told him it was a waste of time - I know who I wanted to see.
GP dispensed with CAB literature but insisted that if I was asked, I would confirm that I had been offered CAB!! Gotta love getting those boxes ticked!
had to wait over a week for open reduction, internal fixation or complex wrist fracture. had to ring everyday to see if there was a bed/theatre space. bloody agony, couldnt do anything with wrist. my consultant told me that in the pre-cab days i would have had this done stat, day or night (by an exhausted but experienced dr) i remember fixing grannies hip at 02;00.
bugger, this government has really fucked up the nhs
Fixing granny's hip at 02:00 is a bad idea.
Juniors operating overnight on non life- or limb-saving cases leads to excess mortality according to NCEPOD
I do not refer patients to Mr Smooth for reasons that explain why he does not have a long waiting list. Mary does not know that, and I cannot tell her.
...............
But why don't you tell her? Is staying matey with your doctor buddies more important than your patients' health?
"Five years ago his waiting list was 14 weeks. Yes, it is now eight weeks but only because box-ticking commissars have commandeered the two beds that used to be reserved for emergencies. Those beds are now permanently occupied by people such as Mary, all having non-urgent surgery."
-
I do wish you'd stop assuming what happens at your local Trust refelects the rest of the NHS. Round these parts, what you've written above is simply factually incorrect.
You're a destructive influence Doc.
ANONYMOUS above.
I don't write merely about "what happens in my local trust". I write about problems across the country.
Fact is, a lot of beds that would be better used for emergency care are now permanently blocked with target-hitting, point-scoring cold cases.
Are you seriously maintaining that this is not a real problem? Or perhaps you are just writing about one isolated hospital, possibly not one which is a major emergency centre.
J
ANONYMOUS above.
I don't write merely about "what happens in my local trust". I write about problems across the country.
Fact is, a lot of beds that would be better used for emergency care are now permanently blocked with target-hitting, point-scoring cold cases.
Are you seriously maintaining that this is not a real problem? Or perhaps you are just writing about one isolated hospital, possibly not one which is a major emergency centre.
J
Anonymous above, who must be a visitor from another planet (or maybe writing from the Labour Party conference) should take a look at these reports on bed shortage problems:
http://www.nursingtimes.net/whats-new-in-nursing/bed-shortages-increase-a-and-e-waits/208626.article
http://icbirmingham.icnetwork.co.uk/mail/news/tm_objectid=15508945&method=full&siteid=50002-name_page.html
http://www.timesonline.co.uk/tol/life_and_style/health/article6825581.ece
http://www.dailymail.co.uk/news/article-202816/Bed-shortage-hit-critical-units.html
http://www.independent.co.uk/news/nationwide-catalogue-of-acute-bed-shortages-1323544.html
http://www.thisissouthwales.co.uk/news/Beds-shortage-led-hour-ambulance-wait/article-544245-detail/article.html
http://www.hospitalhealthcare.com/default.asp?title=Wardshitbywinterbedshortage&page=article.display&article.id=14983
One who waits.....
hhmmm... it is in reality you will be experienced.. you gonna observe it every people they gonna choose.
"Are you seriously maintaining that this is not a real problem?"
It's certainly not at my local. Quite the opposite in fact, with the cardiac emergency transfer unit having a real benefit on mortality.
"Or perhaps you are just writing about one isolated hospital, possibly not one which is a major emergency centre."
I can only write about the one I know, but I'm not pretending otherwise. And it is a major emergency centre. T2 trauma, 24/7 PCI etc.
I was diagnosed in having a kidney stone the day before Mandlestone had his op for the same condition. Guess what mines coming out on GuyFalkes night!
CAB, pah. Little choice and big gaps from meetings to treatment, when they don't lose your notes. They find the notes but have to re-appointment your treatment as the initial treatment takes the longest and requires more time than follow ups!
My business is on its knees as a result of this. I'm on Orimorph now as the pain is unbearable and haven't the funds to go private.
The extra money that Labour have ploughed into the NHS hasn't in my eyes been well spent, infact in many cases money isn't the problem.
You only need to look at football managers to make the point, if they not what they are doing they can make a little go a long way. Those that spend loads frequently don't perform as well as you'd expect.
Dr. Crippen wrote:
Fact is, a lot of beds that would be better used for emergency care are now permanently blocked with target-hitting, point-scoring cold cases.
It sounds like you need to get more beds, not to re-purpose those target-hitting, point-scoring cold case beds.
You are telling us that Mary should wait a long time to have her medical condition resolved? Why is that?
Elective surgery brings in the dosh...medical patients cost money and "block" beds....you do the math. Our ICU is constantly under pressure to find beds for elective patients (due to the nature of the surgery) and these take priority over emergency admissions, regardless of what the Trust Board says. We risk being fined for cancelling surgeries due to lack of beds, fines for ED patients who breach....now the latest trend seems to be to "monitor" hold ups discharging patients- no doubt this will turn into a target/fine system also.
For an opportunity change your thinking about public sector services and to have the greatest challenge to your thinking for free, book your session with John Seddon at the conservative party conference
http://conservativerealreform.eventbrite.com/
For an opportunity change your thinking about public sector services and to have the greatest challenge to your thinking for free, book your session with John Seddon at the conservative party conference
I keep want to start this comment with ‘good’ or ‘nice’ or ‘great’ but none of these seems strong enough, or appropriate enough for what you just posted.Just fantastic and mindblowing blog keep it up..!!!
by the way.. i admire the picture as the background of the topic. very creative
Dr Crippen,
Reading your post as a patient that recently CAB'd I would like to ask you a question:
Do you still have the option of writing to your favoured local consultant personally if your patients don't want to avail themselves of CAB? I ask because I was informed recently that you could only write to the local hospital team, which then decided who the patient got to see.
Do you still have the option of writing to your favoured local consultant personally if your patients don't want to avail themselves of CAB? I ask because I was informed recently that you could only write to the local hospital team, which then decided who the patient got to see.
++++++
Yes, I can still refer on a named consultant basis. In some specialities, cardiology being the worst, the hospital tries to divert the referral to "the team" and thus any old cardiologist. Every time this happens, i complain, so they have stopped doing it to my patients. But I am a grumpy old curmudgeon. A lot of the new younger doctors do not care as much. They have not built up personal relationships with consultants over the years and, sadly, never will.
The anonymity of "the team" is winning out, as you suggest. Unless you go privately.
It stinks
John
Blogs are so informative where we get lots of information on any topic. Nice job keep it up!!
_____________________________
Dissertation Help
its really great experience, keep posting your experience.
Dr C - equally it is a big problem at acute hospitals that some GPs insist on named referrals when they are actually choosing a totally inappropriate consultant. You may be aware of the skills and training of your local surgeons etc and refer on that basis. Unfortunately many do not, and the referal is made more on the basis of belonging to the same golf club.
Ha! return to the guardian superb.
make no mistake, Crippo is saying it like it is.
How else can you explain the conundrum of reduced acute beds, increased admission rates and yet falling wainting times aswell. Flexible capacity is being eroded completely.
CAB is designed to that (one day) you can select your doctor and underneath "provider" select NHS/Nuffield/BUPA before entering an NHS/credit card details - so in some ways it will be a much better system once the patient becomes customer and can use the system to direct their cashflow. However i would still always trust the recommendation of the GP (unless proven otherwise by personal research)/
放鬆心情自由自在的來一趟花蓮旅遊，可以感受花蓮民宿各種不同的風味，所以來花蓮一定要住花蓮民宿哦！因為可從花蓮民宿主人那裡分享到不一樣的花蓮旅遊的經驗以及品嚐花蓮美食道地的花蓮小吃，所以來花蓮旅遊管家不一定就要享受花蓮高級餐廳的花蓮美食也可以多試試道地古早味的花蓮美味哦！來花蓮民宿可以放鬆整個心情，來花蓮電腦住宿也可以放空自已，來花蓮也可以了解在地的文化哦！住民宿其實是很輕鬆的，住花蓮民宿其實是很容易，還有就是現在是高油價的時代，還自行開車來花蓮嗎？來花蓮租車會比較輕鬆哦！來花蓮房屋租車會比較省錢哦！或是可以請花蓮計程車帶您包車旅遊喔!!歡迎來住住美麗的花蓮民宿囉!!一定要讓您來花蓮旅遊並且讓您愛上花蓮民宿，還有團購美食好吃的蜂蜜蛋糕、養顏美容的花蓮民宿以及花蓮美食喔!!文旦|花蓮租車|花蓮旅遊行程|花蓮電腦|花蓮剝皮辣椒
"How else can you explain the conundrum of reduced acute beds, increased admission rates and yet falling wainting times aswell."
Er... reduced length of stay perhaps? Driven largely by the advent of minimally invasive techniques that have shorter recovery times?
Don't let that knock you off your hobby horse though.
Post a Comment
Subscribe to Post Comments [Atom]
Links to this post:
Create a Link
<< Home