Jo, I'm stuck for words . Unfortunately, I know only too well that this kind of ineptitude is commonplace, but the rage I'm feeling right now is fuelled by the fact that this is Vic's LIFE here.

There's not a lot I can say which wouldn't sound like some trite platitude and be completely useless - just keep your chin up, and please tell Vic that I'm thinking about her lots. Thinking about all of you, actually.

L

I'm stuck for words

Me too. Printable ones, anyway.

Infuriating (let's see if IE works).

Good luck. Pass on our good wishes to her. Here's hoping everything is back on track for a recovery in time for christmas.

You need to have a word with the Suspect Paki - http://www.suspectpaki.com/ - I would say share a beer but maybe you could have the beer and he'd have a mineral water.

Thing is, they don't have to do anything for you. They don't have to escalate things. Where else are you going to go if you don't like it?

Of course, you can complain. But chances are that you'll be told that their all working very hard and a mistake happened and all they can do is apologise. Nothing will get resolved, no-one will learn any lessons, no process will improve.

Only with competition will things improve.

I think your analysis is a little too disdainful of human beings, Tim. And that's coming from me, Mr Disdain.

Competition is probably the best way of ensuring that organizations perform well. It doesn't necessarily apply to individuals. Many individuals perform badly under competition and many perform well in isolation. All sorts of diverse things motivate humans, and it's very wrong to assume that the only one that matters is the desire to be better than everyone else. In fact, that's probably one of the least important.

The problem with the NHS, as a rule, is the organization, not the staff. There is a problem with the fact that it has no efficient way of distiguishing between good and bad staff, so there are some bad ones in the system who would probably not be tolerated in a private system. However — at least in Northern Ireland — they're a small minority. (Northern Irish nurses are generally brilliant. I suspect two reasons: (a) a large number of nurses from the South working in the system — they've not been infected by the academic aspirations of the RCN which have contributed so much to the degradation of care, and their presence sets a standard; and (b) Northern Irish people are dead nice.)


> Nothing will get resolved, no-one will learn any lessons, no process will improve.

No, this is wrong. Although mistakes have been made, some of which have been bloody stupid, one of the reasons for the mistakes is that Vic has a highly unusual combination of conditions, which the doctors simply have not come across before. I can't speak authoritatively for the hospital, but it does look like their procedures surrounding, for instance, the administration of Clexane to pregnant women are being reviewed and are likely to change. The obstetricians have been keen to find out exactly when the clots formed so that they can take measures to avoid it happening again. (And we've scuppered those attempts, because they would have involved diagnostic tests that would have contributed nothing to Vic's treatment ata time when she really wasn't up to it, so she refused them. But hey.)

There have also been recent improvements in doctors' attitudes towards Vic's ability to self-diagnose — they've finally realized that she's bloody good at it and are willing to take her word for things — and a complete change in their approach to discharging her: now that she's been readmitted three times, they've finally decided to err on the side of keeping her in hospital rather than sending her home ASAP.

And this all before we complain. Which I think we will.

There has been another relatively minor NHS-related saga going on during this time, which I haven't blogged about. The relevant organization has responded to our complaint by apologizing extremely profusely, taking the offedning member of staff off our case, assigning a new, better, attentive employee to us, and then apologizing some more.

Most people still go into the health business because they have a vocation, you know.

I don't think the people vs organization distinction is relevant, Squander. What matters is what system delivers highest quality health care. I'm not aware of any examples of service performance being raised by handing providers a captured audience. One of the things you might expect under competition is for innovations in checks and balances to be introduced that relieve any individual of the burden of remembering to do something by a certain time. In any business those checks and balances are standard - yet in healthcare one person forgets and there is no system that raises a red flag - and people stay sick longer, or even die, as a result.

Local factors do not explain your experience - exactly the same problems occur around the world wherever government runs healthcare. Its not about good vs. bad people, its about choice and being allowed to go to whichever organization has best solved the difficult problem of fixing sick people. Right now that choice is missing.

I think I can summarise: the system's fucked.

SquanderTwo,

I think your analysis is a little too disdainful of human beings, Tim.

No, I am criticising the system. I think perhaps I should have used "it" instead of "they". Although monopolies are good places for those who think its they, not the customer, that matters.

Often, in monopolistic systems, it's not that people don't care about customers, it's that they don't know what customers want, where competition shows providers what customers want because they spend their money with them.

And yes, money isn't always a highly motivating factor for individuals. I believe that competition would be good for many health individuals, because they'd be able to do their job better with more professional support.

Nothing will get resolved, no-one will learn any lessons, no process will improve.

Maybe that's a little barbed from my own experience with a medical problem I had with the NHS, where after resolving the problem myself, my GP didn't give two shits how I did it.

You're right. Processes can improve. There are lots of good people working in public service who want to do a good job.

But they don't have to improve. If a health visitor or their manager doesn't care enough to phone me when they're not coming to an appointment, what happens? Do they lose income, forcing them to reconsider their working practises to improve things, or just carry on as before?

Ben, Tim,

Compare the following statements:

"It is neither impossible nor unheard-of for improvements to occur within the NHS."

"The NHS is better than private medicine."

One is a reasonable summary of my last comment. The other is what you appear to be arguing with, for some reason.


Ben,

> Local factors do not explain your experience - exactly the same problems occur around the world wherever government runs healthcare.

What on Earth are you on about? The government dont run healthcare in all countries, therefore the government's running healthcare is a local factor.