Worcestershire GP "Out of Hours" Service

[craigwalsh]

I wrote elsewhere (http://www.sucks.org.uk/?cat=6&paged=8) my about my experience with the Worcestershire GP "Out of Hours" service. This complaint was acknowledged on September 23, 2006. According to the NHS Complaint Procedure, the NHS has 25 working days to fully respond to the complaint. If they need more time, this is possible, "but only in agreement with the complainant."

The 25 working days expires today, October 30, 2006. They sent me a letter on October 25 to advise me:

http://www.aquarena-springs.com/images/nhs-complaint.gif

My consent to the delay was not requested, and no new timetable was established. The complaint became, in effect, open-ended.

I e-mailed Kath Garrard, the Complaints Manager and author of this letter, on the afternoon of October 28:

From: Craig W. Walsh
Sent: 28 October 2006 13:15
To: Garrad, Kath (Complaints)

Subject: Your Reference KG/SW/06/9/222/WALSH

Hi, Kath ---

Thank you for your letter of October 25, 2006, received by me on October 27.

You have indicated that your "investigations will take a little longer than originally anticipated" because of "unavailability of staff." But you did not give me a date when this process is now expected to be completed.

A couple of weeks ago I telephoned the Independent Complaints Advocacy Service (ICAS) --- I called them to ask if the hospital could shuffle me off to Catalyst in relation to my complaint about the security guard. (By the way, the answer is that the NHS must handle this complaint: I had to go all the way to the Health Service Ombudsman for England. They have a jurisdictional officer, Anthony Gilmour, and he confirmed that as the hospital would need to provide guards itself --- if it didn't sub-contract this service --- the hospital itself needs to deal with my complaint under the NHS Complaints Procedure.)

ICAS sent me some literature, including a "Self Help Information Pack." There's an update sheet and it indicates that there have been changes to the NHS Complaints Procedure that took place on September 1, 2006. I understand that, "the timescale for the NHS provider to formally respond in full to the complaint is extended from 20 to 25 working days from the date of receipt of the complaint. This can be extended further, but only in agreement with the complainant."

I believe that we reach the 25 working day point on Monday, October 30. You have not requested my consent to an extension: as you've not asked for my agreement I have not given it.

I am, of course, happy to be reasonable, but understandably don't like the open-ended nature of your letter of October 25.

I left a voice mail message for you on Friday afternoon.

Can you please let me know when the NHS will be in a position to respond in full to my formal complaint? Can you also please advise me if it would not be possible, at this time, to issue a partial reply?

It would be helpful for me to know which staff member (by function, not by name) is currently unavailable, and why their absence has delayed the formal response by the NHS.

As you are aware, my wife's and my experience at the GP out-of-hours service on September 23 was very distressing for us. We promptly complained in accordance with the NHS Complaints Procedure, and now await a full reply in accordance with the established timeline.

I look forward to hearing from you.

Kind regards,

Craig

She replied promptly:

From: Garrad, Kath (Complaints)
Sent: 30 October 2006 11:21
To: Craig W. Walsh
Subject: RE: Your Reference KG/SW/06/9/222/WALSH

Dear Mr Walsh,

Thank you for your e-mail.

I have asked the Worcestershire GP Out of Hours Service when they will have the information for a response to be sent to you. I will let you know the timescale as soon as I hear from them.

Yours sincerely


Kath Garrad
Complaints Manager
Worcestershire Primary Care Trust
Isaac Maddox House
Shrub Hill Road
Worcester WR4 9RW

The open-ended nature of this continued to bother me, so I telephoned Ms. Garrad. She said she'd sent the GP Out of Hours Service a message to ask when they'd be able to reply, but hadn't heard back from them yet --- and didn't know when she'd hear back from them. Although she's the Complaints Manager, she seems to be unable to compel a response from her colleagues. She asked me, curiously, what I hoped to "get" from my complaint.

I didn't know how to answer this question. If I'm perfectly honest, if Sister Susan Haines worked for me, I'd give her a written warning. If there had been other complaints, I'd give her a P45. But how the NHS handles its employees is really none of my business.

What I hope to accomplish --- to "get" --- is that Sister Haines will be re-educated on what's expected of her. If she can't treat patients with a modium of sympathy and compassion, then she should be transferred to one of the vast bureaucratic Gulags in the NHS where there is no patient contact.

I asked Ms. Garrad for the name of her boss, on the theory that he (or she) might have more clout with the GP Out of Hours Service. Ms. Garrad apparently reports directly to the Chief Executive, Paul Bates.

I spoke with Mr. Bates' PA, Annette Ballington. He, of course, was unavailable. I asked Ms. Ballington if I could put an appointment in Mr. Bates' diary so at least we'd have a definite date. Apparently he doesn't have any free time until early December.

I asked Ms. Ballington for the name of Mr. Bates' boss, and I was referred to Cynthia Bower (http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4134513&chk=7NAIh8) at the West Midlands Strategic Health Authority. I spoke with her PA, Denise, and was told that actually Ms. Bower is not Mr. Bates' boss --- that would be his Board, of which Dr. Brian Smith is Chairman.

Denise involved Steve Hilton in this, and he called me back a little while later. He'd spoken with Ms. Garrad and apparently the formal reply to my complaint had been finalised, and was just awaiting Mr. Bates' signature. This was completely different from what Ms. Garrad had told me a few hours earlier.

I was told that this reply, via e-mail, would be with me tomorrow. We'll see if this happens.

My simple out-of-hours visit has involved:

Worcestershire Primary Care Trust -- who runs the out-of-hours service
Worcestershire Acute Hospitals NHS Trust -- who manage the hospital
Catalyst -- a private company who apparently owns the hospital, and provides the support services (guards, cleaners, catering staff, etc.)
West Midlands Strategic Health AuthorityWhat a bureaucratic, top-heavy mess. Incapable, apparenlty of even adhering to their own deadline for formally responding to a complaint.

All I wanted was someone to care about me, and to help make me comfortable while I waited for the single doctor who was on duty.

[craigwalsh]

These two messages just received:

From: Garrad, Kath (Complaints)
Sent: 30 October 2006 16:45
To: Craig W. Walsh
Subject: RE: Your Reference KG/SW/06/9/222/WALSH

Dear Mr Walsh,

Following your e-mail and our telephone conversation today, as promised, I write to give you an update regarding a response to your complaint.

The Chief Executive now has the response for approval and signature. As soon as this is done I will e-mail a copy to you.

Regards.

Kath Garrad
Complaints Manager
Worcestershire Primary Care Trust

and this message:

From: Hilton Steve (NHSWM)
Sent: 30 October 2006 16:10
To: Craig W. Walsh
Subject: Our discussion today


Dear Mr Walsh

Further to our discussion today I spoke to Cath Garrard at Worcestershire PCT as promised. She said that she will do everything she can to get the emailed response to your complaint to you today, but this is subject to the Chief Executive’s availability. She informed me it will be with you by tomorrow if not today.

Yours sincerely


STEVE HILTON
Parliamentary Manager
NHS West Midlands

[nigel hastilow]

One of the many failings of the National Health Service is that it only takes one obstructive receptionist to destroy your faith in the whole tottering edifice.

At 9pm on Christmas Day, my father was carrying a chair upstairs when he slipped and fell down about a dozen steps, smashing the chair and causing a huge commotion.

He was dazed, shocked and hurt but we were not sure how badly. At 83, any injury is likely to be serious so, though he was able to stand up, climb back upstairs and lie down on his bed, we called the local doctor’s surgery.

Naturally they weren’t there and we were directed to the Worcester GP Emergency Service where a very helpful doctor talked me through the crisis and discussed the options.

He was kind, tactful, willing and able. He would be prepared to attend my father that night but – as he did not have head injuries, had not lost consciousness and was now asleep – the doctor thought it might be wiser to leave him alone and see if he sleeps through the night.

The doctor gave me a direct line telephone number to the Worcester GP Emergency Service so that if my father took a turn for the worse during the night, we could call direct.

If my father was OK but we wanted him examined in the morning, the doctor said, we could use that same number. He would make a note of the details on the computer and ensure that whoever was working in the morning would be aware of the situation.

This was all excellent. You could not have asked for better, especially on Christmas night.

So in the morning, after a peaceful night, I called the number the doctor had given me, to speak to the duty GP and see if he thought it worth a home visit to check out my father and make sure he was suffering from nothing more than severe bruises.

This seemed, and still seems to me, to be a reasonable use of scarce NHS resources. We did not dial 999, we did not ask for a night-time visit, we did not even, necessarily, want one the following day.

But we did wish to speak to a doctor about my father’s accident and seek reassurance from a medical professional.

This was always going to be too much for the NHS to cope with. From the outset, it was a difficult conversation.

The receptionist demanded to know where I got the number from. She told me I could not speak to a doctor. She ordered me to use the general 0845 609 0669 number.

We discussed this at some length. I was increasingly dismayed. She consulted other people – almost certainly a doctor – and repeated that she could not, or would not, let me speak to a medical professional.

She explained she was not qualified to offer medical advice, she was just a receptionist. If I was not happy with dialling the 0845 number and waiting, I could always dial 999.

I asked if she was recommending that I dial 999. She said that was a question of judgment; as a non-medical person she could not make such a judgment.

In that case, I ventured, perhaps I could consult a doctor. She would not let me but had further conversations with her colleague(s), who may well have been medically-qualified.

This went on for some time. There was a certain amount of acrimony. An exchange of names in a threatening manner. A phone put down. A number – her direct line number – redialled. That sort of thing.

I quickly realised I had met an immovable object so in the end I resorted to the 0845 number and a twenty-minute wait in the queue before my sister spoke to someone (she took over waiting after the paint dried and I got bored). Same office; different receptionist.

We were promised a doctor would call “within the next three hours” (note, this is an emergency service. It’s lucky my father turns out not to have been seriously injured, otherwise he’d be dead by this stage).

In the event a doctor turned up at my parents’ house unannounced. No phone call in advance. He was very nice. He examined the patient and declared all was well.

However, if I had only spoken to a doctor first thing in the morning when I was prevented from doing so, we could probably have saved him a journey and kept my blood pressure under control which, in the long run, will also be of help to the NHS.

Instead it’s just another incident in the long and pathetic saga of the health service’s abject failure to care for its patients.

I was intending to write a letter of complaint to the NHS Trust but I know there is absolutely no point.

Yet with all the vast sums of our money thrown at the service, you might think that occasionally its underlings in positions of power without humanity might sometimes see their way clear to treating their paymasters with a modicum of consideration.

see also: http://nigelhastilow.blogspot.com/

[craigwalsh]

see their way clear to treating their paymasters with a modicum of consideration

We, the patients, are absolutely not viewed by most folks within the NHS as their "paymasters." They view folks in Whitehall as their "paymasters," with all of their politicians' targets, statistics and ever-changing expectations. We, on the other hand, are merely an annoyance. Wouldn't the NHS be a much nicer place to work if it weren't for the pesky, demanding patients!

I was interested (and dismayed) to read that your complaint related to the Worcestershire GP "Out of Hours" Service. Your experience with the receptionist/nurse sounded so much like my own unfavourable experience. Did you happen to get her name by any chance? If so, can you please either post it here, or send to me via PM?

I have been offered a meeting with Dr. Ben McCaffrey, the GP Out of Hours Service Clinical Director. This offer was made when, at my insistence, they sent me a second statement --- from Linda, the receptionist on duty on the evening I visited the GP OOH service in Worcester. Linda's unsigned statement is dated October 31, 2006, one day after Paul Bates at the Worcestershire PCT sent me a formal reply to my formal complaint. Linda's statement is much more in line with my own, and at variance with Sister Haines' unsigned statement of October 13. You'd have thought the NHS would have obtained both statements before replying to my complaint.

I have said I'd be happy to have a meeting with Dr. McCaffrey. As I have been falsely accused of being "abusive to staff," I've asked to have a more senior member of NHS management, or an independent mediator, present at the meeting. We'll see what happens.

I'm truly sorry to hear about your experience with the GP OOH service, but am glad to hear that your father wasn't severely injured and is on the mend.

They definitely have a problem with this service --- yet instead of taking criticism on board and trying to improve the service, it's easier for them to kill the messengers.

[craigwalsh]

As indicated in my previous posting, I have been offered a meeting with Dr. McCaffrey and I have accepted. In my letter to the NHS, I said:

As I have been falsely accused of being "abusive to staff," I've asked to have a more senior member of NHS management, or an independent mediator, present at the meeting. We'll see what happens.


I received a written response today. Kath Garrad, the Worcestershire PCT Complains Manager indicated:

The Trust would be willing for you to approach the Association of Midlands Mediators with a view to having an independent person at the meeting, should you wish and I note that you are prepared to pay the entire cost of this. Unfortunately at present the Trust is in a very difficult financial situation and in order to achieve a financial balance, the Trust had had [sic] to impose a vacancy freeze and some services are unable to deliver the same level of service that has historically been delivered.

From my viewpoint this is bizarre. If folks who complain can be placated through the NHS complaints procedure they are unlikely to drag the NHS into Court. I want the NHS to either apologise for the awful experience I had with the GP Out-of-Hours service on September 23, 2006 (and assure me that steps are being taken to prevent a re-occurrence), or to help me to understand why my criticism of the service is unfair.

But if folks don't get a fair hearing with their complaint, then I suspect some will take the legal route. And the NHS budget will be stretched even further by the cost of solicitors, barristers, etc.

I thought the NHS had managers to look after managers. Funny they couldn't find a spare one to spend a half an hour or so with Dr. McCaffrey and with me.

I contacted the National Mediation Helpline (http://www.nationalmediationhelpline.com) this afternoon and they have referred me to a mediator. An on-site mediation incurs a two-hour minimum charge --- £200. This is normally split between the parties, £100 each. But the "difficult financial situation" at the NHS means, I suppose, that I'd need to pay the £200 myself.

Any other suggestions for an independent person to attend the meeting in Worcester?