2 Sept 2016

Hospitals - Not For Tripadvisor

When you have to visit the same department of a hospital several times, you memorise the signs. I now know that domestic violence spikes during sports events, and what different nursing uniforms mean. I know that if you dare try and get NHS treatment fraudulently, Teresa May herself is coming round with the boys. I know that, despite brexit, we can still get EHIC cards. And I know whether or not I would recommend the department to my nearest and dearest.

Wait, what?

We have spent a lot of time in ambulatory care at Peterborough hospital of late. It's a strange, useful department, designed for people who are too poorly to be seen in outpatients but who don't require an inpatient bed. A lot of people in there are being followed up from A+E, or having transfusions. Almost everyone in there feels like shit and a lot of them look it too. It's not the sort of place you go for a picnic, or the stunning view of the car park and Macmillan unit next door. The water's cold, the outside benches were designed for people with waves for arses, and they really need more reading material, but I'm not about to go on Tripadvisor and leave an excoriating review of the amenities. It's not somewhere you go for a jolly - we are there because Mum has to be there.

And yet, would I recommend this department to my friends and relatives? What a bizarre thing to ask people in an acute care centre. A few years back, I had a brain injury and about two weeks later, someone rang me up and asked me how I would rate the A+E dept. I can barely remember being in A+E, so how I was expected to rate it, I do not know.

The NHS likes to bang on about choice, namely choice of provider. Sometimes this can be really useful - I was able to get my son re-referred to his old hospital for an operation despite being out of area - but mostly it is meaningless, particularly in terms of acute care. When dripping blood everywhere, who has time to ponder to which A+E they are going to drag their detaching limb? Who has that level of local choice outside big cities? Where I live, there is Peterborough, which is five minutes away, but the next nearest large hospital is Hinchingbrooke, which is half an hour in good traffic. In an emergency, there's no question of where I'm going to go. Offering choice in acute care is illusory. Being asked to rate it is meaningless.

Treating patients as customers within the NHS is a real bugbear of mine. A good patient experience is very difficult to quantify. For example, excellently executed palliative care still results in a dead patient. Conversely, a live mother and baby is considered the best outcome in maternity care (as well it should be) regardless of trauma suffered. Patients experience the same illness in very different ways, every clinician has a slightly different approach to treatment, illness progression and injury healing can be very difficult to predict. How high patients are likely to rate departments surely depends on their mood, their particular problems and their experience on that day.

To give an example, when my mum was in Scarborough hospital (rated as requiring improvement by the CQC), some of her care on the ward and in transit was substandard from a professional point of view, but we are all so grateful that they saved her life that we wouldn't consider complaint. If asked whether I would recommend their emergency care team, I would give them a very high rating despite seeing some negligent care later on, because of that gratitude. However, when we have been sitting in ACU at Peterborough for six hours, waiting for medication that seems to take days to dispense, while Mum cries and dozes on a bed, I am disinclined to rate them highly. It's not their fault, their care is always excellent, but my mood is never good there.

To rate patient experience requires more detail and nuance than a simple "How likely are you to recommend us to friends or relatives? 1-5" rating, like you get in bloody Argos. If my curtains take thirty minutes to come down the chute in Argos, perhaps I have cause for complaint. Perhaps my giving them a 2 rating is justified. But giving a hospital a low rating because I had bad news that day? Because a poorly toddler was screaming and it made my migraine worse? Because some drunk vomited all over the waiting room and it took a while to clean up? Because I was scared? Because I was in pain? No. That's not a fair way to rate a department.

When I worked in general practice, we had to do patient surveys. For a month a year, everyone on reception would sick of the sight of this stack of questionnaires, ignored upon the desk because nobody coming to an urgent GP appointments wants to rate the surgery - they want to get their medication and go home. So what ended up happening was that all the regular patients would fill them in, rating us generally highly because they absolutely loved the GP or rating all the reception staff poorly because everyone hates GP receptionists. It never felt like a particularly fair way to assess patient opinion, least of all with all the staff fearful of what they might write (I believe now the CCG sends questionnaires direct to patients).

The NHS is not a shop. It is not Argos. It's not even Amazon. It's a public service. Hospitals are not theme parks, or holiday homes, or somewhere you can reasonably expect to enjoy yourself (unless you're some sort of fetishist). Rating your care is so subjective as to be almost meaningless outside of detailed debriefs after the event. Complaining is one thing: I am a seasoned complainer, usually because of instances of negligence or misconduct rather than bitching about a receptionist's tone, and the NHS needs to be open to justified complaint, but giving a flash rating subject to emotion at the point of care is ridiculous. Make it stop.

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