17th May 2016

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Most days I come to the keyboard with enthusiasm.  Sometimes misgivings.  Occasionally I'm perplexed, angry, even.
Today, I could weep.
I have an elderly neighbour.  Bright, educated, a bag full of marbles and a former educational professional.  She struggles with a complexity of chronic conditions.  I keep an eye on her, she keeps watch over me.  I know her routine, her comings and goings.
On Saturday I noticed the lights weren't on.  By Sunday I knew there was something wrong. To avoid prurience, suffice I tell you; she had an exacerbation. 
It turns out, since last Friday she had been trying to get help.  She told me the combined might and resource of OOH and NHS111 was unable to offer any help for twelve hours.  The district nurse service, of which my neighbour is a regular, similarly, was unable to attend in a timely fashion.
On Sunday I found her anxious, trembling, pale, breathless and from my mountain of ignorance, could deduce, heading for a sepsis or a heart attack, or both.
There was no way I could get her into my car and take her to Fabulous Frimley Park.  Against all the rules and reluctantly, I dialled 999, for an ambulance.
We're this not so serious what happened next might be the script for a comedy. 
I think after forty years of the NHS I'm able to assess a situation, present a lucid explanation and know when help is needed.  In what I though was crystal clear English I presented my up sum of the hiatus facing us.
'Thank you, said the operator...  I now need to ask you some questions...'
I was then obliged to trudge my way through a series of wholly irrelevant questions; 'Is she breathing?', 'Is she bleeding?' ... that would have made the Boy Scout Manual of First Aid look like a medical text book.
Would I '...put my hand on her stomach to assess her temperature....' Err, no.
Apparently calls are recorded; I hope South East Coast Ambulance trainers use this one.
I protested, complained and the, non-clinical call handler (?) went off the line to 'speak to someone'.  That was the last I heard of them...  I hung on, only to hang up when the doorbell announced the arrival of the ambulance service first responders.

The cheery ambulance team (eventually four of them) ploughed their way through a myriad of questions they asked the last time they were called, when my neighbour fell over and a forest of tick-box paperwork.  Apparently SECAmb is a technology free zone.
My neighbour is now safely in Fabulous Frimley Park.
What has happened here?  My take?
  • The ambulance service is geared-up to doing everything to avoid sending and ambulance and doing it on bits of paper. 
  • The OOH is organised to do everything but send a doctor. 
  • The district nurses are organised to be everything but accessible.
The upshot.... a ludicrous game of low-tech pass the patient.  A new skill;  Service Avoidance.  Plus a wholly, unnecessary admission.
Had the district nurses had a proper response capacity, they might have attended on Friday, or Saturday.  Had OOH had an understanding that a crisis need not be an emergency, but can become one if they don't act, they might have been more useful than an ash-try on a Harley.  If the ambulance call centre had a clinical front-line and access to patient records, I might not be writing any of this.
Regular readers will know I have devoted hours of time and resource to bigging up the NHS, pimping its ride, bulling its boots.  Today, I feel like giving it a good kicking,
Who is responsible for this this cat's cradle of 'services'?  This dislocated mess.  This bureaucracy that depends on a male neighbour shoving his hand up an 80 year old woman's night dress to see if she's hot...   
In my book Surrey Clinical Commissioning Group are responsible for this botched together shambles.  What they buy (commission) is what we get and we get anxiety, stress and worry for everyone involved.
They buy services that turn a change into a crunch, that becomes a dilemma.  A dilemma that becomes a predicament.  A predicament becomes a crossroads.  A crossroads turn into perplexity that morphs into a drama and a drama into a crisis.
They are responsible for buying disjointed services that do not work.  Obviously not road testing the care pathways and interfaces that make up a whole system.  

A Clinical Commissioning Group that looks to me like they couldn't buy a bag of Bassett's in a sweet shop.  

They are comprised eight practices, a budget of 110m and a population of 90k.  I've seen bigger bridge-clubs.
This is a dinky, cosy outfit of vainglory that has as much influence in the local health economy as a donkey in the Derby.  
Where's NHSE when you need them.
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