Open All Hours...2

To continue on from previous: I have never much cared for the slanderous notion that women have colds but men always the 'flu, carrying with it as it does a false propagandistic message that women are ever the more resilient gender quite content to seek to run off a broken leg, whilst men will collapse to a sofa for a week if a toe should be slightly stubbed.

This is not, I must assert, a slander ever uttered in the Palladas household for H and I completely recognise our respective personal stances on such matters: should she sense the slightest blemish to the skin it is off to Harley Street by the first available train for tests for skin cancer, whilst I, au completely contraire will sit on any given set of signs and symptoms for at least a fortnight, in the generally false presumption that time is the only, as well as the great, healer needed and that if you ignore any illness for long enough it will pass away of quite its own accord. (Regular readers are aware of course that this course was once even tried by oneself with what proved in the end to be one's very own cancer. There are then acknowledged limits to this masculine inspired stoical approach to sickness, and very much 'Tip for the Day' is, therefore, that time alone as a cure for cancer simply does not cut the, or indeed any, mustard.)

But today the subject is not life-threatening malignancy but rather a far less awesome matter of a swollen and deeply painful elbow. (OK well actually we are making a pitch for possible abscess tending towards - if unchecked - peritonitis and even mortal extinction. But that is to jump too far too fast for the purposes of this tale.)

An ever-aching elbow one has learned to live with as the consequence of some lazy ergonomics. One ought not continually to lean on it whilst typing away, but one does, one has for many years. I lean, it aches. It's a simple transaction. But then some four days ago the ache came accompanied by some serious and painful swelling. Let us call it, what is surely is, a modern fangled disease: 'Computer Elbow'.

And what should a fellow do in such circs? Well clearly, to follow the masculine line and ignore it. Change perhaps for a while one's usual slumped posture and then wait for sensible and long-overdue environmental adjustments inevitably to work their magic. A perfectly reasonable and proportionate reaction and response one would say.

One would, however, not in this case be right. Reasonable certainly given the known facts, but proportionate not at all it has transpired: for swelling - inflation - has but masked infection, and whereas an inflated elbow may subside all by itself once the irritant causing the swelling is removed, an infected elbow alive and kicking with all sorts of bacterial nastinesses needs active, immediate and, as we all know, antibiotic treatment.

All that though is but the diagnostic and subject context. The heart of the matter here is how and why one has journeyed from a Friday morning annoying ache to a Sunday night of waiting for the midnight hour to strike in order to hoick down the last dose of the first day of treatment.

Friday then ack emma status report: feeling a bit ropey and aware that resting heart rate is well above the norm for either age or man. Put both down to industrial-strength hangover from previous night of delicious excessive alcohol. Think, therefore, to self-medicate with Ibuprofen and strong coffee, and reckon neither will do any harm to raging pain in elbow now in its second day.

Headache and hangover subside as these things do, but pounding heart rate and raging elbow pain do not. (Note this, but no more, for now.)

Saturday ack once again emma. Poor night's sleep of restless wakefulness due to ever-present pain, interspersed with fitful dreaming of loud tom-tom beats and dark skies lit by dazzling displays of red-hot fireworks. Decide to take a stroll round to local pharmacy establishment for a swift chat with the resident Drugs Czar Harold. Harold does not hold himself to be medically qualified, has no ideas above his station at all, but is for all that a thoroughly knowledgeable cove when it comes to minor ailments of all sorts. Check, therefore, with him then if there is more to do than knock back the odd anti-inflammatory and suffer in silence whilst time gets to its work.

Sound notion but one blown clean away sadly by Harold choosing to have the morning off and substituting a sweet child in his place. Said sweet child mayhap be solid enough for the purposes of a locum dispensing powders and potions but not, as it turned out, of any substantial use when it comes to the matter of sound advisement. For, says she wrongly, there is no other course of action required other than the analgesics. No mention whatsoever of the possibility of a true infection that uncapped will rage throughout the whole body at the blink of a horse's eye.

One specifies the eye of a horse as it was in the equine context that one next made some progress. For the mother of one of E's stable friends happens to be a G.P. in her leisure time; that is, the little time that can be spared from the endless task of caring for a horse. One does not, therefore, ordinarily seek to burden her more with off-the-cuff remarks about human sickness, rather focusing on how one's horse fares and what is the latest news on its tendency to chuck its young rider if in mareish mood - as these mares so oft are.

Prompted though this time by ever increasing levels of pain, one did ask in purely general terms what might be the reasonable parameters of thought and action in regard to an elbow on the turn. It was then that other dimensions, previously unconsidered, hove into view. Abscesses were revealed as an optional extra, with necessary accompanying elements such as urgent medical treatment of both topical and systemic natures: get it drained possibly and most certainly get on board at once with the antibiotics.

Thought provoking stuff you'll agree. For the moment though nothing more than cerebral contemplation and no actual action following. One could leg it over to one's own G.P. for the full professional view, but then one couldn't it being Saturday and one's own G.P. doesn't do weekends. There is, instead, a telephone answering service that does not take calls, or if it does rarely replies to the simple request for urgent medical attention: "If you are breathing please don't bother us; if you are not breathing please phone your undertaker and stop bothering us." That sort of thing.

The alternative access to health services of any nature would be a by a trip to A&E. Through natural native cunning we have all learned that since the introduction of the false target god of a maximum four hour wait to be seen, no matter how trivial the matter, going to A&E is no longer something one only does when a limb is hanging off, or one is truly desperate, but is a convenient alternative to hanging on the telephone attempting and generally failing to book a G.P. appointment.

That's rather like those hotlines for buying tickets to popular music concerts so loved by E and paid for by her father: miss the beat of 9.00 a.m., when the box-office or doctor's reception opens for calls, and all you'll get for the next three hours is the engaged signal. Until finally you do get through only to be told all tickets were sold within the first nine minutes, or indeed all appointments for the day within that same short time.

But call me of the old school if you will, I tend to prefer not to trouble the hectic lives of Casualty staff until and unless the aforementioned limb off-hanging desperate pitch is reached. In which case waiting until the Monday when G.P.s returned from their weekend yachting breaks or whatever seemed the only choice.

Until of course one suddenly recalled that the local new hospital has something all the rage in the health service these days: a 'Walk-In Centre'. Just the ticket then for someone who simply wanted to walk-in, see a doctor, get a script and continue on with his busy life. And by the Sunday morning with arm rapidly - nay very nearly visibly - swelling by the hour a trip to the WIC was definitely on.

A swift phone call first though to check that the service actually operates on a Sunday morning seemed in order. Not a heck of point in trying to walk-in through closed doors. So one phones the main switchboard number for information. The flow of such information goes something like this:

Good Self: "I believe you have a walk in centre service at your fine new hospital. Could you tell me if it is open at this hour?"

Surly Operator: "Yes, but you have to make an appointment first."

GS: "An appointment for a WIC? That most surely belies the nature of the thing! The clue is in the title - 'walk-in'. One cannot need an 'appointment' for walking in can one?"

SO: "Yes one can, in fact one must. So there. Tell them about it if you like. I'm just following orders! Here's the number for appointments." (That last very much said in call central traditional accent of taking it or leaving it being entirely a matter for myself and of absolutely no interest or concern to the call centre itself or to its surly staff.)

So one did take the proffered number, if with some distaste, and made this use of it:

Good Self: Dials number given

Automated message: "This is the number for making appointments for the wonderful new WIC."

GS [thinks]: I frigging know that, that's why I'm phoning you dolt!

AM: "In order to make an appointment you must speak to an operator. Unfortunately all our operators are busy at present. Please do not hang on in the vain hope of speaking to one of them. Please don't even think of leaving a message as we won't listen to it. Please hang up now before we hang up on you."

GS [swears]: Frigg that for a game of soldiers!

AM [presciently]: "No point in swearing. I'm just a machine."

Machine hangs up.

So back to the first number:

Good Self: What is going on here? Just tried your wretched appointments line and got nowhere. Please suggest a viable alternative option.

Surly Operator Two: "As my colleague just told you" [clearly a marked card me] "you must have an appointment for the WIC."

GS: This is arrant nonsense and you know it. My Bro. Geo., whose professional life is spent designing health systems and processes that actually work, could if he were here put you right on this. A 'Walk In' service is precisely that. No more and certainly no less.

(At this point one must confess one pushed the boat out a bit here. For the actual words uttered were along the line: "I happen to work for the health service and let me tell you...etc., etc." But if a tad over the mark on strict truthfulness a veritable miracle cure for the impasse.)

SO2: [suddenly a lot less of the 'S'] "Sorry, did you say you work for the health service?"

GS: [plunging on] "Indeed so my good woman...."

Hardly 'S' at all O2: "Well in that case Sir, you may simply go down to the centre and indeed walk in!"

GS: "What!"

O2: [more 'S' for sheepish by now] "We've been instructed not to tell people this, but to use the appointments systems. Please don't say you heard it from me!"

Good self decides not to pursue this mystery any further but simply to grasp the chance, howsoever illegitimately gained, and get right on down walking into the walk-in at a trice and a pace.

So one does attend this our brand new hospital. (All gleaming bright and shiny, yet still filled with as much if not more MRSA and Clos. Diff. than its worn down predecessor, though that is for a later tale.) Great stonking signs point one the way to go. Handy that if you've not been there before. (Sadly the one place not to see any sign or signage is actually over the doors that actually lead to the desired destination. Assuredly smart post-modernist architecture doesn't do signs on buildings as such, though sadly of course decrepit patients-to-be still need them.)

By then perseverance and unwilting intent, one does find the very portal at which to enter. Across the wide, deep and terribly tall atrium one spots two desks of a reception variety. The first is labelled 'A&E reception', that being enough of a clue that this was not the one for us. The other has 'Urgent Care Centre' on offer, which sounds about right as indeed it proved to be.

Smiling lady behind the desk - a nurse perhaps if in any way someone with a duty of triage she must be - asks the broad outline of the circs. that brings one here and, on being satisfied one is not a certifiable loon or salesman chancing his arm on an off-day, immediately stripes one down on a very long list indeed then points to a doorway through which to pass.

"You'll be needing this too," says smiling lady/nurse handing me a torn off piece of paper on which she has written in biro 'UCC'. "Sorry about that," she says. "But we've run out of proper slips so tell reception you got this from me and they'll let you in."

So a gatekeeper of sorts clearly, if not a stricy triager as such. No slip, no entry. (Can immediately spot an opening for some sharp young entrepreneur: stand at entry to building whispering to entrants "Wanna UCC ticket. Five fera pound.")

Anyways, into UCC and up to further smiling lady receptionist. Circs. once more explained, name entered on viciously long list and place then to be taken in Waiting Room. So far so anticipated. What though had been less expected was to find said Waiting Room so packed, so bursting even, with waiting souls as to make days spent in any Calcuttan 'Black Hole' a positive lark.

Designed for maybe a dozen folk in comfort, it holds now some forty plus people - all of whom look up with that resigned sympathetic look as anyone new enters 'Bet you thought like I did that this would be a breeze!' - plus assorted pushchairs, wheelchairs and more mewling infants than one could throw a bucket of water over. (If, of course, one were tempted to take such a fluid approach to mewling infants in general, which - perish the thought - one never would!)

Alarming more - a terrible test of the very spirit of the man - there was, among all this heaving mass of humanity, one empty chair. ('Heaving' is perhaps not quite the right word, implying as it does some small capacity for anyone to move in any way of which there was in fact none whatsoever.) Around the walls were plastered some seven or eight plucky fellows and fellesses, all of whom might have given their Granny for a sit-down, but not one of whom wanted to be the one seen to take the last seat available when others might need it more. (And who said there is no hope for England while such wonderful self-sacrificing, embarrassed behaviour stalks the land!)

Turn away now then if any sensitive spirit must, for I am about to confess that I did not share either the manners or the sense of necessary sacrifice, but opted at once for the seat! Shame on me? I beg - and if I have to I shall - to differ. None of the standers actually looked on their last legs, whilst I most certainly felt to be on mine. Quite suddenly awfully unwell, not far short of a fainting fit I could tell. Maybe the 'roar of the crowd' and no more, but glancing down at the item in question - the inflamed elbow - one began at once to see other possibilities.

For lo, the thing that but an hour previous had been but a localised swelling had spread to a raging, ballooned, red-as-fire stiffness from veritable stem to actual stern! Lummy, this was serious stuff. Whatever was on the go was clearly up and running big time, with every intent on reaching the finishing line darn pronto. Time to wait? Not so. (Bro. George would have been so proud of what comes next.)

Two options opened for consideration. The first, to wait one's turn patiently - over the hour one was told by smiling lady mark two would be a decent minimum - and hope not to expire in the meanwhile. Option the second - and selected - was a swift return to reception, reveal one's woes and to plead for special consideration.

Can you imagine then my fright? Not only had I demonstrated to the room my utter disregard for Golden Rule of Waiting Rooms #1 - 'Never Take the Last Chair' - but here I was completely flouting the Great Precept of any British queue - 'Never Jump To The Front'! It must have been my fevered state that so emboldened me to overturn all known, understood and accepted principles of moral behaviour without even a single care to the likely opprobrium of others.

But whatever the morbid cause, the effect was pretty electrifying, for no sooner had one revealed sufficient of the flesh to convey the circs. than smiling lady was out of her chair calling for the nurse to come see at once. Nurse having viewed one was, on an instant, ushered into the presence of a doctor who opined that though neither swift amputation nor speedy removal back to A&E was required it was, in effect and fact, quite like the Battle of Waterloo itself - a close run thing.

That being settled and the alternative treatment of the expected dose of industrial strength antibiotics being prescribed, I could not but ask about the funny farce that had preceded my arrival here.

"Ah," he said, in a satisifed manner and one could immediately tell one had asked quite just the right question of the right man at the right time. It would take a man of Bro. Geo's. expertise and experience fully to detail all that then came forth, but the jist of the man's thoughts ran thus:

When the PCTs were handed the job of providing out-of-hours primary care some few years back it was a monster of a mess. The Government had predicted - if one can use such a scientific word for hopeless, random guessing - that only some small percentage of G.P.s would choose to opt out of their previous continuing and continuous duties to their patients.

When, however, most G.P.s legged it out the out-of-hours doors faster than you could cry "The surgery is closed. Haven't you got homes to go to?", there was not the funding, the capacity or the required planning to establish a viable alternative.

As a consequence, out-of-hours services have more or less imploded, with few doctors - apart from those flown in especially for the purpose from Dortmund or environs - willing and available to do the work, too few premises in which to operate the service and little or no money to pay for it.

The cunning native, not content with this absence and demanding its full accustomed slice of the NHS pie, had meanwhile spotted that you could now get a half-decent or better service from A&E, what with the introduction of four-hour waiting targets and all. Previously put off by the prospect of being told to wait a minimum of three days in a draughty, dank department, they discovered instead smart premises, with running hot and cold drinks, some magazines published in this very century and a waiting time of less than the average Tesco check-out on a busy Sunday.

What, however, worked for them did not of course work for the system, and A&E departments up and down the land were forced into over-drive and, worse, over-spend attempting to keep up with a demand that never really should have come their way in the first place.

So initial strategic foresight on the part of the wonks having fallen traditionally short of the mark - the world having gone to a place it had no right to be according to their predictions - they were forced to have another go. And that other go was towards these new beasts 'Walk In Centres'. Need a doc but not a stretcher as such? Then walk this way. Well again they did, these cunning natives, though not so much walk as stampede. Show them a narrow side-track on a Care Pathway and the ungrateful horde trample it into dust, with scant regard for the beauty of the design of the thing. Build a nice clean Waiting Room for twelve and be outraged when it fails to hold the forty plus who actually turn up.

We can't have this rank disorder think the wonks, we must impose order and structure and make people behave as we would have them. So the wonks design an appointments system for their supposedly 'walk-in' service. People may come if they must, but if they must then they must 'flow' not stampede. Can't have demand dictate supply!

That might work if the appointment system itself actually functioned, but even if it did it wouldn't because down at A&E they are still wrestling with the walking wounded who have walked into an 'emergency' department when all, at worst, they have is an 'urgency'. For them the 'Urgent Care Centre' is a godsend in a largely godless world and blowed if they are going to stop referring people to it just because the wonks want appointments.

So now there are two ways of getting into UCC - by legitimate appointment and by the side-door of A&E on demand. These two streams collide of course, and any person arriving having dutifully booked to be seen at, say, 11 of the morning will find twenty or so others who expect to be seen before then having themselves been waiting since before dawn.

More shambles to add to the farce of chaos. And what do the 'managers' of the skewed system do to fix the muddle? Why, instruct their front-line telephone operators to lie to the public. Appointments only is to be the party line to peddle to the great unwashed, and if they don't know any better then for Heaven's sake don't tell them!

Unless, of course, you 'work for the NHS'. Remember that trick. It may come in handy!