Dear patient - why your care is getting shattered, not more 'joined up'

Healthcare is fragmenting as a result of changes ministers claim promote 'joined up care', finds a frustrated NHS worker.

16 January 2015

Dear Patients,

It has been a while since I last wrote. Since then the steady drip, drip of changes occurring around me have become easier to spot. They make my working life and your care so much more difficult.

When you come to see me you often tell me your lovely GP sent you for some ultra-sound and x-ray imaging, to help my diagnosis. Very thoughtful and sensible of them. Unfortunately, these days I find such scans have often been outsourced to a company outside of the NHS. The NHS still pays for it but because it is a private company, the images are stored in their own system. So as an NHS worker, I can’t always see the images. Which is a pity, because I do need the pictures as well as the report really, to make a good diagnosis.

The same problem arises for the poor patient who has a quick in-and-out job (the most lucrative) at a private facility funded by the NHS. They get their bits x-rayed there then. Later in the year, they see their regular NHS specialist consultant for their long-term ailment. The NHS consultant has a look to see if the patient has had any scans lately - and finds no images on the system.

I wonder who owns your images; the images of your body?

I’m finding the same problem with your blood test and other pathology and microbiology results lately. Several times a day I need to check recent results ordered by the different NHS health professionals who care for you. All your results used to be carried out in county NHS pathology labs and stored in one NHS-run system. But someone decided such services were ideal for outsourcing to other labs - including privately run labs - and now I struggle to find results of tests. They aren’t getting put on to an easily-accessible system for NHS workers. Sometimes the only way to see results is order more tests myself. It is all getting really quite tedious.

Apparently, a lot of the recent changes that have caused this fragmentation are in the name of better joined-up care. Who knew?!

‘Joined-up’ care takes many forms. A popular way to achieve it is to take bits of various departments and make a new, specialist one. Musculoskeletal teams (treating back and limb problems) are a particular favourite. Unfortunately, such teams often pluck workers from different departments then decide that the system is so new and innovative, that it’s really only fair to let the private sector bid to take it over. Oops! Didn’t see that one coming…

The new department has some lovely joined-up features but sometimes doesn’t join up very well with the rest of the county’s services.

And what’s left behind in the NHS is reduced in scope, limited to the expensive, complex and unpredictable cases the private companies don’t want to ‘cherry pick’, and struggling to survive as a result.

The government are particularly keen to ‘join up’ not just different bits of healthcare, but health and social care too - having unglued it in recent years, as I told you about last year.

Sounds like a great idea, doesn’t it? Where I work, the joined-up care message is coming through loud and clear. We have an integrated care team, a kind of recipe made up of bits of adult social care and bits of NHS. A consommé soup; little consistency or substance but looks good.

Of course the NHS budget is still ring-fenced, isn’t it? Erm…maybe not. Adult social care has leached a fair bit of our staff time to the new ‘integrated care team’. We had a jolly good game of ‘hunt the admin’ staff recently, following yet another complaint from a patient wondering where they had to go/what they had to do/who to speak to. We found them in the end; they had all gone to the new team to do council work. They said it was lucky that the NHS trust is still printed on their payslip or they might have forgotten what the job was that they were hired to do originally.

It’s not just round here - I gather this Better Care Fund thingy, taking cash away from the NHS into local government, isn't shaping up too well anywhere.

Friends in another county have told me about another way they are ‘re-joining’ health with stuff that’s been split off and re-branded ‘social’ care. Their NHS department (outsourced of course) now offers the so-called ‘social’ treatments on the same premises in the evening - for a fee.

Yes, you are thinking “but isn’t that on public property?” It’s ok - the government thought of that and they gave the premises to NHS Property Services (a private company), so it’s no longer yours.

Oh yes, I nearly forgot, dear Patient, I have some good news. Last time I wrote I mentioned a lovely lady who seemed destined to never improve with only de rigeur 'joined up' 'care in the community'. All my pleading went unheeded until she got a lot worse - leading to an emergency admission which resulted in her initial problems being solved. That's right, it took an emergency admission to get her a hospital stay (of several weeks) to solve a problem that 'community care' alone could not solve over a period of several years.

I'm not sure it that's a good result.

Anyway, I have to go now because I have offered to complete an 81-question survey for a friend and colleague who has completed a leadership course. This means she’ll be counted as having ‘managerial responsibilities’ - lots of clinicians do, something I wish Mr Farage would remember when he complains of too many managers. Anyway, I have to decide if she "encourages others to become 'ambassadors' for the vison and generates excitement about long-term aims". No, I'm not sure what it means either.

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