Care and Communication

Hello, how are you? Have you been alright
Through all those lonely, lonely, lonely, lonely nights?
That’s what I’d say, I’d tell you everything
If you’d pick up that telephone

Snipping the roll and placing the finger of my good hand on the end, the nurse crosses the room to answer the phone while I watch another emerge from the bay opposite, selecting materials from the grid of caddies in the centre, all the time recounting a trip to New York to the american voice behind the curtain.

It could be any efficient, industrial workplace; not up to a Japanese standard of 5S and JIT manufacturing, but getting there. The Plaster Room forms a corner of the Trauma Unit with a consulting area, reception, a ward, x-ray and a room used by physios completing the rectangle. Every few minutes staff step out from one of the doors like figures in a swiss clock to call a patient in from the comfy seats in the central waiting area. Behind the Trauma Unit doors it’s an exemplar of order, but getting there is another story. Unless you drive in and win the lottery for a space in Car Park 1, the routes to Trauma are long and confusing with the one from the West Wing requiring some inside knowledge. It could be a metaphor for the apparent disconnect between care and communication within the hospital.

The ringing stops, and I stop to wonder what’s odd about that? The ringing. It’s an internal call, like the one from the surgical ward to get me temporarily plastered again. Someone wants a standard sling sent over, but to a specialist in fracture treatment there’s no such thing as a ‘standard’ sling, so a sling diagnosis session ensues and I’ve got it. It’s the sound of the telephone. It’s the only one I’ve heard during five visits over two weeks. That’s not to say I haven’t seen and heard people using phones, just that the only other time I’ve heard a hospital ring tone was on the other end of a phone ringing in.

Is that the answer? Is that why the operator, cutting back in after several minutes or when the number finally rings out, has to keep trying other lines until all possibilities are exhausted, finishing with sorry, do you want try again later? Is it because nobody can hear the phones? Or is there a policy of muting and not answering external calls because they take up too much time? That would be fine if the communication were as efficient as the care and I always knew where I was supposed to be and at what time. But that isn’t the case. On two of the five occasions I didn’t know, and even when I did, twice I arrived long before my notes did.

It might only be admin, but the service can’t function efficiently without it. And in an age where information technology has revolutionised communication and information sharing so that several megabytes now reaches its destination on the other side of the world within seconds, why is a few kilobytes failing to make the journey from one clinic to another on the same site? Why does the NHS appear to be going backwards?

Along with Radiology’s image repository, there is an exception. An appointments database accessible from anywhere in the hospital along with a telephone and someone to answer it. But for that to be useful, your appointment needs to have been entered into it first, and if it hasn’t, then it’s back to the operator.

When I first arrived in the Hand And Plastic Injury clinic with a referral from Witney Minor Injuries Unit the night before, staff coped and my case was dealt with efficiently, I didn’t see any cracks. Then when I moved between clinics with a changeover time of 2 days I started travelling faster than my data. Now I’m settled into the Trauma Unit it’s caught up with me and, unlike the HAPI clinic, I’m given the details of my next appointment before I leave. I don’t need to spend long unproductive periods on the telephone.

For me it looks like another happy ending ahead. However, despite good facilities and people, I think my two weeks spent going back and forth to the JR with two cancelled operations shows a system under strain, and systems with no slack begin coughing up exceptions and problems that clog it up further. Which makes me anxious, because there are times when I rely heavily on our National Health Service, and I fear for our future together.

I agree with the NHA Party; the NHS has been far from safe in our Dave’s hands, despite his passionate assertions. And if it wasn’t for the Junior Doctors camped outside Jeremy Hunt’s door because he won’t talk to them, I don’t think there would any hope for it at all. They deserve our support.

Okay, so no one’s answering
Can’t you just let it ring a little longer, longer, longer?
I’ll just sit tight, through shadows of the night
Let it ring for evermore

Telephone Line, Jeff Lynne


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