"A void in my soul"-( NHS Complaints - Part 2 ).

My friend and fellow blogger Angus Dei, wrote those words yesterday. I have no monopoly on eloquence, or indeed anguish, but it sums up the effect that the loss of hope has on all that tread the route of the Complainant. Far more succinctly, than any that I have penned. Far more for he, and many others that I call friends, that stand with me in the pursuit of justice and candour, for they have lost loved one's. I have not, although it seemed a close call.

I once said, that this endeavour can be likened to wading through a swamp, with a dagger thrust in your heart, but, yes, there is a void in mine and all those hearts, that battle with a system so designed to make you fail, that it can and often does break the spirit. It is really not the system even, but those that operate it and the framework in which it sits. The Orwellian structure that the NHS has become lends itself to a system of 'them and us', with all the power and resources vested in the state run behemoth which the Complainant must battle. For you to win is virtually impossible; you are very much 'David' to their 'Goliath'.

We none of us, I believe want revenge, but we do want redress. By denying this need by the many constructs they place in our path to any sort of justice, they engender that primitive emotion within us, often to our detriment. We become obsessed, paranoid even to wreak some damage against this implacable monster that robbed us of our well-being, confidence, complacency and even sanity. We 'rage against the machine' often in self destructive and even dangerous ways. Many are wracked with guilt; the guilt of the survivor. We are reduced to automata, thinking of nothing but the events of our downfall. We shun friends and family, make new enemies, often of our friends and even, of the loved one's that are left.

If you are lucky, as was I, before you completely self destruct in a welter of pain and misery, impotent rage and all the damage these inflinct; something or someone brings you to a realisation that it is not your fault. You are neither bad nor mad, just damaged more than you would ever believe possible.  I came close to losing the very thing that made my life bearable, the love of the person for whom I was battling this implacable beast. I sat in tears for long periods, couldn't get my breath, heart pounding, reaching for that cigarette, the bottle of booze.

Taking care of her became obsessive, seeking every way possible to help, to heal, to make me hurt for the pain she was suffering. I needed to pay for the damage to her, for which I imagined I was responsible. I had let them harm her; I could have stopped this, it was all my fault. I am not cured of this, nor will I ever be completely. But victory in the battle with Authority would have helped to heal some of the wounds. Would have assuaged more of the guilt than it has so far. But it has not been so. We are still in the limbo the system leaves you with; waiting for the next episode in the saga of the Complaint.

NHS Complaints - Stage 1 - Local Resolution

A Critique from a Patient.

"The first problem encountered was the delays in obtaining Medical Notes.

Although these are supposed to be available within 20 days of request, that means 'working days'. You have also to send a fee, just register your need (£10) so they can assess the work needed and then tell you of a further fee of maximum £40 (which it always is) to provide you with the copies. Nothing will be done until your payment is recieved and processed, so we are already well beyond 20 days overall. You will in fact, in all your dealings with complaints system, find that time assumes an elasticity akin to a rubber band.You are of course at some disadvantage, because you have no idea as to what constitutes a complete set of notes or otherwise, or whether some have been witheld. 

With your notes to help, you can then formulate your complaint and forward it to the Hospital or PCT. Again the passage of time will extend to suit 'them' rather than you. Although protocols are laid down, every excuse will be made to delay, such as people off sick, on leave, left the department, abduction by aliens ? All of these calculated to allow the passage of time to obscure issues and your memory of events.

Your reply will eventually arrive; probably penned by a Complaints Manager, or worse 'A Patient Experience Officer'. It will usually be condescending, rich in terms that you may not understand unless you have medical or scientific training and littered with excuses and obfuscation. You may also recieve some possibility of an apology for the experience you have had. Or, an admission that certain things that should have been done that were not. And of course they will ensure that such problems will not re-occur because they have measures in place to ensure it will not.Pure 'bullshit' of course, and should not be countenanced by any complainant. You need to know that their measures will be put in place and be seen to be so. But of course they are unlikely to invite you inspect or check this out; you are simply expected to accept their word.

Remaining dissatisfied at this stage, you may take advantage of a meeting that may be offered to discuss your complaint. You will assume it will be with Doctors or others who had a hand in your treatment. It won't; it will be with the machinery of the official excuse and bafflement department. The specialists, whose role in the scheme of healthcare, is to navigate a safe passage for the Trust through the complaint, to achieve the best outcome for their employer. You will not be allowed to put a face or even often a name, to the Architects of your treatment. They will be hiding behind the 'stonewall' of the Medico-Legal team with whom you will be confronted. This usually fronted by a Consultant, not in the normal sense of the word but one that mainly earns a living being an Expert Witness, or Single Joint Expert in Private Practice, as well as taking taxpayer gold in the NHS. These 'mercenaries' of Medicine, make a handsome living working for anyone who can afford their extortionate fees or of course the NHS. Yes we are paying them, to deny us justice and candour, and get their cronies off the hook.

Obfuscation will be the order of the day; issues will be clouded, and finally you will be told that any negligence in your treatment is a 'matter of opinion', as to whether or not your complaint has value. This is the 'perfect storm' of medical errors defence, 'the bolam test'. They say that patriotism is the last refuge of the scoundrel, well Bolam is the final defence of Doctors who have transgressed. If a 'body of opinion' within the Physician cohort agrees with the treatment you feel to be negligent, then it is correct. It is unjust, counter intuitive, robs you of the redress that you seek, but it is the Law of this land.

Your meeting is finite. You will not be allowed to overrun, despite the fact that you may be distressed by the dissection of your experience. You will be alone or with your ICAS advisor, who may, or may not act as moderator. You also have to remember your opposition are important and busy persons, with meetings to go to, money to make, and more complainants to shaft. You will at some time be asked what you want 'them' to do about your complaint. Pretty much a 'when did you stop beating your wife' question. They will also apologise for the poor experience you feel sums up your treatment, but will give no tangible hope that anything will change. 'Smoke and Mirrors' is what you will be shown, all signifying nothing.

You will leave at the termination of the allotted time, feeling lost, distraught, drained of hope, even doubting your own veracity. Probably in tears, as was I and my J, with their weasel words of sympathy ringing in your ears. And of course with your hope of redress in tatters".

Lies, Damn Lies, and Statistics.

It has long been a suspicion that Data presented by the NHS did not compare with anecdotal evidence from the Patient cohort. More than anywhere,  the data for time spent in A&E, seemed by many, not to concur with with their personal experience. But of course the view in isolation of an individual, is subjective and often viewed by them as, the exception rather than the rule.

All Hospitals have a target time of 4 hours, from arrival in A&E, to discharge or admission. Target times are shorter still for Trauma Orthpeadic or other urgent admissions. Currently all are supposed to achieve a minimum of 98% of the target. Whether we believe in targets is irrelevent, especially to badly injured or sick patient who needs help. So the outcome does have merit.

Overall the Dataset for 2007 - 2008 shows this target is not met, failing by 2% at 96%. Curiously, 6% of these were discharged or moved elsewhere in the last ten minutes of 4 hour target. Close in fact to 147,000 patients of nearly 2.5 million. An incredible feat, one might feel, for the NHS Hospitals involved, with some having a remarkable recovery, beds being found at the eleventh hour, or perhaps just wheeled into a corridor or cupboard, as some actually relate.

Whatever the reason and jaundiced our view of this 'last orders' rush, it is quite a feat. But what has now emerged, in an independent audit of these figures, at the Nottingham Queen's Medical Centre, part of the Nottingham University Hospitals NHS Trust, is that staff 'bent' the rules to ensure targets were met, or came close to meeting the target. 1889 records were wrongly recorded, as being in target time since April 2008. A 'whistleblower' had raised the issue in 2005, but was ignored (you may have heard of this phenomena before).

Words like "enormous pressure" and "failure of systems" were trotted out by the man with the egg on his face, the Chief Executive. Dr. Peter Homa, but the Hospital already had a poor record in this area with a score of only 52 in the patient satisfaction survey on A&E waiting times. The top 20% of trusts scoring 81 with the best being 98. So they take a poor record and then 'fudge' the figures to prevent themselves from looking even worse. It makes one wonder in fact, if there is any point at all in trusting data from any Hospital or even the Dept. of  Health. The figures are in fact a meta-analyses of the data provided from the Trusts. No one usually gathers the information independently, the Trusts are simply er.... trusted. Perhaps that is the first mistake.

According to the 2008-2009 data in the DoH Hospital Episode Statistics this Trust achieved the 4 hour window in 97.3% of cases, leaving 4305 patients outwith the target time. They have admitted an error of 1889 cases; that is almost half as much again ! This puts them below the target by over 2%.

This is a Teaching Hospital; an alleged centre of excellence where young Doctors and Surgeons are trained to assume the mantle of Healer. The truth is somewhat more stark. It is a crumbling monument to 60's design in concrete, decorated in... concrete. It is short of front line staff and facilities, has an ISTC built within its own grounds, that went bust before opening and arose like a phoenix under another name months later. Its car park had to be demolished as it was dangerous to use. They haven't rebuilt it because the money for the new one went elsewhere. Yet the building is contemporary to the car park if not older and hangs by a slender thread, propped up by Messrs Screw,  Bodgit and Scarper's  tender mercies.

Worst, it is the place, that failed me and mine, in the pursuit of justice and candour, after an appalling litany of errors in treatment and aftercare. Now we have seen, how they lie to protect themselves, from any sort of censure. This is just the tip of a very large iceberg. They deserve to founder upon it.