At the doctor’s there is a small carefully placed notice to the effect that our practice will no longer refer people direct to the consultants etc. at the local hospital. Their recommendations will now go to an assessment panel which will decide.
Who they are; to whom they are accountable; where they are and what criteria they might use is not known. At the same time a friend of ours needed to call for medical assistance on an urgent matter.
His doctor turned up and did not like at all what he saw. But there were problems. The doctor could not send him to hospital and certainly not refer him to the appropriate speciality. The patient; or one of his family or friends had to telephone 111.
There was a snag since the man has another highly dangerous potentially terminal condition and it is imperative for the hospital to be warned to be ready for him. Also, if affected he has but a short time to get treatment which is over and beyond what his doctor could do. He needs paramedics and an ambulance.
But with the 111 system this has now become impossible because of the procedures and the fact that the person at the end of the phone is neither a clinician nor has medical qualifications. The issue is determined only on the immediate condition and without reference to any of the predictable contingent risks.
If the right boxes are not ticked as they are unlikely to be in his case then there is no ambulance and his helpers must simply turn up at the hospital and hope for the best. If he does just turn up at the hospital then one slight error in the handling of the case means that within minutes he is no longer a patient but one for the Coroner.
Although his case may seem to be rare it is not all that rare. This is because whilst the condition is known the system now deals only in terms of the single matter at any given time regardless of any complications either known or potential. So when one condition creates significant risks for any other this cannot be catered for.
What has happened is that his doctor is no longer allowed to use his common sense or professional judgement. There is no flexibility of approach according to overall need. The hospital is no longer allowed to consider complexities in complicated cases. An ambulance may only be called if the prescribed boxes are ticked.
If they are not then a fatality becomes simply a statistical margin of error in the new system. The new system is almost tailor made to generate fatalities in the most dangerous and high risk cases especially those which require urgent and immediate action.
Meanwhile the paper work will be kept in order; targets met and the increased activity among the funeral directors will no doubt enhance economic growth.