By Steve Carne, Jan 11 2019 10:59PM
Today was my Diabetic half-yearly checkup. A good thing. Blood pressure, weight, draw a bit of blood. I love my diabetic nurse (let’s call her Susan) because she listens, she asks questions about my life, we swap notes on current NHS politics, she is an expert in drawing blood out of my always reluctant hard-to-find veins.
I wonder how Susan is? I’ve not seen her for over a year and a half. I miss her. And I don’t know who I will be seeing today as i pull open the GP Surgery door.
My heart sinks as I tap the digital screen on the wall just inside the GP Surgery door. (Another new software I notice). Receptionists are far too busy doing important stuff to say “good morning” or smile. I know because I can hear them laughing behind the shutters on their windows.
The login screen tells me I am the next patient with (not real name) Julia HCA. How many people here today actually know what an HCA is I wonder? The Nurse’s Room is still next to the waiting room. I know this because the door still has the room plaque “Surgery Nurse” on it - in a nice understated NHS blue.
But beneath it now sits a much larger piece of white plastic with a rather heavy clumsy black font displaying HEALTH CARE ASSISTANT. Being an artistic spirit my heart aches at the complete lack of care and aesthetic sensitivity thats gone into the creation of this overbearing plastic functional sign.
My heart sinks further when the door opens and I recognise Julia HCA. My first encounter with Julia HCA was the last time I saw lovely Diabetic Nurse Susan.
That appointment I returned home with four large wads of cotton wool - stuck to both arms, back of both hands (large bruises later) where the needle had been swivelled, twisted and jabbed in an attempt to extract my life-source. On that occasion. after four arduous attempts, Julia HCA had accepted defeat and called Diabetic Nurse Susan away from her very important paper-work (in the next room) to draw my blood.
One sharp, a prick so small I didn’t feel it at all, a smile and a line of friendly genuine chat - two tubes of blood were filled easily. Perhaps my relief at seeing Diabetic Nurse Susan was a factor? I miss Diabetic Nurse Susan.
Anyway... Julia HCA tells me to take a seat by the bed. The chair that is facing away from her. I turn my head so I can see Julia HCA - the other human in the room. Julia HCA is busy reading her screen and tapping her keyboard. She tells me she is going to measure my blood pressure, weigh me and take some blood. Because that is what the screen tells her presumably. When Julia HCA finally looks up I’ve already rolled up my shirt sleeve and placed my arm on the bed.
Without looking at me Julia HCA slips the cuff of the Blood Pressure machine onto my arm. She says firmly “Don’t talk or move while the machine is working.”
She turns away to the counter and gets busy opening the requisite needle pack, card tray and plastic tubes that drawing blood will require.
I don’t move or talk. I’m feeling the pressure. I stare at the PAID FOOT CARE leaflet stuck to the wall...
The blood pressure machine stops whirring and the cuff begins to deflate. Julia HCA scribbles on her pad. She does not offer a comment on her scribbling. I ask what the figures mean. It’s a little over the target. I refrain from suggesting why that might be.
And so the fun bit. Drawing the blood. Today is better. Julia HCA has had 18months more practice. Today only takes three “small prick” attempts and a weary “oh come on” sigh before finally stabbing a vein (in frustration?) and rich dark red fluid flowing forth. I experience a combination of deep relief she does not need to stab me again, gratitude that she has improved, and disappointment that I will not get to see Diabetic Nurse Susan.
So just two large cotton balls taped to my arms this visit. Now...shoes off, pockets emptied and I stand on the scales. Julia HCA tells me my weight in kilos which i have also read from the digital window. Julia HCA goes to the computer. Silence is broken with a “oh 2016 is the last time we weighed you...”.
We both agree that’s bullshit - my words not hers. But Julia HCA cannot tell me how much I have lost since my last visit because its not on the screen. I’m disappointed but resist voicing my internal “for fucks sake”.
Shoes on in silence. Slipping jacket on I thank Julia HCA. Nothing much more to say. Completing her computer screen box-ticking Julia says “Goodbye, see you in 6 months time”. I leave. I realise that throughout this entire clinical process Julia HCA and I have not made eye contact. Not once.
The questions begin as I walk home. (I’m lucky not needing to travel far). Where is Diabetic Nurse Susan? If Julia HCA is replacing her with her skills as the conduit twixt me and computer screen database what is Diabetic Nurse Susan doing? Is she next door doing very important computer work? Is she being a “Martini Nurse” - out and about putting ‘right care in the right place at the right time’ into the community? Or perhaps she’s at a Clinical Commissioning Group or Sustainability & Transformation Partnership meeting offering her valuable clinical expertise towards integrated accounts packages?
This is my experience of the modern NHS GP surgery. I don’t doubt there are good people in them still. But this experience has been faceless with no sense of a relationship, connection or purpose between me and the care professionals - those who once were praised and rewarded for their personal human interaction skills but now are forced to fit the machine of the “health economy” which is one more American idealogical phrase that has crept into our NHS. Scary article warning: PwC New Health Economy in an age of Disruption
Disruption is about right. My relationship with Diabetic Nurse Susan has been disrupted. Ended probably. I have no personal connection now between my sense of looking after myself (Preventative Care - what the NHS claims healthcare is all about) and a healthcare professional who actually gives a shit. Doctors have been warning about the dangers of destroying the doctor/patient relationship since 2012 - the Year of NHS Disruption
Disrupting patients and staff, denying proper human interaction and replacing it with a computer screen or an app only creates an apathy in me that gives rise to me being a patient who doesn't really give a shit either.
Can’t blame Julia HCA. She must know she’s cheaper and not respected in the scheme of things.
Can’t blame my Diabetic Nurse Susan. She’s off somewhere no doubt trying to be integrated and keep her job afloat.
Blame the GP surgery? They’re struggling to find staff on limited funds, under yet more pressure from NHS England to join the new, ultimately faceless, Super Hubs which are supposed to cover 30-50,000 population areas. Even though there is little evidence to prove they will lead to better healthcare.
I can definitely blame NHS England and NHS Improvement along with numerous other business busybodies like the Kings Fund, Nuffield Trust and Health Foundation who with their research studies are “wreckless driving” this inhuman new model of care that will produce better financial outcomes for company shareholders but will not produce better healthcare for patients - not here or anywhere.
It’s been a busy week with new job and campaign admin. I have yet to catch up with all the fuss and nonsense of the new NHS Long Term Plan. Part of me feels there is no point in reading the f**king thing. More of the same as the last bastard 5 Year Forward View plan that has laid the foundations for this “new model of care” we are seeing not so much evolve but explode (disruption don’t forget) inside our NHS.
Why are we allowing Simon Stevens, Chris Ham and others to adopt the Accountable Care Organisation healthcare model following the American model of care when it is universally recognised as being just a bit crap (utter shite) and "based on faulty assumptions, poor economics, and junk science"
This is just one reason why 999 Call for the NHS are continuing our fight in the courts. We have to keep fighting for a healthcare system that is human based, focused and managed. Not a corporate money making machine where patients and doctors are just faceless cogs in the economic machine.