Those that know me know that I am absolutely committed to learning; I love the idea of us all being critical friends to each other so that we can work closely with those who are providing public services on our behalf. I have been doing quite a bit of work in the NHS recently so I am aware of the challenges they face financially, structurally and in securing the wider public voice in policy making and service design. So this is my contribution to Havering CCG – make what you will of it. It is hot of the press: I have just returned home after spending all night in A&E with my son, so forgive me if it isn’t very well structured or particularly articulate. It is however, my experience for the ‘experts’ to use as they see fit, and my contribution to their learning.  I will send to COO of the CCG and the Local Healthwatch.

Catalyst

1am and my 16 year old is crying again (this has been on and off for the past two days). For those that know him you will find that hard to believe – a strong front row rugby player, unbelievably and frustratingly independent, and mature. But today he wants his mummy – I know it is bad because he got in my bed for a cuddle, but a cuddle from mummy just isn’t enough sometimes!

Chronology

He returned from Tunisia a couple of weeks ago and hasn’t been right since – sleeping in the day, low energy and just not been himself. He said he had a sore throat but in true working mum style he wasn’t dying so he was going to be fine! On Tuesday I was a bit worried so he went to the doctor (on his own because he is so annoyingly independent: he is a scientist so he knows symptoms, causation etc etc., and is a male, so doesn’t like going to the docs). Still I got him to go. Doc says nothing wrong, probably a virus and prescribed him with an anti-histamine spray to help.

Wednesday I returned from work to find him crying like a baby in agony. I gave him nurofen, gargled with salt water, brought him throat spray with anaesthetic in it, and hoped that would alleviate any pain while the virus left his body.  All the time questioning whether this really was a virus.

Thursday all day he was  crying on and off, and in what can only be described as excruciating pain when he tried to swallow his own saliva. None of the sprays were working, Nurofen was only working for about half an hour, he couldn’t bear the pain anymore. By 1am this morning (Thursday/Friday) I said ‘do you think it is bad enough to warrant a visit to A&E, to which he didn’t hesitate in saying yes.  I knew it was bad for him!

£7.50 in a cab to Queens Hospital to find it heaving with people – at least a 4 hour wait. Before I checked him in I asked the receptionist to tell me what the wait was at King Georges – it was about 2 hours. New taxi – £10 to King Georges. 5 people waiting and peacefully quiet.

Arrive at King George’s at about 2ish. They have 4 desks (3 were open and staffed). The ‘system’ is you go to desk one and she hand writes the basic details in a book, then gives you a colour coded card, and asks you to shuffle along to the girl sitting next to her (see how close they are from this pic) who now asks the same questions but adds in who your doctor is and checks our address. We are given a green card (low priority). I go and get a drink from the machine – £1.40 for a diet coke! And no healthy food to eat.

40 minutes later he is crying again. He can taste the puss in his mouth, and I can smell it! He is really not in a good place. This was clearly obvious to the receptionist, so she says she is referring him to ‘majors’ now. I think that means we have moved from the Urgent Care Centre where only one doctor is on duty to the A&E department where there is a team of ‘experts’.  There were a few more patients in there – maybe 5 in total?

20 minutes later he gets seen by triage (lots of staff around doing nothing so I am wondering why it takes 20 minutes but it was only 20 minutes I guess).

Once seen, I saw 2 more patients – total of 7 in A&E I think an none life threatening on immediate observation.

Triage says it is a bad infection and would like him monitored and seen asap as his pulse was a bit fast – 106. They also wanted to do his bloods to check he didn’t have malaria. Lovely staff who did the bloods – professional, friendly and kind.

Two doctors were sat at the desk for most of the time I was there (I only discovered they were doctors when I left – I thought they were receptionists because they hardly moved from the desk, talking about general stuff, not medical).

Over an hour later I wondered how long we might need to wait for the return of the blood tests, so I asked the doctor who was still sitting at the desk. His response was ‘we are busy’ to which I said ‘you’re not really that busy are you – there is no one around’. He didn’t like that at all so reminded me that earlier on (while we were waiting to be seen by the nurse) they had a mental health patient admitted from the local specialist mental health service – she had been self harming and was distressed. That incident took 3 cops and 2 NHS staff to deal with and they dealt with it reasonably ok (lots of room for improvement though). It lasted about 10 minutes. It had been deathly quiet since then and as far as I am aware the mental health patient didn’t have her bloods taken.  So he said ‘there is a sick child next door”. The child wasn’t that sick to attract the two doctors away from the desk though!

He told me he would have to look on the screen to see when the bloods come back, so I asked if he would mind doing that for me, to which he said “no, wait for the other doctor to come back – he has just popped away from the desk”. He was back in a couple of moments. We waited for his visit (we were about 4 steps away from him in a cubicle). One nurse offered me a cup of tea while we waited (which was welcome if not an awful taste!), two other nurses were unpacking deliveries and stocking shelves, one was talking to a patient whilst passing time. In total I counted 9 staff – none busy with patients.

40 minutes later the doctor came to see us and said my son had a severe throat infection which required antibiotics. They gave us the antibiotics and off we went home (£6.50 cab)

My initial reflections:

• If the doctor had diagnosed properly on Tuesday we would not be using the urgent care centre and then A&E;
• If the doctor had diagnosed properly on Tuesday my son would be better by now
• If the doctor had diagnosed properly on Tuesday we would have been sleeping tonight instead of using scarce resources which cost a lot more than a GP visit
• If the doctor had diagnosed properly on Tuesday we would be over £20 better off
• We have used the GP, Pharmacy, Urgent Care and A&E for a throat infection because the doctor did not diagnose properly
• If we can see and smell the infection, why couldn’t the doctor?
• Queens hospital was packed to the rafters and King George’s empty – they are about 3 miles apart – resource allocation?
• Next time the NHS berate the public for using A&E incorrectly they might want to check if the doctor hadn’t diagnosed properly
• The other people there attended for a urinary tract infection which wasn’t going since seeing her doctor; another had suspected broken rib from a holiday, one had mental health problems, and I am unsure about the other 3.
• Where is this experience captured by the NHS? I am not on the Patient Reference Group, a member of the PPG, nor a member of Healthwatch. I don’t need a self help group, I don’t need to be re-educated about how to use the NHS more effectively, and I don’t need the VCS to provide me with a service which the NHS don’t currently provide (all the foci of planning around engagement for CCGs at the moment).
• I want a high quality service from my GP which prevents this from happening again – he, after all, gets paid a reasonable some of money every year for my son, and he never has to see him (until this evening)
• Will I trust the doctor next time?
• Will my son go to the doctor next time?

Their vision

This is displayed in reception: passion? No, but some pleasant nurses trying their best; responsibility? No. Innovation? Far from it! Drive? Not a chance. Empowerment? Thankfully I empowered myself to challenge the poor service.

Signed – your critical friend x