Games They Play...

H here, fuming!

A sad morality play of modern times in the health service:

Call came through while dear PP was out on his rounds to say that Peggy had taken a tumble, was in an ambulance on her way to A&E and could someone pop down to hold her hand, she having no family and fewer friends. Pure vicar's wife territory of course and rather an attractive notion to go see how the old trout was doing: not Peggy - though she is both old and fishy - but Newchurch Hospital where once one donned the apron of nurse to the fevered. Some ten years since I last worked there and even longer since I had used its facilities ("See Newchurch and die" was the motto among the staff let alone the patients!), so a venture into the brave new world of the 'modernised' NHS was an occasion not to be resisted.

Of Peggy there is not much to say - they poked and prodded as they should, pronounced a severely sprained ankle, bounced her up and down a few times to confirm she was tolerably fit and said she could go home with '50 painkillers and that nice Mrs P', which latter was sweetly appreciated by me if not by Peggy, who was in her usual grump.

But it was an overheard conversation between two of the medical staff that has me fuming with more than righteous indignation this evening and more than half-despairing of the mortal corruption that has crept into our health service. As we all know - or should know - hospitals are not run any longer by doctors (or even better by matrons) but by 'targets'. One key target is that no one should have to wait in A&E for more than 4 hours before being either admitted or discharged. (Quite why 4 hours should have been chosen and not say 3 or 5 is a complete unknown, but there it is.)

Meeting this arbitrary target is now the be and the end all of staff's attention and many games are being played to ensure nominal compliance if not actual achievement of swift and effective medical care - which was the original idea. A sound idea in its own right, but naturally one not achieved through the imposition of a target that can and is manipulated. People discharged without proper assessment or treatment, people admitted unnecessarily - and all to play the game of 'Beat the Clock' - this we are all too familiar with.

But tonight's episode of the NHS Game Show was truly shaming.

A consultant had been bleeped to attend to a patient in need of this person's particular specialism - stomach I think though the organ or disease thereof is not relevant to the case.

Consultant duly arrives pretty pronto and takes a shuftie at the medical notes of the waiting patients. "But hang on a minute," says attending consultant. "You've bleeped me to see Patient Q who certainly does need my services, but you also have Patient W who is clearly much more ill and a priority for my immediate attention."

The duty chief of A&E could only huff and bluster in best 'Little Britain' fashion - "Yeah, but no but, yeah but no but yeah, but..." - before finally coming clean and saying that yes while she acknowledged the clinical priority of Patient W, that poor person had already and disastrously passed the four hour deadline becoming thus a dead case as far as the target was concerned; whilst Patient Q, though agreed not so ill as patient W, was still running under the four hours with but a bare fifteen minutes to go before the big bong.

Would therefore the consultant mind setting aside his clinical judgements, his thirty years of dedicated service to the sick of the land, his professional ethics and codes of conduct and attend to the patient who needed him less but who could, if sped through, come in at under the allotted time?

What corrupting forces must be at work, poisoning the hearts and souls of staff, for this to happen? How did a nursing sister so come to lose all sight of what is right and what is decent? You will doubtless expect me to be blaming Tony Blair for this evil in our midst (I use the word advisedly - 'evil' that is and not 'midst') and yes of course I do, though this time I shall opt for a variant on the lesson of how sin came into our world and, more vitally, how it can be expelled once more.

Patricia Hewitt has announced that she will resign if health service budgets don't balance by the end of the financial year. She is lying of course. The budgets won't balance, but she won't resign because she will say that they have and that she's staying put. But just to tip the balance in our favour can I urge that every health service manager's motto from here 'til next April must be that of the darling old dear who won the Pools then blew the lot - 'Spend, spend, spend!'

An almost happy ending to the above tale: the consultant not only refused to attend to the less ill patient in order that a time target could be met, he actually threatened to assault the nursing sister who proposed that he should. Something about large surgical devices and places where the sun rarely shines. Bravo he!