One in a Million? A Customer Service Problem in the NHS

 

The protestors and rioters from last week, who took a stand against wealth creation should perhaps also recognise how our National Health Service is the envy of the world and also how it would benefit from more tax revenues….which are made possible by more wealth creation…

A young woman in her early thirties sought treatment from her GP believing that she had sinusitis. The doctor noticed her acute discomfort and pain and realised that she needed to go to the hospital if her condition did not improve within four hours.

During the next four hours her condition did worsen and an ambulance was called. The paramedics came fairly quickly and looked into her pulse, eyes, breathing, and heart and carried out other checks to establish that she had not had a stroke or was not facing other imminent risks. Upon arrival at the hospital they passed patient on to the Accident and Emergency ward and went off to their base.  By this time, the patient was in acute pain from a pounding headache and the increasing level of nausea was adding to her discomfort. One of the paramedics remarked just before she left that what the patient was experiencing ‘was more than a sinus or a migraine’ and suggested urgent treatment by the doctor.

The ward sister had other ideas and after ‘processing’ the patient decided to place her in a queue. When asked how long it would take before a doctor would see the patient, she replied that there was a four hour wait. The patient’s family asked for a reconsideration which was denied. They then decided to take the patient to a private hospital where a team consisting of general practitioner, ENT/head specialist and a neurologist soon diagnosed meningitis and began an urgent course of treatment. The patient was discharged after six days of exceptional care and treatment and is now making a slow but sure recovery.

The patient’s family is considering making a formal complaint. However, they are also aware that the NHS is likely to come up with many defensive positions. The family has since discovered that serious meningitis patients, when not treated urgently, have had strokes and three have died. How is the A&E ward likely to respond to a formal complaint? They could resort to any one of the following number of positions or a combination of them:

• The ward sister was always aware of the risk factors but it was patient’s family who discharged the patient and therefore, deprived her of treatment;
• It was the family’s wish and right to take the patient to another hospital and the ward sister had no control over them; she allowed them to leave according to their wishes;
• Although a four hour delay had been ‘announced’, the ward sister or her team would have kept a close watch on the patient and would have either moved her to the top of the list or taken her straight to the doctors’ treatment room upon seeing any evidence of life threatening developments;
• The patient’s family decided to leave the hospital at around midnight and at that time the hospital had limited resources but a long queue of patients;
• Although the family had exposed the patient to considerable risk, the ward sister did not consider that it was her responsibility to stop the family from taking away a patient that the health service’s own ambulance service had brought in.
•  The advice given by the paramedic that ‘it is more than just a migraine or sinus attack’ was not completely lost or ignored.

The family has a firm view that given the propensity of the health service to make excuses or to offer implausible explanations couched in medical jargon, they are not going to make a complaint. The family also believes that the entire process of registering a complaint is time consuming and unproductive. ‘The NHS is very good at defending itself’, they say.

Had the patient’s condition worsened and especially if she had become exposed to irreversible danger, the A&E ward would admit that it had ‘several lessons to learn from this incident’. Following, at best, an acceptance of mismanagement but not a formal admission of liability the business of the A&E ward would have returned to normal. 

The views held by the family about the NHS and their perceptions of the health service’s slick approach to freeing itself from risk factors and dealing with danger leave very serious concerns. There is, of course, also the dreaded statement “There are lessons to be learnt from this episode…. and all response mechanisms for dealing with similar cases in the future have been thoroughly upgraded”.  One member of the family is less convinced. Is it not becoming too common for service providers to fail miserably before they admit to having lessons to learn?