Attention to detail could save the NHS

In this blog I break one of my own rules. I shall argue from anecdote rather than statistics. However, the anecdote is my own, and it relates to one of the claims being made about this winter’s problems with the NHS.

Last summer I had eight encounters with the NHS in 10 days. This episode showed Britain’s “national religion”, as Nigel Lawson once called it, at its best and worst. It is yet another example of how the NHS could save both money and lives. And sheds light on the current pressures on accident and emergency departments. I supported, and still do, the last Labour government’s decision to increase National Insurance to give the NHS more money. But, as William Blake once wrote, those who wish to improve things must do so in “minute particulars.”

Doctors have been telling journalists that 111 staff send too many patients to A&E. After my experience, I can believe it; but I am not sure that 111 staff are to blame.

1. After some weeks of gradually increasing backache, I contacted my local surgery. It now offers telephone consultations. An appointment was fixed for the curiously precise time of 3.21pm. To my surprise the doctor rang at exactly 3.21pm. He diagnosed inflammation and prescribed some pills. He also said there was an outside chance of another, more serious, cause. As a precautionary measure, I should come in for a blood test.

2. I went to the surgery, collected my prescription and had my blood test. Over the next few days, my backache eased, but I began suffering from possible indigestion. I put it down to over-indulgence on a foreign trip.

3. A week later my doctor rang. He said the blood tests had come back. Everything was fine, except for my potassium reading, which was too high. He was “99 per cent certain” this was a false reading, because the blood had probably been “lying around” before going to laboratory at the local hospital. But, to be safe, he advised me to have a second blood test, but at the hospital, not the surgery.

4. The following morning I went to the hospital. I was in and out within 20 minutes.

5. That night I woke up with bad stomach pains. In the morning I checked the instructions with the pills. They said heartburn was a possible side effect. The solution, fairly obviously, was to get new medication. It was a Saturday morning. I knew my surgery opened for a few hours. However, when I checked on its website, it said it treated patients on Saturday only by appointment. So I rang, and heard a recorded voice saying that I should wait until Monday or, if I needed immediate treatment, dial 111.

6. I dialled 111. After a few minutes I got through. I told the story of my symptoms and medication. I also mentioned the potassium result—adding that my doctor was 99 per cent certain it was a false reading. This was the moment that everything changed. A high potassium reading, I discovered later, indicated a risk of a stroke or heart attack.

The young man (well, he sounded young) asked me to hold on while he spoke to his supervisor. When he came back on the line, he said an ambulance was on its way. “What!” I exclaimed. I have never been in an ambulance before, and saw no need to start now. I was perfectly capable of walking to my surgery or, indeed, my local hospital.

7. Five minutes later the ambulance arrived. Two paramedics came in. They tested my heart and pronounced it to be in perfect condition. But, in view of my heartburn, they would take me to the local hospital.

8. My wait in Accident and Emergency was a perfectly reasonable 45 minutes. But then this was a quiet morning in September, not midnight in January. When the hospital doctor saw me, I told him my story—and added that as my blood had been tested there 24 hours earlier, he could presumably check my potassium level. He reacted with the kind of shock best caught years ago by HM Bateman’s iconic “The Man Who…” cartoons. It plainly couldn’t be done. He decided that all I needed was a second set of pills, to counteract the side-effects from the first set. Within two days I was feeling much better. And my potassium level turned out to be fine.

I am not sure what all this cost the NHS: hundreds of pounds at least, perhaps more than £1,000. It cost me nothing—even the drugs were free, as I am old enough to be exempt from prescription charges. But had my blood not been left “lying around” in the first place, or the surgery answered its telephone on Saturday mornings, the NHS would have spent far less. I was lucky that it didn’t in the end matter that one department of the hospital was unable to obtain the results of my second blood test from another.

I know the NHS has far bigger problems, and endured far greater calamities, than those described here. Let’s hope these “minute particulars” get sorted. I would not like to have a real heart attack and find that the ambulance fails to reach me in time because it is busy attending a patient who should not need an ambulance at all.