We were fortunate, here in Suffolk, to be part of the pilot for the new national 111 non emergency health service. I saw fortunate meaning that completely ironically. The last time Tigerboy was poorly, with a chest infection, I called NHSDirect and was taken through a questionnaire, then told I needed to see a doctor, so to call my doctor’s out of hours service. (I seem to remember that NHSDirect used to deal with out of hours themselves, but maybe I’m remembering that wrong.) When I called my doctor’s, I was told to call 111, who took me through the same questionnaire, but not nearly as smoothly, and then eventually gave me an appt at an out of hours service in the next town. I wonder what you do if you don’t drive 🙁 Oh hang on, we’ll get to that.
Last weekend, Friday night, Tigerboy spiked a temperature. It was sudden and hot, and given the weather we’d been having, even though I knew I’d been careful to keep him out of the sun and well hydrated, I worried that it was sun related. So I called 111.
Same long, completely irrelevant questionnaire, that contradicts some of what you’ve already told them, but they’ve got to go through anyway. And then when they’ve done that, they come to the conclusion you need to speak to a doctor. Obviously when they try to connect you to one there isn’t one available, so you’re told you’ll be called back in 5 to 10 minutes.
The first thing that’s obvious about 111 is there aren’t any clocks there. The call back took more like half an hour. During this time we were trying to cool Tigerboy off naturally – stripped down (not that he’d been wearing that much beforehand) and outside in the cool evening air, he wasn’t looking any happier though. Then the doctor finally calls back and starts taking a medical history. That long questionnaire? He can’t see the answers to it. Which makes it all rather pointless really 🙁 Given it’s a baby, it’s a given that they are going to want him to see a doctor, so I get told I’ll get another call back with an appointment. (I think that’s how it went. I should have made notes really.)
So eventually I’m given an appointment in 40 minutes time about 20 minutes drive away. I run around, cooking tea for everyone else, packing a bag, and eventually pile into the car and head off, arriving about 3 minutes late after I’ve driven aimlessly around the hospital trying to find the carpark I’m following signs for and then give up and go in the one I know about. Costs me £2 to park, which is nice.
Doesn’t matter about being late, takes over 20 minutes to be seen anyway.
The doctor I see appears to be new there. She doesn’t know where anything is – opens and shuts the same drawers in a set repeatedly trying to find covers for her thermometer and ear peery thing. Nothing about her demeanour gives me any confidence. She examines a screaming Tigerboy and declares he has tonsillitis and needs antibiotics, as well as calpol/nurofen alternating to bring his temperature down. If I can’t get his temp down or the antibiotics into him “you should worry” and bring him back. By this time it’s after 10 on a Friday night. Where am I going to get antibiotics? I know that there are two new late night chemists opened up just down the road from home, but she dismisses them, says they shut at 10 and goes off to ask the receptionist what I need to do.
Apparently the Sainsbury’s in the centre of town is open til 11. So I head off to find it.
It’s a good 20 minute drive away – I don’t know the centre of town very well, so I’m satnav reliant, but I do know I’m heading away from home. I arrive just after 10.30, to find the carpark empty and a bloke I recognise from the clinic standly forlornly outside locked doors, staring through at the grill inside.
“It’s shut,” he tells me, and certainly there’s no reason to disbelieve him. Even though there are still lights on, there’s no way in.
I’m starting to lose it now. I’m tired and stressed, I have a sick baby and I’ve been given the wrong instructions. I ring 111 back and fight my way past their attempt to requestionnaire me to explain the situation. I’m a bit cross and may raise my voice slightly. I’m promised a call back within 5 minutes.
Remember that missing clock?
Shortly after this, the woman who was with me in the clinic waiting room turns up in her taxi with her three children and husband. (So that’s what you do if you don’t drive. You get a taxi. Wonder what you do if you can’t afford a taxi.) Her child has also been diagnosed with tonsillitis, and she has a script for penicillin as well. I tell her it’s shut. As we’re standing outside the door discussing this, a member of staff appears inside, to let out a man carrying a prescription. Apparently what I should have done was ring the unmarked buzzer on the wall to get access to the pharmacy which *is* open til 11.
Beyond cross, I run in, prescription in hand, leaving the sleeping baby in the car in sight of the husband in the taxi, and forgetting to pick up my purse, which I could have used to buy calpol to start bringing his temperature down.
How long does it take to measure water into a bottle? Quite a long time it seems. The other woman tells the staff member to take me back out to get my purse so I can buy the calpol and grab the baby – we manage this with about a minute to spare before the tills go off at 11. And it gets better yet – the doctor has prescribed both of us a ten day course of antibiotics, but only given 5 days worth.
About 15 minutes later, on the drive home, I get a call back from 111. So that’s 30 minutes after I call. I use the speaker to explain my ire at not having been told about the buzzer, and it’s a short call.
I’ll cut the rest of this story short. Tigerboy won’t take the penicillin, and gets in such a state about it he throws up everything else, and then refuses calpol/nurofen. When I taste his medicine I can see why, it’s absolutely foul. Three unsuccessful doses later I call 111 again, and eventually get to speak to a sensible doctor I can understand, who fights her way through the system to find his previous notes, and refers me to another appointment with yet another doctor who gives me a different antibiotic and a thorough patronisation session. Just because I’m not a doctor doesn’t mean I’m stupid you know. Oh, and when I go to the chemist to pick up the new prescription, I discover it was open till 11, so I could have driven home the night before, got the prescription, and been in bed with the baby an hour before I was, without any of the stress, or the costs of the extra 40 minutes drive.
He takes the next antibiotic, and then throws it up 5 minutes later all over me. Despite this he seems to be getting better, so I cease and desist on all meds, and watch him carefully. Sure enough, 24 hours later, he’s a bit tired but all bounced back, apart from the after effects of the second antibiotic that turn his nappies black. Could be just me, but I don’t think that was tonsillitis then. And when I looked that up on NHSdirect, they don’t commonly give ABs for it anyway?
So, let’s summarise.
A questionnaire that doesn’t get passed to the doctor, and is of little use to the person reading it.
A computer system that doesn’t present previous *crucial* information without a fight.
Out of hours clinic miles from home, with doctors/staff without local knowledge, handing out insufficient and plain wrong information about chemists and dispensing inadequate prescriptions.
A waste of time and money, entirely probably endangering lives.
I can see a number of ways to make things better that would save money in the short and long run. But that requires joined up thinking, and I’m not sure any of our politicians understand that.