Retarded access

James Willis

You don't want to be written off as someone who thinks everything was better in the past, says my daughter on the phone, against the sound of growing tumult from the twins. I understand that, I say, and I don't think that — there's a great deal that is far better than it used to be — but I've got to write my column today and it does seem to be an opportunity …

An opportunity to pass on what she's just been telling me, that is. Not that she wanted to worry me. In fact she's as cheerful as she always is. But she has just told me two depressing stories in succession, and you've probably guessed what they're about — access. Not about Advanced Access, of course; ordinary people have never heard that silly phrase and don't use it. But if they have heard it, it would never occur to them to associate it with these experiences. If the Department of Health or anyone else thinks they can make something advanced just by giving it the label, when what they really mean is retarded, it certainly hasn't pulled the trick this time.

So, story one: one of the twins (7 months) has had three lingering, slightly wheezy coughs, following colds, since the check-up (3 months ago) when the GP said his chest was clear. My daughter thought it was time for another listen, having been atopic herself from infancy, but when she rang for an appointment there were none left that day. Try again tomorrow, she was told. Same again. Oh well, perhaps he's not too bad, let's leave it over the weekend, and perhaps mention it to Dad.

Well yes, she says, it is bad isn't it. And actually, (this is story number two) there's something else that happened to a friend at work that really is awful: she had a car accident on Friday and hurt her back. She decided to be brave and wait over the weekend and then when she rang first thing on Monday for an appointment there were none left. Try again tomorrow she was told. Same again when she did.

At this point my daughter takes things in hand and rings her friend's surgery: Look, she says to the receptionist, my friend has had a bad back pain since a car accident 5 days ago and she still hasn't seen a doctor. After this things start to happen, and a doctor rings her (the friend) later in the day.

But I can't see how anyone is going to know anything about any of this, says my daughter, in spite of all the auditing and accountability that is supposed to be going on these days. Nobody asked her friend what was wrong, and for that matter she hadn't been asked herself when she rang for the baby either, so how could anything appear in any of those famous figures? Perceptive girl, wouldn't you say?

I'm not saying that either of these stories are particularly horrendous, and our other daughter with our other grand-baby seems to see her doctor (or at least a doctor) at the drop of a hat, but they are stories that have happened in my personal experience within the last 4 days as I write. Believe me, the whole country is humming with similar ones. Some of those will be horrendous, and none of them will show in the statistics either. I think a lot of doctors are protected from them, perhaps the last to know (unless they have been reading Jeremy Laurance in The Independent recently) but if they could hear that nationwide chattering, all at once, then in George Eliot's phrase, they might ‘die of that roar that lies on the other side of silence.’

My headmaster used to go on about us ‘bringing the school into disrepute’ by walking into the town with our ties slightly loose, that sort of thing. ‘Disrepute’ — ‘reputation’ — that is, what people tend to say about you. A school's and a doctor's reputation is everything, and so is the reputation of the medical profession. Doctors and their patients suffer when that reputation suffers. Doctors are dependent upon it for so many of their rewards, and patients are dependent upon it for so much of the effectiveness of their doctors. It is not pure selfishness that leads us to defend it. And in doing so we have enormous power. United, doctors can always say ‘no’ to things that are wrong. In the end, providing a good service to patients is what is important rather than kowtowing to blinkered and self-interested dictates from the Department of Health. Especially when those dictates are couched in contemptible doublespeak.