NHS 'customer service' a priority

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The BBC are reporting:
NHS 'customer service' a priority

 

Can't complain about the service. There isn't any.

 

This is just my opinion.

CUSTOMER SERVICE!?!?!?!?!?!?! WTF?

I really don't understand this. Why are they spending money (and you had better beleive that when something like this is released there have been Meetings and working parties etc to generate it all of which cost serious money) on telling us to be huggy?

I have a Damn good GP. He is abrasive, short, sarcastic and often borderline rude. He has the bedside manner of an abatoir worker. However when i developed a new flavour of clusteral migraines he spent about 35 minutes going through an exhaustive history and a full neurological exam when he was already running about an hour late and had a waiting room full of patients! THAT is what people should want from their medics not a questionaire after the treatment along the lines of "My clinican was a jolly fine bloke with whom i would be happy to lift a pint. Strongly agree, agree, neither agree nor disagree etc"

As usual the masters on the NHS look upon the Steaming heap of excrement they have created and fearlessly tackle the big issues by sprinkling icing sugar on top of it.

I'm sorry if i sound fed up. Its because i'm fed up.

Robert

 

Nice to agree with UNISON and Robert.

A patient is a patient, not a client and still less a customer. This is the politically correct brigade trying to downgrade professional expertise to something resembling supplying breakfast cereal at a supermarket. Current government thinking in the U.K. is that altruism cannot exist and everything is related to money - a concept that Tony Blair picked up from Bill Clinton. That this is fatuous and perverted thinking can be demostrated by any half competent psychologist.

The patient may be the customer of a Health Trust but they are OUR patients, NHS or private. They are in pain, they may be bewildered and frightened, they certainly need reassurance and appropriate treatment. That is what we do.

If Sir Gerry Robinson thinks that he knows better then let him come to my clinic and inform the patient that I saw last week that her biopsy was positive for an aggressive malignant melanoma. Let him tell her through her tears that he is practising 'customer focus to make her experience as pleasant, straightforward and as unstressful as possible'. The experienced sister I had with me could teach him ten thousand times the lessons that he could teach her in that area.

I would not presume, and I take it that none of the contributors to this site would presume, to teach Sir Gerry how to run a television station. By the same token it is presumptuous and highly offensive that this jumped up salesman tries to teach us to do our job.

Rant over!

Bill Liggins

 

Well said Bill!

 

i have recently moved to texas and i pay the equivalent of 280 pounds a month for myself my husband and my son, which i think compares very favourably with how much we paid in GB. we have to pay the equivalent of 12.50 pounds whenever we see a doc, and 100 dollars for an inpatient hospital stay, this is with scott and white who are one of the top health plans in the country.
what does not compare is the level of service we recieve.
my son went to see a doctor on friday for a routine problem, we saw a fab peadiatrician, and he is having his operation on monday.
this is normal over here, we have checkups, blood tests and scans every year, whenever we see the doc we also see a nurse and have our bp and weight checked, and are asked if there is anything else we need help with.
whenever i saw my gp in wales i always felt like he was bored and didnt not take anything seriously, i had to wait a year for a scan on my ovaries, in the meantime we moved, when i got to texas i had a scan within one week.

i worked in the nhs for 11 years as a podiatrist, and while i feel my treatment of patients was great, i did not have access to nail drills, silipos, orthotic materials or quality pharmacy supplies, i could only see my patients every 6 months. so really my level of customer service was poor. i was not even able to have access to a doppler, and when i asked for one i was told it was not neccesary and i could just as easily palpate the pulses, i only saw high risk and diabetics, and this was one of my main bugbears.

my grandfather was told by a rude and forceful nurse to get up and walk to the bathroom 20 minutes after having a quad bypass 4 years ago, he died an hour later, my grandmother went to her hateful rude and sarcastic gp for a year with back and stomach pains and bleeding from the rectum, he told her to go home and take a laxative - FOR A YEAR, he did no tests in the 10 or so times she went back, by the end of the year she was in agony, she paid privatly for a scan, they got her in the next day and she was told she had advanced colon cancer, she died within 2 weeks.
these are just 2 examples of customer care in my family alone, i can think of many more, its disgusting and needs to be changed, britain is a third world country to me after living here
there is no comparison and the sooner GB switches to private healthcare the better.

i loved my job, and miss my family, but i will never go back, im really bitter -sorry!

 

Hello Milo

I don't know how long you have been in the USA but you are entirely missing the point. The debate does not concern the relative advantages/disadvantages of the two systems. The situation under discussion is 'spin' which has been ever present in the U.K. for the past 10 years at least. Sir Gerry, a non-medic individual, amongst others, is trying to make a faulty system appear better than the reality by encouraging a 'charm offensive'; why else would a television magnate think that he could 'fix' such a complex organisation?

If you were born in the U.K. or spent much time here, then you will know that the ethos of 'treatment free at the point of delivery' evolved over millenia from religious bodies providing hospitals (in France, still Hotels de Dieu) in which practitioners freely gave of their expertise. You will also know that although healthcare delivery has changed, the ethos of unrewarded committment has not (which of us refuse to treat patients because a clinic over-runs. Which of us does not carry out CPD in our own time, or even contribute to sites such as this?) That is why this latest government initiative is so insulting. You make the case by pointing out that in your experience you were under resourced. It is entirely possible that the reason was taxpayers money being spent on pointless initiatives such as this, or otherwise wasted.

You make staff happy by providing them with a suitable environment to deliver their service to the best of their ability. You make staff decidedly unhappy by spending the resources on 'fat cats' who know damn all and who manufacture boorish statements against those who do.

Bill Liggins

P.S. I have not seen the poll referred to, but a pound to a penny it's as full of holes as big as Dr Gill Morgan's mouth!

 

Quite agree, Bill, and your comments regarding patients -v- customers certainly has my sympathy, but I do think the report touches on a serious issue in the NHS - the way patients are treated by frontline staff. Robert says his GP is "abrasive, short, sarcastic and often borderline rude" and applauds this approach, which may be ok for Robert, however many other people might just find this offensive and distressful. Recently, one of my patients - a real nice elderly lady - developed a bleeding nipple. The GP fastracked her to the breast clinic and when she was eventually seen by the consultant (a four and a half hour wait after her appointment time) he said " So you have a bleeding nipple - you think that's serious? What a waste of my time. Haven't you heard of mastitis?" I suppose you could say he was just being sarcastic and borderline rude, but as it turned out following some investigations, she had Paget's disease of the nipple and duct and later had a mastectomy - something she coped with admirably. What she found most distressing - and still does - was the consultant's attitude during the initial visit. Not surprisingly, he never apologised, even when the results of the investigation came back, but I suspect he might have a different approach in his private rooms.

Have to say that after two decades working in the NHS this kind of attitude is more widespread than many acknowledge - and not just within the ranks of consultant surgeons who - a minority - especially seem to cultivate this kind of behaviour. The last podiatry department I worked with in Blackpool had a significant number of staff whose behaviour to each other and to patients was appalling. The staff/staff and staff/patient relationship was described by an external review agency as "dysfunctional" and had serious consequences for patient care. A core element of staff - maybe 30% of the department - went out their way to make life as unpleasant as possible for colleagues and their attitude towards patients under their care was little different. Having worked in many NHS Trusts throughout the UK, I would say this was not an isolated case and if anything, it is getting worse. Dare I suggest it is institutionalised?

Fully agree that some of this could be down to frustration and exasperation at government and management "initiatives", but there should be a personal responsibility to treat patients with due consideration, courtesy and dare I say, kindness, unless, of course, they happen to be abrasive, sarcastic, rude GPs or consultant surgeons or traffic wardens or politicians. Then it's open season.

 

Hello Mark

I have no quarrel with your point. Courtesy costs nothing and should be a natural attribute, especially when dealing with vulnerable people and colleagues.

The point I was making related to Bob's eloquent expression 'covering the excrement with icing sugar' and the arrant hypocricy associated with politicians teaching good manners to their peons.

Of course, we should all follow our leaders and defer to the outgoing Deputy Prime Minister in matters of courtesy, delicacy and gentlemanly behaviour!

All the best

Bill

 

Hi Bill , Mark et al

I don't know if you actually saw the documentary Bill?? but his guy talked a lot of sense in it. He was totally opposed to the plague of the NHS "THE MEETING".All those working parties meetings that produce no result but then there follows endless rounds of meetings as to why there is no desicions made from the previous meetings and the vast waste of public funds that accompany this culture. He also was trying desperately to give clinicians their power back in the decision making of patient treatment matters.

My own local trust had a "working party (costing £10,000,000 of tax payers money) about where to build a new super hospital. All was agreed but along came the minister of health( that useless bloody woman) and stuck her oar in buggered the whole thing up so badly the hospital is no longer to be built. The existing hospital is in such a state they ARE actually removing light bulbs from the corridors to save money!!!. The chief executive (#3 in just over a year) was sacked /resigned with a £600,000 pay off for her greatest achievement which is to have created more administrators posts than clinicians in that hospital and closed wards /beds . nursing posts in the process. Morale in that hospital is non existent.

In my days in that hospital some 4 decades ago there was 1 hospital secretary, 1 assistant and 1 matron that ran 5 hospitals not just one AND they were run properly !!!!!!

My elderly Aunt (92) fell a couple of weeks ago and fractured her hip. I spent four and a half hours standing in A & E whilst they were finding her a bed. She was left without food or drink (nil by mouth for 4 days) and my wife reported when she visited the old girl was by an open window frozen cold and covered in her own excrement and unable to talk because her mouth was caked dry. They promptly came in rolling her over onto her fractured hip causing her to scream in pain and then just left her. They made the mistake of thinking because she was old she was daft which if they had taken the time to speak to her they would have known nothing is further from the truth !!. She told my wife the nursing staff were rough and one in particular told her "thats what you deserve you've had your stint".
I have a Consultant friend in that hospital and asked her to "declare an interest" and she got the Elderly Care consultant involved. He immediately gave her 4 pints of whole blood as she was bleeding into her hip and instructed her to be fed, started her on antibiotics for the newly acquired chest infection. She had a hip replacement 3 days later which got her out of pain BUT she got MRSA and is now being barrier nursed.
I could go on and on but will say I have never seen such appalling nursing care. Why these unfeeling , uncaring people inflict themselves on the elderly is beyond me. I don't have a problem with her dying but is she at 92 not entitled to a dignified pain free death ??
That is basics That is where the NHS is failing BADLY
Cheers
Derek

 

Hello Derek

Agree 100%. Get back to basics and stop the Health Secretary and her army of cohorts from mouthing platitudes. Unfortunately the current culture not only encourages but demands hordes of managers/administrators and their fellow travellers. I suppose no publicity is bad publicity but what is required is action, led by clinicians who are dedicated and determined, not by faceless beaurocrats.

Bring back sister led wards to whom cleaners, clerks etc. are responsible. HCAs responsible to registered nurses,nurses responsible for named patients, responsible to sister who is responsible to matron who inspects every day. Simple stuff but it worked and would work again. Trouble is, how are you going to clear out the dead wood?

Bill

 

Hi Bill
Just another point

As an IPP :- My clinic cannot over-run as the patients pay me to be seen on time ( they are busy people as well).

CPD ? Always in my own time and unpaid

And contribute to sites such as this ? To talk to my colleagues and vent my frustrations and listen to theirs a meeting of minds at different levels to which I hope we can all learn and pass that knowledge on to effect better patient care for all.

Cheers Fella

Derek

 

Hi Bill

We have to get rid of the "PC Muppet's" !!! Those who spout this absolute unworkable BO**OX that is crippling the clinician.

That is what Gerry Robinson was I think advocating in his documentary ( the last one. Worth a look if you can find it).

My colleague in my practice is an A&E consultant. He will tell you the NHS is STILL the best medical institution in the world bar none.

The problem is the scope of what is available is now so limited the pre and post follow up care to the major event is unavailable. BASICS again.

Bill I am a humble purveyor of foot care , how you get rid of this culture in the NHS ? I don't know better brains than mine will have to sort that one out.

But for starters lets get rid of "protocols" and bring back "clinical judgment" lets make the practitioner think again instead of remember ( It's worked for me for 40 years) Lets get rid of PC and bring back "COMMON SENSE"

Lets forget Harold Shipman and remember whatever you are capable of will never be realised until you commit the act, legislation and regulation will never alter that fact.

JEEEEEZ I could go on here forever but I will spare you that

I think you will get my mindset on this one , just an old chap rambling, or is it .......

Cheers
Derek

 

Interesting threads with some good opinions and worrying stories.

One point, Mark, you said

I think you misunderstood me. It's not the abrasive approach i applaud. What i applaud is the fact that he's a good doctor who takes the time and knows his stuff. In the case you talked about the consultant was wrong! he dismissed the case inappropriatly.

Given the choice we'd all like a doctor with the communication skills and the competance. Given the choice however i put competance first!

Regards
Robert

 

Fairy nuff, but as Bill said, courtesy costs nothing and in today's environment good communication is essential, especially where informed consent is concerned. That said, I had a referral today from an orthopaedic registrar who asked me to provide a pair of

Just can't get the staff these days, huh?

 

Hi Robert

I'm afraid competence alone is no good. Unless the patient understands the practitioners direction , the patient complience is removed and treatments will never succeed.
Just my opinion
Cheers
Derek

 

Hi Mark

I expect that is a secretarial error because the registrar used his Dictaphone.

Perhaps if he used his finger his communicative skills would improve ?
Cheers
Derek

 

An interesting idea. Perhaps thats why surgeons have a reputation as poor communicators. When patients are under GA you don't have to be so huggy.

I take you're point however. Compliance is sometimes necessary for treatments to work. (unless you are a paramedic!) Still not sure this will be best acheived by treating patients as customers. The customer, we are told is always right. Half the time people are patients because of something they are doing wrong! 30 stone people who have up until now led a sedentary lifestyle should probably not start with jogging.

Strangly whenever i use my finger to communicate people complain! Hey ho.

Regards
Robert

 

Think you're maybe missing the point, Robert. I'm no fan of DoH initiatives but it seems the focus of this particular one is to get clinicians to consider a patient-centred approach, which is similar to the principle of client-led systems used throughout business & commenrce. Sure the patient is not always right and sometimes the best advice for them is not that advice they may care to hear, but there are different strategies you can use to get the message over - without pissing them off to the point where they may enjoy castrating you or worse, report you to the HPC. In practice, I guess this means that instead of telling the old dear to "fcuk off cos her shoes are crap and that's the reason her corn is always septic" you might just have to give her a bit more time and try and explain, nicely, why this is so, what shoes would be the better option and where she could find them....hang on, I forgot, we don't treat patients in the NHS anymore, we just assess them....but you get my drift. Personally speaking, I would love to see all NHS care contracted out to private practitioners as it would create the greatest hike in clinical standards and patient care the profession would ever see. Slim chance of that though, huh?

 

I hate doing the explaining nicely bit. Its amazing how they all suddenly turn deaf and confused when you try to explain why shoes should be broadly foot shape.

I applaud the concept of the patient centre approach. I just don't feel its the MOST pressing concern for the NHS at the moment. I think the money and time could be better spent on, oh i don't know, cleaners for eg. In the heirachy of needs you only move to the next level when the present level is satisfied. Given the year we've had in the NHS i think they should be focusing on the fundamentals. Clean hospitals / clinics (for MRSA), adequate staffing levels, (so nurses have time to feed patients where need be and we get to do more than tell the patient whats wrong with them etc) and less working parties, reports, guidlines etc would be my suggestions.

But hey, i've been wrong before.

Regards
Robert

 

is this opinion just restricted to podiatry?

 

Podiatry is the only profession I have direct experience of, Andy, but I think you could apply the same principle to other primary care allied health professions like physiotherapy, SLT, dentistry & etc. Always said the NHS should concentrate its directly employed workforce in what it does best - acute and specialist care (i.e. hospital based provision) - and commission all other services direct from practitioners.

 

do you not feel we may end up with a situation similar to dentistry at the moment

 

That might well be the case, but has this been to the detriment of the dental profession? At some point the UK podiatry profession has to ask itself whether it's in the best interests of the profession or its patients to provide a second-class, low-cost foot health service which is restrictive in practice and care. Or should it strive to provide a comprehensive service in which its patients receive the best care possible and its practitioners are rewarded commensurate with the service they provide. The dental profession took that decision more than a decade ago and decided all the sh!te and bile that eminated from Richmond House and Whitehall weren't worth the trouble and set about developing an independent service for their patients, aided by a dedicated insurance scheme. Meanwhile the podiatry heirarchy still waits dutifully at the feeding trough for whatever scraps it can garner for its members......(Agenda for Change ....ad naseum..... )

 

should podiatry not be free at the point of delivery then?

 

That's a political issue Andy. Are legal services free at the point of delivery? Hairdressing? Dentistry? To whom is podiatry currently free at the point of delivery? At risk diabetics? Who arbitrates rationed care? The fact is podiatry in the NHS has been contracting for over a decade and many patients who have complex foot problems have been badly let down and neglected by the NHS. One question - why should healthcare be 'free at the point of delivery'?

 

not wanting to sound like i'm wearing a cardigan but is it not because we already pay for it through taxation.

BTW for me hairdressing is free at the point of delivery as my wife cuts it

 

whether it be a cardigan or a flak jacket is open to question, but our present system of taxation can only provide our citizens with a limited amount of cover - and as you will appreciate, podiatry comes way down the list of priotities. being somewhat parochial, what do you suggest is the best way of funding care for those who suffer from foot health problems?

 

I used to until she cut a large V into the back of my neck with scissors. As we were not yet married and her maiden name was Vousden i thought this was in the manner of the Cattle brand / Mark of zorro. Bled lots an i still have a scar.

So far as the Podiatry / Dentistry / Hairdressing debate. Everybody knows about dentists and what they can do, generally the public can be relied upon to seek a dentist if they have a problem with teeth.

Lots (most?) of people don't know about podiatrists and what we can do. If we start charging for treatments like biomechanics and nail surgery a lot of people might miss out on what we can do for them because they don't know enough about us / trust us enough to pay £200 for a pair of orthotics! I'm thinking in particular of the 75 YO with failing mental health and arthritic feet who would benefit hugely from orthotics. She might take a referral from her GP to go to the foot clinic, she's unlikly to save up her pension, seek out a private practice and pay through the eyes for the same service.

True. But many more have had good care and improved symptoms / standard of life which they would not / could not have paid for.

Regards
Robert

 

i take the kylie minogue approach, better the devil you know

 

That's got to be one of the most self-deprecating arguments I've heard in a while, Robart. I know podiatrists have a reputation for low self-esteem and professional inferiority, but you're in danger of sinking to uncharted depths here! Who says the public don't know what we do? Why not go out tomorrow to your local high street with a clipboard and ask a few dozen folk.... 1) what is a podiatrist? 2)what treatments do they provide? 3) who would you consult if you develop foot pain? .....and you might be pleasantly surprised.

You hit the nail on the head regarding trust though. Providing you have a good reputation for clinical competence and are reasonably adept at communication i.e. not rude or abrasive, you should be able to charge your patients a reasonable fee for your care. Personally I think £200 for the provision of custom orthoses is ridiculously low - Rx devices usually cost me between £90 and £120 plus postage. Factor in your initial consultation, examination and casting appointments, plus follow-up review and I would think a fee in the region of £500 - £700 would be more in order. Of course your 75 y/o lady with failing mental health and arthritic feet would more than likely not benefit from custom functional orthoses but might require a change in footwear with some simple insoles which might be a little less than your stated fee, but in my experience, charging a realistic fee is not an issue providing you help the patient and alleviate their symptoms.

One of the big problems for the profession is the culture of healthcare where it is 'free at the point of source' like the NHS in the UK. Of course it is not 'free' at all - the public pay dearly for healthcare through NI and general taxation - but the perception is that the NHS care is free therefore it has little or no value. Could be just another reason (some/many?) UK clinicians have that inferiority complex, mhmm?

 

Cheers for that. Wasn't depressed before. Am now. I have low self esteem and other people don't even think enough of me to spell my name right ' sob '

Sir humphrey Appleby once said "a pessimist is what an optimist calls a realist".

Why not? Because if i'm right i will be unpleasantly justified rather than pleasantly surprised and after this i might just slit my wrists at that point!

For the record there's a difference between having a professional inferiority complex and thinking that the GU Don't know just how much we can do.

Oh nice dig. Cheap shot, but nice.

Actually i have lots of such patients who benifit enormously from custom orthotics. We may have different ideas about what kind of custom orthotic mind. For the old and arthritic i find something like a Poron 94 over Lunarsoft composite to pre met with a Maxacaine forefoot cushion works wonders for both support and comfort. Of course the problem with using soft materials in casted orthotics is that they tend to bottom out after around 6-12 months and need replacing. Being, as we are, an NHS service and therefore free at the point of contact we can do this. Tricky if you are charging £200 (or indeed £500) per pair.

Regards
Robert

 

http://news.bbc.co.uk/1/hi/uk/6265500.stm

Seems like the boys in the van were coming back from a Customer Service seminar. Meanwhile, big John Smeaton had Glasgow's own variety of 'service' waiting for them... www.johnsmeaton.com