A friend has developed renal failure and cancer and needs a lot of complex therapy.
A widower, he lives in a semi-rural area with little public transport. Recently he was given sequential appointments on each day of the week at two separate hospitals, each some 15 miles away by a cross-country route.
His first problem was getting there: he was once expected on the ward at 7.30am. He's too ill to drive; it's too early for the routine outpatient ambulance or the voluntary car service. He can't get there by bus - it's physically impossible at that hour - so he's had to depend upon his friends: not just once, but every day for a week.
Why don't hospitals offer basic overnight 'hotel accommodation' for selected patients with transport problems who have to attend early in the day? It would only require a bed, toilet facilities and access to a canteen.
The second problem is the co-ordination of his appointments across two specialties - dialysis, biopsies and more dialysis, together with further attendance for therapy and treatment planning. Once he was late for an appointment because another one in the same hospital overran: he had a stand-up row with the staff as a result. This lack of joined-up working isn't an isolated event. Our practice is frequently told that patients have defaulted on their outpatients' appointments when, embarrassingly, they were inpatients at the same hospital at the time.
My friend also found it intensely annoying (and exhausting) to have to travel to the same hospital on three separate days when these appointments - for minor tests, advice and therapy - could, in theory, have taken place during a single morning.
Surely it is not beyond the wit of man to devise software to schedule appointments that minimise the frequency of patients' journeys to hospital and identify double-booking? Being seriously ill is bad enough without the extra physical exhaustion and mental stress involved in just getting to hospital. Integrated scheduling of patient care (with appropriately spaced, non-overlapping appointments across specialties) should be the norm in the 21st century NHS. It's high time this happened.
- Dr Lancelot is a GP from Lancashire