Friends and family beat Choose and Book

Last autumn, I recorded in this column the difficulties experienced by my friends Charles and Tom in getting timely and effective diagnosis and effective hospital treatment for their cancers, from which both died. In November another contemporary, Bill, had to wait nine weeks for a surgeon to deal with a prostate crisis, which turned out to be malignant. It is a long-established theory that the NHS is a two-tier system. The higher tier, which gets great service according to the theory, is white, middle-class, university-educated, articulate, internet-savvy and speaks proper. The lower tier is the rest of us – in other words, about 95% of the NHS's patients. In the last year, when I see what has happened to Charles, Tom and Bill, I find that the above theory needs modifying. They were white, middle class and so on, and therefore should have qualified for the top tier service, but nevertheless the system beat them. I have come to the conclusion that it was partly their fault; they were not stroppy enough. They had a problem: they grew up during the war, and went to boarding schools. Consequently, they grew up with an automatic deference to authority. So when they came to be messed around in the last six months of their lives by the glacial diagnostic processes and poor communications of the NHS, they were reluctant to make waves, or, as I would put it, demand their right to better treatment than the rest of us. So they didn't. This infuriated Charles's son, a neurology consultant, who wanted to march in with big feet, to use his medical eminence to extort better treatment for his father from the lackadaisical (though prestigious) hospital, which was treating him. Both his father and his mother opposed their son, on the grounds that rocking the boat would be counter-productive, and also because it was wrong socially and morally to 'pull rank' medically. I understand that colossal family rows ensued. In the end, it was only when Charles told the hospital that he couldn't take any more chemotherapy, and the hospital responded brusquely that he was on his own then, that Charles's son weighed in with the patient advice and liaison service to get decent palliative care for his father. This worked a treat. I ask myself whether his intervention earlier might have accelerated his father's treatment in hospital, extended his life, and reduced the trauma to his family. Last week I heard of another contemporary having to call on family medical clout to get a consultant appointment in an acceptable length of time. This time it was a sister-in-law in a university town, aged 85, who had an MRI scan at the beginning of December and then an interminable wait for a consultant appointment on which hangs a major operation. When the appointment finally came through just before Christmas, it was for a date late in January with a junior doctor who had no knowledge of her case. Her GP was furious, and suggested that my sister-in-law should ask her formidable consultant paediatrician son to intervene. He did, and bingo, he got an appointment two weeks earlier than the original date, with the right consultant who knew her history. To make doubly sure that she got the right clinical advice, the consultant son travelled some distance to support his mother at the appointment. I found it significant that it was the GP who suggested that the son should march in. To me, it was a tacit acknowledgement from one part of the NHS that the normal appointment system, Choose and Book or whatever, for this hospital is a shambles, and the only way to sort out the problem is to "pull medical rank". I find this rather shocking. It is no longer good enough just to be white, middle-class and articulate, to get top-tier and timely treatment! I blame the coexistence in some hospitals of Choose and Book with traditional telephone appointments, causing both systems to foul up and leave patients in the lurch. I suggest that hospital managers and Connecting for Health spend some time sorting out this rather elementary problem, before they embark on any brave new computer initiatives costing millions. In a fortnight, I describe a way of getting good service from the NHS, even without medical clout.