The first things I’d like to say before I get going on this is that the NHS is an amazing thing. We’d be lost without it and I for one have experienced some of the very good sides of it in the last few days. The absence of blog posts for a while have been due to working fairly ridiculously hard of late both at work and at family. So hard in fact that I ignored a chest infection for a bit too long. Being an asthmatic, this is a very stupid thing to do as I learned at the weekend.
My cough turned very nasty. When I coughed I nearly fainted sometimes, I spent most of the weekend on the sofa asleep, when I got up I was very light headed. This had been going on, on and off to a much lesser extent for nearly a week, getting better, then getting much worse. Something was clearly wrong. Checking my peak flow (why I needed to do something so scientific when things were clearly wrong is beyond me now) showed what I’d feared, I was down to between 20-30% of normal lung function for someone of my age and height.
So, time to enter the world of NHS Direct. As the photograph at the top shows, my first attempt at this was somewhat abortive. Even trying to enter a single letter into the “What are your symptoms?” box led to the lovely error dialog. Graceful degradation appears not to be alive and well here.
I then went hunting for the phone number and called in. The voice prompt suggested that I should go through the online system first, but did give me a chance to talk to someone at the other end who triaged me very efficiently and courteously, clearly using some form of expert system.
They then passed me on very efficiently to a nurse who seemed to have quite a lot of the information from the conversations of the first pass, which was very encouraging. The further questions and answers led the nurse assessing me to deem me to be a priority case that according to the system would result in a GP coming out to me to have a listen to my chest and take action. Interestingly despite being registered at our local GP practice for over 2 years they still had me at my previous one, but eventually after a bit of Google/Google Maps work from me and a bit of reading out of postcodes of GPs near me from them we’d found my GP practice and I was logged into the system as a patient suffering acute asthmatic problems, likely to have been caused by a chest infection. Obviously if we had an electronic patient record system I wouldn’t have had to recount a history of my asthma or of my medication which normally keeps it well under control. We won’t go there though.
After a short while I received a call from a doctor. They first medical question was how long I’d been suffering from a urinary tract infection which was the first inkling I had that things weren’t quite so joined up. I then had to go through the entire patient history again. I was then told that although I was clearly a priority patient that I wouldn’t receive a home visit as if they went to every asthmatic who had called in that they “wouldn’t be able to get to any other patients”. It was suggested I walk to the walk-in clinic at St Georges which since I was in Tooting wasn’t too far, or that I drove there.
Both these options seemed foolhardy considering the patient history I’d given. Coughing left me light headed (coughing fit leading to light headedness while driving may be dangerous, possibly). A few moments with Google Maps just now suggests what I thought when talking to them on the phone that it’s about a mile to the walk-in clinic. Normally I’d be fine with that. However, on Sunday night walking to the bathroom on the same floor of our house was a challenge. They couldn’t tell me where the walk-in centre was or whether a cab could drop me a sensibly or safe short walk away from it. I was then told that if I was worried about walking that far I should call 999. This led me to question the prioritisation. If I wasn’t a priority case for a home assessment, what made me a priority case for using an ambulance for transport to and treatment in A&E. My breathing was very poor but controlled. Eventually after a period on hold I was told that a doctor would be coming to see me.
The doctor arrived within an hour. When he arrived he had a printout with him which I thought was quite exciting and endearing. It reminded me of Tom Taylor doing fun stuff with microprinters which always makes me smile. His first question to me was “What medication were you given when you visited the doctor last week about your throat infection?”. Both he and I seemed fairly incredulous when I told him that I hadn’t been to the doctor last week, certainly hadn’t been prescribed anything and hadn’t spoken to anyone about a throat infection at all in any of my conversations on the phone. I did have a sore throat, but only through coughing and the side effects of raised doses of inhaler deployed steroids. The question came from the spurious information on his printout which I now wish I had a copy of. He assessed me as having a chest infection, prescribed oral steroids and antibiotics and gave me a prescription for more inhalers. Neither he nor any part of the service he knew about could tell me where the 24 hour pharmacies were in the area.
I then had a hunt for a pharmacy. There’s a pretty good Pharmacy finder on the NHS Choices website. I played with some of the data backing NHS Choices at a Rewired State event so knew there was information in there about opening hours and postcode. Sadly there is no way on the site of combining these things to find the nearest pharmacy open when you need it.
You can search local and then look for ones open before 9am or after 5pm. Ironically these filters also seem a bit broken. Searching for local pharmacies open after 5pm gives me no results, even for ones which are clearly open after 5pm in their entry on the site. Map view? Nope… There is the lovely UK Pharmacy iPhone app, but that’s built on a the only official dataset there is, not the NHS one which has opening hours and telephone numbers, but a Neighbourhood Statistics dataset from 2006. This isn’t a criticism of the app, you work with what you have access to.
The whole experience shows more than ever that we have to join things up better. There were too many moments of misdirection of information for me to have confidence in the flow of the hard collected data from NHS Direct flowing to the local units and then from the local dispatch to the doctor who visited. Surely even with the dumbest internet connected phones and email we can move patient histories more coherently than this. It felt like chinese whispers played to the point of distruction. The outcome for me was good, I saw a doctor, but only partly because I questioned the wisdom of having an ambulance come and collect me.
As I’ve been taking the medications and abiding by the bedrest I was instructed to take. I’ve been watching what can only be described as a lot of daytime TV and news. My cognitive surplus deficit must be quite huge. I’ve heard a lot about decentralization of services, putting people in control, putting communities in control of service provision and local outcomes: The Big Society. After my experience I fear we are so far from systems that deliver information well between centralised services such as NHS Direct and parts of the frontline practice-led NHS that moving any further towards the vision set out last week may be running before we can crawl.
Those fears aside, I’d like to play my part in The Big Society, just to test it out (although some of us may claim to have volunteered on community projects for a while now). I’d like to volunteer to build a simple HTML5 local pharmacy thing. I just need the raw material. I’m signing up to get access the non-commercial use version of it here. However I’m rather slightly confused as to why I can’t commercialise anything I made out of it (presumably anything including an advert even to pay for hosting would be disallowed) in these wonderful days of open data and the ecosystems and new economies that are due to be flourishing from it.
