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The Administrative Experience NHS Exposed’s very own webmaster experiences the NHS first hand. Our Webmaster spent a total of three hours at a hospital appointment with a elderly lady. Inspired to write about his experiences, James Landon tells us his view of the administrative staff. Sometimes, in a quiet moment (not that we have many of those at NHS Exposed!), I wonder about this web site and its subject matter. Is the National Health Service really the inefficient, disaster-ridden apology for a public service that our readers constantly tell us it is? Perhaps, in moments of stress, they have simply had the misfortune to encounter a similarly stressed, tired NHS employee or two, and this has inadvertently clouded their view of the entire system? And then I have my own dealings with the NHS, and I realise yet again that, yes, the NHS is, in fact, a national disgrace. It is a badly run, chaotic, lumbering behemoth of an organisation, in which the efforts of those staff members (and there are many) who actually care about patients are constantly thwarted by unfettered bureaucracy and the negligent, couldn’t-care-less attitude of their jobsworth colleagues. Recently, I escorted an elderly lady to an out patients appointment at my local hospital – it would be unfair to identify the hospital in question, as I know that similar incidents occur everywhere, all the time. Suffice to say that it is a large teaching hospital, where one might reasonably expect that things would be fairly well organised. We arrived at the hospital in plenty of time for the appointment, which was fortunate as locating the department proved surprisingly difficult – the appointment letter identified the consultant, and the part of the hospital, but neglected to mention that the clinic was on the first floor of this sprawling building. Naturally, the map enclosed with the letter was blithely unconcerned with these minor details, and although the building bristled with signposts, none of them mentioned the required department. Eventually, a passing nurse very kindly gave me precise directions, including the vital clue that the clinic was upstairs. We set off for the lifts and, sure enough, screwed to the wall in a suitably inconspicuous alcove by the lift was a sign, which, in letters no more than half an inch high, proclaimed the existence of the elusive department. Feeling justifiably triumphant we ascended one level, and again cast about for some clue as to the whereabouts of the clinic. None were in evidence, but the kindly nurse’s directions were impeccable and we found the clinic’s reception desk with only a little more wandering. The receptionist commandeered the appointment letter, read it, and then, not unreasonably, sought to confirm the patient’s name and address, before going on to ask about next of kin and her religion. This seemed a little excessive for an appointment concerning a sore knee, but at least she was being thorough. The patient, who is an approximately 5 feet tall, 73 years old Caucasian female with a cut glass English accent, was then asked to identify her ethnicity from a long, laminated, list taped to the top of the high reception desk. She obligingly stood on tiptoe to read the list, despite suffering from a sore knee, and pointed to her ethnic grouping as requested; how shorter patients accomplish this bureaucratic necessity is beyond me – perhaps the NHS provides them with a step ladder at the tax-payers’ expense. Having completed the formalities and returned the appointment letter, the receptionist directed us to take a seat in Waiting Area 1, a pleasantly open space complete with television and comfortable chairs situated some way along yet another corridor. The need for these amenities soon became apparent, as we waited, and waited… and waited. Eventually, a nurse appeared and told us we’d been sent to the wrong waiting area; apparently, we should have been in Waiting Area 2, which turned out to be a small, poky cubicle lacking in a TV but well provisioned with traditional hard, uncomfortable chairs. Clearly, this department was fully alongside the necessities of modern-day health care, which seemingly require the patient’s race, religion and next of kin to be slavishly recorded. Such outmoded concepts as sending them to the right clinic, as printed in bold in the appointment letter, are mere relics of a legacy system and have no place in contemporary medicine. Right? Upon arrival at Waiting Area 2, the patient was quickly and courteously addressed by another nurse; obviously, the chairs weren’t the only remnants of the old-style NHS in this waiting area! Even here, though, modern influences were at work. Having twice asked the patient which knee was giving her problems, and twice recorded the answer; the nurse proceeded to ask the patient if she was sure that the pain was in her right knee. With more, well, patience, than I felt was warranted at this stage, the patient confirmed that it was, helpfully adding that she knew this because that was the one that hurt. Is this triple confirmation really necessary? Are there really people out there who don’t know which of their somewhat limited choice of knees is hurting them? If so, and if they are sufficiently common for this to be standard operating procedure for medical staff, the human race has far more serious problems than a dysfunctional health service! Apparently satisfied that three identical answers were enough to suggest that the patient may possibly have a sore right knee, the nurse, still brimming with helpful courtesy, handed over a form and dispatched us to the X-Ray department, where we soon met three further shining examples of the Health Service’s finest. The reception desk in the X-Ray department was, thankfully, much lower than the specimen we had encountered earlier, and, upon arrival, we were able to watch over the top as we were professionally ignored by all three receptionists. These ladies were clearly highly skilled operatives, who had been extensively trained in the diverse arts of completely disregarding Joe Public. At one end of the counter, demonstrating the Obsessive Typing technique, sat a gloomy-looking lady with long, lank, red hair, parted in the middle in the manner that was last fashionable in the 1970s. Her attention was riveted to her computer screen, and the likelihood of attracting her attention seemed slim. Her colleague at the other end of the counter seemed equally unapproachable. Favouring the Telephonic Tittle-Tattle method, this generously proportioned lady sat with her back partly turned to the counter and a telephone propped under her ear. She was engrossed in recounting the scandalous events of a recent night out; pausing only to shovel a steady stream of sandwiches, sweets and fruit into her otherwise fully occupied mouth. Clearly this orifice would not have sufficient spare capacity to conduct a conversation with us for some considerable time. Backing up these two front line veterans of the receptionists’ trade with a competent performance of the Preoccupied Paper Pusher, yet ready to join the fray at the first sign of imminent customer service was Exhibit C. This lady cannot have been far short of retirement age, and clearly thought she looked better in high heels, a mini skirt and a Farrah Fawcett-style hairdo than was actually the case. The whole of her attention was devoted to redistributing small items of office flotsam and jetsam amongst the desks at the back of the room. The Obsessive Typist broke first. After some minutes, she carelessly glanced sideways, giving me the opportunity to thrust the patient’s form under her nose before she could look away. Obviously unhappy with her performance, she glanced at the form, tossed it onto a pile of similar forms on the desk and told us to take a seat in the already crowded waiting area. We did so, and settled in for a wait that was to last for more than one and a half hours. During this time, I had the opportunity to watch the Weird Sisters at, for want of a better word, work. The Telephonic Tittle-Tattler remained glued to her telephone, although it seems that the gossip session must have ended at some stage; on several occasions I heard her imperiously demanding, between nibbles, that no more patients be sent to X-Ray because they had a queue already. I have no doubt that patients in the clinics and on the wards would have been delighted to avoid the place if at all possible, but sometimes you’ve just got to have an X-Ray, regardless of whether or not a face-filling receptionist wants you to or not. An elderly gentleman with a military bearing hobbled into reception, leaning on a walking stick and obviously limping on his right leg. After being ignored for as long as possible, the Obsessive Typist glanced at his form and sent him back whence he had come because his form did not make it clear that the problem lay in his right leg. In vain did he protest that it was bloody obvious, that he could tell ‘em where to X-Ray, and couldn’t they just ring the clinic to confirm? Eventually, defeated, he hobbled away. For all I know he’s still limping along those endless corridors. The monotony was briefly broken by the Obsessive Typist’s shriek of “For the love of God, what’s it doing now?” As I watched, a laser printer that had been unwisely situated on top of a tall cupboard hummed into life and began to spew a stream of paper into the reception office. The geriatric Farrah Fawcett, with more agility than one would expect of someone her age, dragged a chair up to the cupboard, climbed up (health and safety regs, anyone?) and began hitting the printer with something – I couldn’t see what, but it sounded heavy – until it stopped. Not, I would venture to suggest, the best way to treat an expensive piece of equipment. I wonder what they’ll put on the fault report? Despite the T T-T’s demands, various porters arrived and deposited a growing number of patients in the waiting area, some in wheelchairs, some on trolleys, and, like those of us who had arrived under our own steam, all in an increasingly sour mood. A poster by the reception desk proclaimed that there had been 44 incidents of assault against Trust staff in the past three months, that this would not be tolerated and that all offenders would be prosecuted. Similar stern words strove to prohibit verbal abuse; there were no guidelines as to what would, or would not, be considered “verbal abuse”, but I strongly suspect that it would include any words implying that these good ladies couldn’t organise a booze up in a brewery, let alone run a busy reception desk. Of course, I do not advocate abuse or assault under any circumstances, but, having spent more than an hour and a half watching their antics, I can easily see how more intemperate individuals may feel inclined to unburden themselves of their irritation and frustration in a vocal, if not physical, manner. When her turn came, the patient I had accompanied was treated with care and courtesy by a friendly young radiographer, and we were soon back at the clinic, complete with X-Ray films. As we arrived, the receptionist – yes, the one who sent us to the wrong waiting area – was putting her coat on. She announced her intention to go home, and it was quite clear that she didn’t care one little bit whether we saw the consultant or not. I, however, had other ideas, and expressed them in a suitably forthright manner. Within minutes we were with the consultant, who, like all of the other medical staff we had dealt with, was polite and sympathetic towards his elderly patient. Despite being obviously very busy, and a little tired, he examined her and inspected the X-Rays with nothing less than absolute professionalism. The contrast between the medical staff and their secretarial / administrative colleagues couldn’t be more clearly defined, and I cannot help but wonder whether a large proportion of the Health Service’s problems can be directly attributed to the lazy, incompetent and downright negligent behaviour of its administrative staff. After all, it’s just a job to them; what do they care if they screw up? Medics must face the (admittedly incompetent) General Medical Council if they get things wrong, and risk being struck off if they’re negligent, but administrators are not answerable to any such body. Even if their behaviour is so bad that they get the sack, there is nothing to stop them from applying for other administrative posts, either within the NHS or elsewhere. In the absence of any central governing body for secretaries, receptionists and other support staff, perhaps the NHS should consider implementing something akin to the Alert Letter system so often deployed against medics. A central database of all past and present employees would be easy enough to implement, and could easily track problematic members of staff. A simple check would then be sufficient to prevent the NHS from employing – or re-employing – someone who has previously proved to be incompetent. Of course, in this politically correct, blame-free age, when identifying the patient’s religion, gender and ethnicity is deemed more important than sending them to the right consultant, such a measure is unlikely be implemented. Indeed, loud objections would be raised if it were to even be considered, and you just know that the loudest of all would come from the Weird Sisters and their innumerable kin. The Human Rights Act, or some equally worthy but poorly thought out legislation, would be dusted off, perverted and forced to prostitute its terms for the purpose of throttling common sense, and the full force of the law would ensure that the bone idle, ineffectual functionaries whose avoidance-of-work ethic is such a blight on the NHS today would still be in their jobs tomorrow. No amount of training – or retraining – will cure this malaise. The problem is not one of ability, but of attitude, which, in the majority of cases, can be summed up in one word: BAD. Patients are treated as a nuisance – a distracting interruption to be disposed of as swiftly as possible, rather than the reason that the NHS exists in the first place. Unless and until the NHS dispenses with the services (for want of a better word) of those employees who cannot grasp this fundamental concept, I cannot see how this once magnificent institution can hope to regain its former glory – or even survive.
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