GP ap­point­ments by Skype are both im­moral and stupid

The Sunday Telegraph - - Features & Arts -

Iwoke up one day last Novem­ber with the feel­ing of wet­ness on my an­kle, even though it was dry. As some­one with pretty bad health anx­i­ety, I was im­me­di­ately dis­con­certed. Things got worse over the next few weeks, with feel­ings of in­ter­mit­tent freez­ing and burn­ing ac­com­pa­ny­ing the odd wet patches. Panic en­sued after an ill-ad­vised Googling of the symp­toms, and I be­came con­vinced I had a ter­ri­ble neu­ro­log­i­cal dis­ease.

I ar­ranged a Skype con­ver­sa­tion – in­tended to be re­as­sur­ing – with a neu­ro­sur­geon friend of the fam­ily. After lis­ten­ing to my symp­toms, he ad­vised me to get my­self seen to pronto. When the GP told me it would take four months for an ap­point­ment with a neu­rol­o­gist, I de­cided to pay through the nose to see one pri­vately, and was might­ily re­lieved when he dis­missed the pos­si­bil­ity of any­thing sin­is­ter be­ing at play.

In­ter­est­ingly, when I saw the neu­ro­sur­geon in per­son at a so­cial event two weeks after our anx­i­etyin­duc­ing call, he too dropped all the con­cern he had ex­pressed on Skype. I looked, he said, the picture of health. The dif­fer­ence be­tween our electronic and real-life meet­ing was fun­da­men­tal. Over Skype, I was a list of symp­toms re­sem­bling any num­ber of dread­ful con­di­tions. In per­son, I was a healthy and vig­or­ous-seem­ing woman with noth­ing wrong – ex­cept my neu­ro­sis.

So much of the in­for­ma­tion doc­tors rely on comes from see­ing pa­tients in the flesh, where they can ob­serve nu­ances of move­ment, ges­tures, skin, and – cru­cially – prod you. Which is why my hair stood on end when I read last week of new money-sav­ing pro­pos­als for the NHS – part of its night­mar­ish-sound­ing “ser­vice re­design” for the dig­i­tal age. I was par­tic­u­larly hor­ri­fied to see Theresa May, along with a num­ber of health chiefs, proudly an­nounc­ing a vi­sion of a brave new world in which 90 mil­lion out­pa­tient hospi­tal ap­point­ments would be con­ducted over Skype, rather than in per­son. I can see why you could Skype your lawyer or ac­coun­tant. But your doc­tor? Med­dling with the sin­gle most im­por­tant tool of medicine

– the phys­i­cal ex­am­i­na­tion – would be as im­moral as it is stupid. Re­as­sur­ingly, med­i­cal ex­perts were quick to point out the fool­ish­ness of the plan, but it is still ter­ri­fy­ing that such an id­i­otic pro­posal could be pre­sented smil­ingly in pub­lic.

Ter­ri­fy­ing, but hardly sur­pris­ing. The idea clearly came from the same place as all the worst NHS ideas and tar­gets have in re­cent years: man­age­ment in ca­hoots with politi­cians.

Si­mon Stevens, chief ex­ec­u­tive of NHS Eng­land, boasted that un­der the dig­i­tal ser­vice re­design pa­tients would be able to “ac­cess ad­vice at the touch of a but­ton”. But Mr Stevens, like many of his col­leagues, has an MBA, not a med­i­cal de­gree.

He and his ilk should prob­a­bly spend more time with ac­tual doc­tors and pa­tients rather than strate­gists and politi­cians. It might re­mind them that peo­ple don’t want to ac­cess ad­vice “at the touch of a but­ton”. They want to be seen, in the flesh, by a hu­man be­ing, just as more and more peo­ple are shun­ning self-check­out ma­chines in shops for the plea­sure of go­ing to a manned till.

The Skype idea, along with oth­ers put for­ward to ad­vance the promised NHS dig­i­tal rev­o­lu­tion, has man­age­ment ob­jec­tives, not med­i­cal (or even hu­man) ones, writ­ten all over it. The NHS is groan­ing un­der the weight of its 35,000-plus man­agers. A ma­jor sur­vey by the BBC last year found that the health ser­vice now re­cruits them faster than nurses.

But no amount of man­agers can save a sys­tem with chaos at its core. And who can now pre­tend that the sys­tem isn’t bro­ken? I kept faith in the NHS un­til re­cently, but – like al­most ev­ery­one I know – can no longer ig­nore the re­lent­less­ness of be­wil­der­ing over­sights. I have been turned down for the ser­vice’s much­vaunted CBT ther­apy for help with chronic in­som­nia be­cause I wasn’t sui­ci­dal enough. I’ve had du­pli­cate ap­point­ment let­ters sent out with dif­fer­ent times and dates, and promised fol­low-up let­ters that have never ar­rived at all.

A friend of mine was told she’d need to wait five months for a spinal scan, in­for­ma­tion gleaned only after she called two dif­fer­ent ap­point­ment lines four times, with each re­fer­ring her back to the other. She was told gruffly on the fifth at­tempt that it was her job to chase her ap­point­ment through what had be­come an amaz­ingly com­plex labyrinth. I shud­dered along with her to think of how a less con­fi­dent, el­derly or sim­ply a far less well per­son would cope in such a sit­u­a­tion.

Then there are the weird psy­cho­log­i­cal ef­fects. We’re all find­ing our­selves apol­o­gis­ing to the GP for trou­bling them, em­bar­rassed to im­pose – de­spite pay­ing our taxes – when we know how un­der-re­sourced the ser­vice is.

It’s im­pos­si­ble to deny any more that the jig is up. This is sim­ply not a First World health ser­vice. It is an un­nav­i­ga­ble, ran­dom-seem­ing sys­tem, with pa­tients at the mercy of en­demic opac­ity and con­fu­sion.

The NHS, they say, is a re­li­gion. But it isn’t a re­li­gion; it’s a First World health ser­vice that no longer be­haves like one. It’s time for a re­think. We prob­a­bly need more pri­vati­sa­tion, or at the very least, a top-up fund sim­i­lar to the TV li­cence to help se­cure not more man­agers but more doc­tors, hos­pi­tals and drugs.

But un­til the delivery of first class medicine be­comes its pri­or­ity, this evan­ge­lism is go­ing to cost NHS pa­tients – more than it already has.

It’s im­pos­si­ble to deny that the jig is up. This is sim­ply not a First World health ser­vice

Digi­tise: the health sec­re­tary Matt Han­cock wants more out­pa­tient ap­point­ments to be held edo over e S Skype ype

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