Tuesday: the NHS and success


Sometimes (to be honest, probably quite a lot of the time) the NHS just works. It's important to be as noisy about its successes as we should be noisy about its stumbles.



Antique Relative phones, reporting pain and a concerning swelling. Unusual, and sounding to me a bit alarming. I phone NHS24: ‘OK, that sounds alarming – are you next of kin? – what's Antique Relative's phone number?’


A nurse has phoned Antique Relative for a chat, and phoned me back to give advice. It's not clear what the problem is, but there are couple of possibilities and it would be wise to get a GP appointment today.


Phone GP receptionist. You need a house-call? ‘Oh dear' – sucking of teeth – ‘I can't be more precise than some time this morning’ (sigh; nevermind; I'll go and wait). Get on bike.


I just beat the GP to Antique Relative, who twinkles charmingly, but is clearly not themself. Antique Relative is deemed to be commendably healthy (indeed deplorably so, given their sturdily defended ignorance of what public health professionals might fondly term ‘sane dietary habits’ – I resist the urge to co-write a book proposal, ‘The Traditional Scottish Diet: fried atkins without the woo’, for people who were born pre-cholesterol, and it seems also prior to the invention of the vegetable). But yes, that swelling is a Thing. ‘Does this hurt?’, ‘no’, ‘this?’, ‘a bit’, ‘only a bit?’, ‘aye’. GP rather perplexed by an odd mix of symptoms (‘if it was what I thought it was, they'd be in agony’), but one of the possibilities is a Bad Thing, and it is concluded that we should go to the hospital for a radiologically closer look. Oh well, nevermind: the hospital has WiFi, and I can cancel meetings from there. The doctor phones ahead, and scribbles a telegraphically compact note for us to take. Antique Relative is occasionally wincing, but phlegmatic – it'll be sorted out. I look forward to a long day staring at institutional beige walls and bolted-down furniture.


Arrive at hospital and hand in letter. No sooner has the bum grazed the bolted-down furniture – and I could murder a cup of tea – than ‘can you go through please’. OK, so tea later.


Antique Relative having been checked in, extremities counted, and nurses twinklingly chatted up, a Nurse Practitioner promptly appears with an ultrasound machine. ‘Yup, thought so! Ermm, are you sure this isn't sore?’, ‘Well it's no very comfortable.’ ‘Jeez...’.

Then the sort of dislocated three-way conversation usual with the deaf and slightly forgetful: ‘How long have you had this?’ ‘It's hard to say.’ ‘You were telling me about a small swelling on Sunday, weren't you?’ ‘Oh, that's right.’ ‘_(aside)_—do I detect a mild case of...?’ ‘—yes’.

This turns out to be indeed the Bad Thing, requiring a minor but urgent surgical intervention. The Nurse Practitioner's straightforward procedure doesn't quite come off, therefore Plan B; but ‘I'm afraid the duty surgeons are in theatre, and I wouldn't like to say how long it'll be. You might have to wait a bit.’ Nevermind; settle down....


‘Hello, I'm the surgeon.’ (whut? am I to get no work at all done today?) ‘What do we have here?’ I push off – tea! – to try to find a vending machine (and fail, by the way; this is getting critical) and when I get back I find one beaming Antique Relative, one beaming surgeon (‘I love my job’), and no more evidence of Bad Thing.


Done, dusted and mopped up, and a followup appointment being arranged, but there's the question of after-care. ‘Do you think you'll be OK with this stuff?’ ‘No problem!’ ‘—do you think...?’ ‘—we might need some initial support’ ‘—indeed; hang on’. So the nurse gets on the phone to HSCP, the city's adult social care unit (recently taken back in-house by the local authority, to general jubilation), to negotiate a temporary change to the visits Antique Relative currently gets. ‘And you can start this evening? Great!’


In a taxi, with a bagful of supplies and antibiotic medicaments, to Casa Antique Relative. A recap of the day, and a call to HSCP to confirm arrangements. All's good, but I want to have a chat with the carer, so ‘do you have any idea when they'll arrive this evening?’ ‘Sorry, no, it depends on the scheduler – but I'm afraid it could be any time between seven and half-nine.’ Nevermind. Get on bike, homeward.


Cup. Of. Tea.


Back to Casa AR. Settle down for the wait....


bzzzzzt Oh, hello. The carer knows Antique Relative well, and we all catch up, and discuss and adjust the scheduled support. Medication is examined. General twinkling. Carer hot-foots it to next call. ‘How're you feeling?’ ‘Och, fine: how about we nip down the road?’


Pub. Hello, everybody!

All is right with the world.


bring bring brinnnng... Hello? ‘Hello – this is the district nurse – we've just called in on Antique Relative, and they're clearly managing OK and everything looks good. HSCP are on the case? Good. You OK? Good. We're based at the GP's, so call us if you need us.’ Righto. Good. (I find myself thinking of bracing sea-breezes).

This is what success looks like

Taxes: this is why we can have nice things.

This, to drive the point home, is three distinct arms of the NHS (NHS24, the GP, and the regional health board, all with different funding lines), plus the local authority's adult social care service, passing a potentially dangerous case on, one to another, resolving it, and sorting out the aftercare so that Antique Relative stays at home, as far from hospital as possible (desperate place – full of sick folk), and out of retirement accommodation (‘definitely not! – desperate place – full of old folk’, quoth AR). Healthcare aside, the bureaucracy alone warrants a round of applause. The process as a whole doesn't always go this smoothly and quickly, of course, and not all treatment stories end up in a pub, but no individual step of this was out of the ordinary: this isn't an above-and-beyond story.

And no, for those watching from foreign shores, no cash appeared at any point.

The benefits don't just accrue to Antique Relative. I'm a beneficiary of this setup, too, since my ‘caring’ is not at this stage required to go beyond admin, moral and familial support (which can of course be at least partly pub-based), with HSCP doing the day-to-day counting of limbs and pills. I do not, when it comes down to it, have a challenging time.

I got no work done on Tuesday. My employer is commendably OK with that: I'll get the work done one way or another, and if I don't, life goes on. But the existence of a well-articulated social care service means they generally don't have to take that hit twice: though in the terminology of this field I'm a ‘carer’, I'm not routinely rushing off, or arriving late, dealing with routine problems. My taxes and their taxes save them money and complication.

It does no harm to remind ourselves that this articulation is also justifiable in the coldest of economic terms, as angst- and money-saving efficiency. But that's not the fundamental reason why all of this is the right thing to do. There's moral and social justice here, and dignity, and I am consciously happy to live in a society where a story like this is regarded as just Normal.

Norman, 2019 October 14