Wednesday, November 19, 2014

In Defence of the NHS, part 2

In an earlier post on this subject I praised the hospital staff for their care and consideration of me, and others, during a short stay. I also lamented the attitude which I experienced of some GP receptionist staff. Although the person about whom I complained was very rude and uncompromising, maybe there is a deeper concern, perhaps endemic, which could give rise to such an attitude.

Since hospital I need certain medical equipment to enable me to live a normal life. A specialist nurse advised me, and supplied an initial stock of the equipment, together with the details necessary for re-ordering. When the re-order was necessary my preferred supplier advised that the local GP reception had reduced the order by 75%, had refused to deal with them again, and made no arrangement to inform me! Once again, on enquiry I discovered that notwithstanding my changing need my GP surgery will deal with only one supplier and is dismissive of the others.

There are certain implications in all this. the most charitable is that their preference is for economic reasons. Since the surgery do not pay the supplier directly (the bills are paid by the NHS centrally) the economies, if any, have to be procedural. Dealing with only one supplier provides for less confusion among staff, fewer destinations for prescriptions etc., easier training and control and a stable system. They also may be better able to assist patients with queries about the supplier and to smooth the path to hitch-free supply.

Contrast this with an alternative scenario. How much disruption to the GP's system would the presence of a competitor supplier cause? True there would be the possibility of the wrong document being sent to the wrong supplier, but with electronic mail and the innovation of the Electronic Prescription Service (EPS) this is negated. A little more training of staff may be necessary, but only concerning document recognition. An alternative supplier may be cheaper for the NHS, surely a consideration, and if they are found unreliable in their dealing with patients or GPs they can always be replaced; is that the rub?

When I was in commerce one of  my responsibilities as a manager was to deliver value for money. Our agents (other companies) were always under review, and they knew what was expected of them. If my company were not receiving the revenue expected, or the service agreed, meetings were arranged to thrash out any difficulties (on either side) and if matters continued to be less than satisfactory the agent was replaced. Why should that not happen in the NHS? I have no evidence to suggest that it doesn't other than the aggressive stance taken by the surgery and their operation of an apparent monopoly.Do they serve the best interests of the patient who ultimately pay their salary, the GP who directly employs them and has a tight budget to run, and the NHS which constantly tries to fit quarts of expenditure into pint pots of income? I'd like to think so but it should be transparent - it is MY NHS after all.

Competition is healthy for any business so long as it is fair, it forces prices down and service levels up. If a company is found wanting in any area the competition will eventually eliminate the laggard or force it to change. Monopolies on the other hand are incestuous, inflated, anti-improvement, and generally loss-making. Without profit there can be no new investment, no expansion to attract more staff, and probably no development. The company stagnates, becoming out-dated and fossilised, benefiting no-one. So the employees suffer, the patients too and the GPs and ultimately the NHS. Sound familiar? And all for the want of diversity.

Sunday, October 05, 2014

A great day out

As a member of an amateur operatic society in my youth I got used to dressing up and appearing in public, but there was always physical separation between them and me. To appear among the public, in costume and role playing would make me feel somewhat eccentric, but some do it on a regular basis. Today I visited Basing House, or at least the ruins of it, and witnessed for the first time something of a civil war re-enactment. There were Royalists in large hats with feathers and Parliamentarians in helmets and armour. Muskets cracked and a three-pounder cannon boomed. Orders, alien to modern ears, were rapped out and men with sixteen feet long pikes snapped to it. 

The site of Basing House is huge. The house used to be the size of Hampton Court Palace, in its prime, but was in fact two houses, the old (11th century) and the new (16th century) standing side by side. During the English civil war the owners of the house, Royalist supporters, together with their tenants and staff held out for three years against the Parliamentarian siege until eventually Oliver Cromwell arrived in person with six thousand troops and a very large gun. Holes were blasted in the walls, the postern gate was breached, and Cromwell's troops were in. Within forty five minutes the occupants were either dead or captured and the house was ablaze. Cromwell ordered its complete destruction.

The re-enactment does not seek to replicate the siege or its outcome, it is merely a flavour of the seventeenth century on the site of a historical event. What it does replicate is the costumes and weapons in as authentic appearance as possible. I cannot speak of the methods used to make them, but those materials used, wool, iron, wood etc are true to the age. Certainly the appearance is impressive, as is the knowledge of the event and the enthusiasm of the participants. The noise and smoke generated add to the atmosphere which is more than could be said for the younger children present who cried when the guns went off, but the afternoon was very pleasantly passed in the warm October sun.

Speaking to one or two of the participants it is clear that historical re-enactment is an absorbing hobby which takes many of them around the country. New recruits tend to be chosen as the early bodies, while the more experienced get to be musket men (a shotgun licence is necessary) or artillery men. There is an emphasis on safety, as you would expect, and the womenfolk also participate in the more craft related activities like lace-making or basket making. Cooking is also done in seventeenth century style (and we all got to take part in its consumption!), and there is a scribe and clerics. Truly something for all. 

Sunday, September 28, 2014

Politics

  I do not understand politics, I have never understood politics, and I shall never understand politics. When the referendum on Scotland's future was being held someone on my Twitter timeline suggested that if Scotland voted 'yes', David Cameron should resign. I failed to understand this since the referendum was not his idea, and was not involving anyone not resident in Scotland. When I protested I was told that it is the honourable thing to do since dissolution of the Union would happen on his watch. 

No one, so far as I saw, suggested that Mr Salmond should resign if the vote was 'no'. In the event he did, but as the referendum was his idea and he is the First Minister of Scotland should not his resignation have been mooted in the event that he lost? This seems to me to be manifestly unfair.

One of the founding principles of UKIP was the UK leaving membership of the EU. Of course they were, and are, unable to make good on their principle, but the Tories, currently in government, have promised a national referendum in 2017 if returned to power. To me the natural course for UKIP would be to align themselves with this promise, thus being in with a chance of extricating Britain from the clutches of Brussels. Even without themselves having power after 2015 (the mountain is simply too high and too steep for them at this time) UKIP voters, by ensuring a Tory majority could achieve at least one of their fundamental aims. But no, UKIP leaders have decided to align themselves more with the left of British politics, where no national referendum is in prospect (indeed Mr Milliband has explicitly ruled it out) thus falling at the first fence!

To me this has the effect of weakening not just UKIP's argument on Europe, but by extension it must surely call into question every other "principle" for which they campaign. Added to this is their reversal, within 48 hours, of their proposal for a "luxury tax", and their public embracing of the Tory defector Mark Reckless. Mr Reckless apparently lied to his erstwhile Association Chairman only two days before defecting about being solidly Conservative and willing to campaign for them in the coming General Election. By openly welcoming Mr Reckless UKIP have, to me, lost any remaining credibility as a political party. They now appear as a shiftless bunch of egotistical opportunists who no longer know what they want, but are prepared to say anything, do anything and sacrifice completely integrity of their party, their leaders and their voters for the temporary glare of the limelight. 

But, as I say, I do not understand politics.



Saturday, August 02, 2014

Family Ties

For the first time I more than a year my family gathered together for a celebration meal. Besides my daughter and two sons and their spouses there was the addition of a two year old, so we were eight at table. 

Number two son and his American wife volunteered to provide enchiladas, in our kitchen, and started work around 10 am. Using two slow cooking crock pots, and other mysterious gadgets chicken was prepared as was the sauce. Care had to be exercised to cater for dietary needs and personal tastes, so that finally three versions were provided. 

Salad was prepared also in two bowls to avoid a peppers contretemps. Beer was on hand for those who wanted it as was Coke, water, and just about anything else people might need. Abigail joined us at table, although she had eaten separately, and a convivial atmosphere ensued. Short work was made of the enchiladas, beer, salads et al and we sat and chatted for a while. Abigail entertained us with her two year old prattlings until her bedtime.

Number one son and his Norwegian wife (mainly her!) provided home-made ice cream, meringues, and strawberries in a sort of do-it-yourself Eton mess kit which, being delicious, was soon devoured! We then settled to a game or two of Cards Against Humanity. Hilarious, rude, irreverent and all round good fun the evening sped by.

It was a good evening. The Wife and I certainly enjoyed the experience and it was great to see the family together. The next opportunity will be at Easter 2015 so here's hoping that the experience can be repeated successfully then.

Tuesday, July 29, 2014

In Defence of the NHS

In nearly 72 years I have been incredibly lucky to never have been in hospital. Negative stories about the NHS are legion, but I have long suspected that those stories are about either unfortunate individuals on the receiving end of poor decisions or care; or about the leviathan bureaucracy that accompanies the institution. In mid July I had the opportunity to experience at first hand the UK's flagship institution, second only to the monarchy.

I had an appointment for an intimate procedure which would include at least one night's stay. All of the staff I encountered, from the off-duty nurse who directed me to the right area, to the Registrar who oversaw my procedure, were friendly, helpful, approachable and professional.

The ward to which I was assigned had just 6 beds, but was only a “bay” of about 5 similar bays which made up men's surgical. The whole unit is staffed by about 20 people from staff nurses to domestics, overseen by a Sister. They work incredibly hard. Our staff nurse was busy and on her feet from 8am for 12 hours (with breaks) and I not once detected impatience, irritation or anything other than a smile and a willingness to help. Sometimes one had to wait due to a more urgent need elsewhere, but the pleasant disposition never faltered. The night staff were just as attentive and caring, even performing routine tasks by torchlight to avoid disturbing sleeping patients.

One patient required surgery and was collected, in his bed, around 10 pm, destined for theatre. Some two hours later they wheeled him back, quietly, talking in hushed tones (not quite a whisper), and shielding a light from the rest of the ward. The ward staff had tasks to perform before they could leave him to sleep, and they went about their business as quietly as possible.

The food was adequate in quantity, not a serving that one might get at home, but bearing in mind the sedentary nature of one's stay it was enough. I certainly didn't feel hungry after eating. The variety on offer for each meal was reasonably extensive without being confusing, and there was always the chance of something extra for later on offer too. 

The secret, it seems to me, was that each ward had its own housekeeper whose job it was to oversee ward organisation, meal arrangements and cleaning regimes. There seemed also to be a spare room so that at intervals each ward would be moved in rotation enabling deep cleaning to be carried out. All in all, I was almost sorry to leave after three days, so welcoming and relaxing were the staff. I have nothing but praise for the dedication, hard work, caring attitudes, and reassurance I found on this my first foray into this arcane world.

Then there was the local GP's receptionist. On being discharged from hospital I was provided with certain equipment, which I needed, and was instructed in its use. I was also advised to ring up the supplier of that equipment to arrange future supplies, which I did at the earliest opportunity.

Two or three days later I had a phone call early morning from the receptionist complaining that I had used the wrong supplier as her system didn't recognise mine and in future, if I wanted to use the surgery I had better use her designated supplier, whom she failed to identify!

I think the difference in these two episodes can best be categorised by professional versus rank amateur. I'm willing to believe that Ms receptionist is good at her job vis a vis the doctors, but she has no people skills at all. Worse, she seems to believe that but for her no one understands the NHS, which would collapse under its own inefficiency if she weren't there to save it. People like that (and I am told that many doctors' receptionists are like it) get the NHS a bad name and the service, both to the public who pay them, and the surgeries who directly employ them would vastly benefit from some retraining or dismissal. These people are effectively the shop window of the NHS, the customer service representatives, and attitudes need to, and must, change. Many surgery receptionists deal with elderly and vulnerable people, and all of them deal with the sick with conditions ranging from relatively trivial to life-threatening. Many patients get confused when unwell and some are, alas, confused due to age or infirmity. To be faced with a harridan such as I encountered (and have formally complained about) is unhelpful, rude, arrogant and unnecessary. Save the NHS, get rid of the attitudes and those who exhibit them, and let's have a truly caring, helpful and world-class service.

Wednesday, October 23, 2013

Wedding

Paul & Cate married on the 16th October 2013. In the event, and sadly, the American contingent cried off some weeks before the event due to costs and the US government shutdown. As a result the attendees were the Hughes family large. Carl arrived looking very smart, and was superb with Abigail.

Cate looked fantastic. Her dress is by a new American designer and is spectacular. She took Paul's breath away when she arrived as he had not previously seen the dress, and he could barely take his eyes off her. She looked divine.

The chosen venue was the George & Falcon at Warnford. Paul, and Cate had spent considerable time planning and it showed. There was food aplenty, flowers in abundance, and the service was five star. The ceremony was simple, secular and friendly. Thereafter the proceedings went like clockwork. The staff knew us all by name, and nothing was any trouble, a wonderful day, immeasurably enhanced by the venue and its staff

Our family Vikings had made sterling efforts to attend, the girls taking time from school (including Camilla) and Christopher from University. Simon and Inger Anna were on leave from work, and Abigail had little choice. They all scrubbed up well, the boys looking smart and the girls very pretty. Simon officiated as best man and ring bearer and was rewarded by being an official witness on the register.

Maria had actually bought a dress for the occasion, and looked gorgeous. So seldom does she wear anything but trousers (at least when I see her) that I had almost forgotten that she has legs! She did wonderful duty as chief bridesmaid, ensuring that Cate's dress was always presented well to the cameras. She, too, was rewarded by being an official witness, thus ensuring immortality. 

Helen was resplendent in orange. From the flower in her hair, and the pashmina over a cream blouse, to the clutch bag she was a blaze of sunshine. Set off well by a full-length black skirt and shoes she certainly turned my head. Over the wedding breakfast she also performed her celebrated "I'm a Little Teapot" routine to much mirth and applause.

At the end of the evening our pre-booked taxi whisked us home, tired, happy, and slightly inebriated. It is no exaggeration to say that a good time was had by all.

Sunday, September 15, 2013

It Had to Happen

Well, after very many years, and several cats, the inevitable has happened. Previous posts have related the anxiety caused by our beloved Portia first going missing for some 9 hours, then just a week later becoming so ill within half a day that we feared we should lose her. In the interval between these dramas she continued to delight us, although obviously not fit and being very elderly. Then yesterday...

We are, and always have been, reasonably early risers. By 0730 yesterday we were up and doing and Portia was anxious to go out. Since we do not appreciate having to clean the floor after one of her "accidents" (she frequently misses her box) her freedom is one of our morning priorities, and so with collar donned (to operate the cat-flap) the door was opened and out she went. That was about 0745. By 0830 she had not returned, but that in itself is not unusual. As we were ready to go out ourselves then we left food and water, and the cat-flap open. We arrived home at about 1130 to find the food untouched. So far as we knew Portia had not eaten since the night before, had certainly not had her daily drugs and was now missing. Again!

And so began again the search of neighbour's gardens, the woodland which surrounds our property, garages, outhouses, undergrowth and anywhere we could think. Nothing, but this time at least the search was in daylight. By now it was gone 2 o'clock and a little light lunch beckoned, but before we could indulge the phone rang.

A veterinary practise some 8 miles away said they'd had our cat brought in and had traced us through the microchip she sports. Portia had been found wandering in a reasonably distant and remote part of our neighbourhood (a good ¼ mile away) evidently confused and obviously old and ill. Most vets are closed at the weekends and so the very kind lady took her to a vet within the store Pets at Home who traced us. We raced to rescue Portia, forsaking lunch, and brought her home with, unusually,
not a peep of protest from her at the long car journey. She spent at least two hours re-acclimatising to the house before relaxing and settling back down. There was no attempt to go out!

Another neighbour identified for us the kind lady who had taken in Portia, and we were able to phone and thank her. Fortunately she is a cat person who also runs a sanctuary in Greece and herself has two Maine coon cats. She leaves the country in another week - we dread to consider Portia's fate had her adventure been a week later.

We are resolved to not let Portia have free reign again, she is not safe anymore. The aperture in the back gate is blocked and her forays into the garden, which is otherwise enclosed, will be supervised. She no longer jumps high enough for the top of the fence. This morning was instructive. Portia was not happy at the new restrictions on her freedom, but over time she'll get used to it. We are not happy either at the new restrictions on our freedom but it is necessary for our sanity. We shall continue to monitor her progress and her adaptability to the new arrangements, which may become easier as the weather cools. We love her, and want to keep her with us for a lot longer yet.