Atelier WeekNotes w/c 5 Feb and 12 Feb 2024

A tale of interacting with the NHS.

I am writing newsletter of #weeknotes of starting the Atelier of What’s Next (a studio for initiatives at the frontier of generating a better future). For my rationale for starting the Atelier see here.

Right. It happened again. A combination of work and family crises intersected, and the WeekNote got squeezed. Apologies.

In a break from our normal programming, below I have written up one of those crises, because it tells us something about Britain today, the context in which the rest of the work needs to happen.

• Scene 1: A GP surgery waiting area.

• Scene 2: A phone call. 

• Scene 3: A second phone call

• Scene 4: At Lewisham Hospital

• Reflections

A ‘standard’ WeekNotes, with updates on the Atelier priorities and initiatives, will come out in the coming week.

How can the Atelier of What's Next be of service to you, and your purposes? We'd love to hear from you. Perhaps you have a challenge or idea to put in the studio. Maybe one of our existing topics appeals to you. What if you love to make new things happen by being part of the studio? Or if you have feedback or comments that would improve this deck. Either click the button below or email davidbent@atelierwhatsnext.org.

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Scene 1: A GP surgery waiting area.

I go to my GP to pick up my children’s vaccination records. There is a measles outbreak in Lewisham. I’ve received a text alert and an email from their schools saying I need to check with my GP about whether they’ve had the MMR vaccine. My youngest was sick on the day recently when there were vaccinations. My eldest is, in effect, being home schooled. So, I can’t just rely not he school having got it right.

There are a few people ahead of me in the queue. There’s one receptionist.

Man 1 (mid-60s): I’m here to get my biopsy results. Guy's Hospital told me to get them from the GP.
Receptionist: You should get them from the hospital.
Man 1: Guy's hospital said to get them here.
Receptionist: Date of birth? (He gives it.) Name? (He gives.) Which hospital?
Man 1: Guy's.
Receptionist: What were you asking for?
Man 1 (teeth gritted): Biopsy results.
Receptionist: I’m just looking. No, we’ve not got it.
Man 1: They said they had sent it.

My past experience: when I was chasing some heart results recently, Lewisham Hospital laughed when I told them the name of my GP. “Oh, them, yes, they are always losing results."

Receptionist 1: Wait, I see. They sent it by what we call email. Not by what we call the test channel. I will ask them to send it to the test channel.
Man 1: so, what is the result?

Remember: this is the result for biopsy, presumably a possible cancer diagnosis.

Receptionist: I can’t tell you. You will have to make an appointment to be told by a doctor.

Man 1: Where, the hospital or here?
Receptionist: Dr S__-P____.
Man 1 (obviously and understandably put out): Dr S__-P____? Is there here or at the hospital?

Meanwhile, a queue is forming behind me.

Man 2 (mid-70s, just behind me in the queue): This surgery has really gone downhill.
Receptionist: The appointment will be here. You will need to make it online.

The GP surgery has a new-ish system. The receptionists don’t have access to the appointment system. New appointments can only be made online.

Man 1: OK.

He leaves. The queue is building very quickly behind me.

Man 3 (behind me, at end of queue): The machine is broken. We can’t log in to say we are for our appointments.
Receptionist: You can’t log in? The machine is broken?
Man 2, to the world in general: Makes you wonder what we pay our national insurance for.
Man 3: That’s right.
Receptionist: OK, I’ll do the registrations.

Five people go ahead of me, to register that they are here for their appointment. After each person is registered, a member of staff from the surgery interrupts the receptionist with a new task. Time passes.

Woman 1: I need to hand in my faeces sample.
Receptionist: Oh, I can’t take that. Not in that envelope.
Woman 1: It is in the container I was given! What am I supposed to do with it?
Receptionist: Give it to me around the corner.

Disappears for minutes. More staff interrupt her. Then back to the queue.

Receptionist: Oh, you have missed your appointment.
Woman 2 (late 80s, stooped): I was here on time! The machine wasn’t working!
Receptionist: I will see if we can fit you in.

More time passes. Eventually it is my turn.

Me: I’ve been instructed to get my children’s vaccine records to see if they need the MMR vaccine.
Receptionist: We don’t do vaccinations here.
Me:...
Me: I’m not asking for a vaccination. I’m asking for their records.
Receptionist (reluctantly): OK, what are their dates of birth and names?

She gives me the print outs. They are in medical jargon. I cannot see MMR or measles anywhere in them.

Scene 2: A phone call.

I call Lewisham School Health Immunisation Team (I found their number on a school email).

Lady with strong West African accent: Hello!

Me: I need to get my children to have the MMR vaccination. Where can I go?
Lady: Well, there is Down'm and Keale'soap. Do you know which is closest?
Me: Where is Downham? I don’t recognise that.

A quick Google search gives a village on just north of Burnley. I live in South East London.

Lady: It is near Goanp’ak.
Me: Where?
Lady: It is near Goanp’ak. Goanp’ak! Goanp’ak!
Me: I don’t understand that word. Could you spell it?
Lady: Goanp’ak! Goanp’ak! Goanp’ak! Goanp’ak!
Me: You keep saying the same word in the same way and I keep not understanding...
Lady: Goanp’ak! Goanp’ak! Goanp’ak! Goanp’ak!
Me:...
Me: Could you spell it?
Lady: G for…Golf!
Me: G.
Lady: R for…Road!
Me: R.
Lady: O for…Open!
Me: O.
Lady: V for…Very!
Me: V
Lady: E for…England!
Me: E
Lady: Pak for Pak!
Me: Grove Park?
Lady (like it is the most obvious thing in the world): Yes, Goanp’ak! Like I said, Goanp’ak!
Me:...
Me That’s not my closest clinic. The closest is probably the other one...
Lady: Keale’soap?

I happen to know the build name of the other clinic.

Me: …Kaleidoscope?
Lady: Yes, Keale’soap.
Me: And they definitely have a clinic open today?
Lady: yes, of course! Yes! I know for fact!
Me: OK. Thank you.

Scene 3: A second phone call

I call Kaleidoscope, just to check.

Me: Hello. I’m calling to check if you have an MMR vaccine clinic today.
Receptionist: I’m pretty sure we have a HPV vaccination clinic today.
Me: Right. But do you have an MMR vaccination clinic?
Receptionist: We do vaccinations.
Me: Sure. But, I’m talking about MMR vaccinations. Because I have had messages from the NHS saying there is a measles outbreak and I need to make sure my children are vaccinated. To go Kaleidoscope will take about 2 hours out of my day. So, I want to be certain that there is an MMR clinic.
Receptionist: Oh, you want to know if there is an MMR clinic?
Me: Yes!
Receptionist: You didn’t say MMR.
Me: ...
Receptionist: I will check.

Time passes.

Receptionist: No, there is no MMR clinic today. You will need to go to Lewisham Hospital on Thu or Fri.
Me: OK. Thank you.

Scene 4: At Lewisham Hospital

I arrive with my two children to the Education Centre in Lewisham Hospital that is doing the MMR clinic. I have an electronic copy letter from the Director of Public Health at Lewisham Council. The letter clearly tells any parents to take children to the Education Centre to get any MMR vaccinations they may have missed.

Me: Hello. I think one or both of my kids have missed at least one MMR vaccination. This letter tells me there is a clinic here today to address this.
Receptionist: How old are your children?
Me: 14 and 16.
Receptionist: I’m sorry, the clinic is only for 2-11 years.
Me: …
Me: I can’t tell you how angry that makes me. I have spoken to various people, and have this letter. All of them say getting a measles vaccine is important and that there is clinic here today.
Receptionist: I’m sorry. Let me get my boss and look up your children’s records.

Time passes.

Boss lady: Hello!
Me: I am here for the catch up MMR clinic for my children.
Boss lady: How old are they?
Me: 14 and 16.
Boss lady: I’m sorry, the clinic is only for 2-11 years.
Me: Yes, your colleague said. I can’t tell you how angry that makes me. I have spoken to various people, and have this letter. All of them say getting a measles vaccine is important and that there is clinic here today.
Boss lady (sucks teeth): Why does this keep happening?
Boss lady: I’m sorry we were told that we should only do 2-11 year olds.
Me:… Receptionist: I have checked the records, and one of the children has only had one MMR vaccination.
Boss lady: I will call Public Health at Lewisham Council.

Proceeds to call them on speaker phone.

Boss lady: Hello? This is [gives name and location).
Other person: (Hangs up).
Boss lady (to her colleagues, there are 4 of them gathered): Did she just hang up?

Calls again.

Boss lady: Hello? This is [gives name and location).
Other person: Hello. Sorry, we were cut off.
Boss lady: I have another parent with children over 11 years old here. Why do you keep telling them to come here, when we are 2-11 only?
Other person: [inaudible]

They argue. Boss lady calls me over.

Me (into the phone): Hello. I have a letter here from the Director of Public Health at Lewisham Council saying that there is an MMR clinic for children. I am here with my children, one of whom needs their final MMR. What is the downside of giving it to them now.

Boss lady nods and shushes me away. They continue to argue. The call ends.

Boss lady: I called them on speaker so you can hear what we are up against. I will give your child the booster they need. Because you are here, and it is important.
Me: Thank you.

My child gets the vaccine, and a biscuit. As we are leaving, another parent with clearly teenage children enters the clinic.

Reflections

It is not the receptionists fault. They happen to be the interface between me and the rest of the NHS. It is not their fault if there is disorganisation, or if they have too little time to do the duties they have been given. When overwhelmed it is easy to not listen well (as infuriating for me as that was).

Getting the text alert was a good thing. Both my children are now fully vaccinated against measles. Hurray! The alert worked.

The experience was excruciating. It took tonnes of time. It was hugely inefficient for me and them. (It didn’t help that some of the people I spoke to just got into a loop.)

NHS sometimes works OK. Since the start of the year, I have had to interact with the NHS on 3 other things. None was as excruciating as the above (though my GP practice, Jenner Practice within Modality Lewisham did manage to lose one set of test results; can’t say as I’d recommend the Jenner Practice, except to someone I didn’t like). Going back a bit further in time, my wife got excellent and urgent care for her terminal cancer during the second COVID lockdown.

Going forward: more of the same won’t work. I’m no health system policy expert, but those who are argue for “capital investment, increasing management capacity and staff retention – not just more doctors and nurses”.

Will Labour offer something different? After the Conservative Party Conference, I said we had more culture war coming, and Labour will need to have a backbone. Recently, Labour walked back on its £28b a year green commitment, which made me very angry because it prefigures an administration that will be bullied into failure by the right wing press.

The opinion polls say a majority of people are for more tax and spend. The 2022 European Social Survey had the most favourable towards immigration since the survey began (for instance, the people scoring 7 or greater that immigration makes the country a better place to live rose from 20% in 2002 to 56% in 2022).

Meanwhile the Tory-driven media bubble fixates on immigration and tax cuts. Labour has boxed itself in, committing to the Tory spending plans and accepting much of the immigrating framing.

But we know that more of the same won’t work. Will Labour offer something different, to create a mandate for change that will last the turbulence of being in power in a conflicted, climate-changing world?