It’s the simple things and the petty bureaucracy

Watching last week’s BBC Question Time, I heard Eric Pickles say that he had spent all of his political life trying to achieve better integrated public services.  I once had a brief conversation with former BBC Crimewatch presenter Nick Ross, who said that one of the reasons the programme existed in the first place was to facilitate better communication between police forces.  Now today I’m reading the CQC report which highlights the potential problems with quality of care for dementia patients. Will joined-up services ever be a reality?

My father has dementia. So far, although his dependency on care and health services is fairly light, the biggest problem we’ve encountered isn’t pure quality of care, but more what I’d call the frustrations of petty bureaucracy.  There are hundreds of examples: the long letters and complicated forms sent direct to him, even though another part of the same organisation is supporting him precisely because he is no longer able to deal with long letters and complicated forms; the GP who asked why we’d attended an appointment – an appointment which we had only attended because the practice had said we had to, otherwise “no more repeat prescriptions”; the rules, paperwork and “compliance” which removed the common-sense and perfectly reasonable domestic systems we had come up with as a family to help my father cope.  And yes, some of these we were told were not up to the standards “required by the CQC”.  

But to quote the late, great Douglas Adams, “resistance is useless” because so many organisations see rigid adherence to “standards” as quality assurance.  It might be in the manufacturing of components.  But in the care of any patent, whatever their diagnosis, care comes from those who apply common sense and compassion.

Too many times when we ask “why” something is unsatisfactory, unsuitable or just downright silly, we are told “it’s the rules” – or that other great get out of jail card, “it’s patient confidentiality”. For better care, genuine communication between individuals, teams and organisations, we might be prepared to take a risk on some theoretical breach of our own confidentiality.  The confidentiality is after all only supposedly protecting the information we own about ourselves.  So who better to say what is and what isn’t being put at risk? But we’re never given that option.

My own GP practice goes to what I consider to be extreme and unwieldy lengths to supposedly protect my confidentiality.  That is, right up until the point you’re sitting in the waiting room and they flash your name up on a big illuminated screen to tell you which room to go and find to see the GP. People who would have no way of identifying me as a patient, have just been given a huge sign as to who I am, what I look like and the fact that I’m ailing in some way.  So much for my right to confidentiality.  Oh yes, and for those now saying, why don’t you join their patient participation group and work to make the systems better – I clicked on the link on the practice website to volunteer my services, only to get a message saying the email address didn’t exist.

But then as my very wise and practical next door neighbour always reminds me, common sense is not common……