Citation:
Jones, P. (2007) Introduction for Patients & Carers II
<>, Accessed

Introduction to h2cm for Patients & Carers: Part 2

In the waiting room and counting 1,2,3 ... Politics: No escape...

To say that health and social care are political is a gross understatement. This introductory page is political as it concerns your experience of care services yesterday, today and in the future. As the media has publicised in an effort to boost voter turnout, all the journeys we make are political.

Whatever the colour of government, make no mistake that the health and social care professionals DO have your interests at heart. Of course every walk-of-life has its bad apples, still, please do not underestimate the motivations that prompt people to enter the caring professions. Your acceptance of the professional's motivation, must be rewarded by their recognition of the patient's and carer's situation. Hodges' model is what is often termed situated. In terms of being in the moment health care, medicine create situations that are unique - in the extremes of emotion they produce.

Clipboard with medical chart, stethescope and pencil

If you are a carer: you are most welcome to this space. You have made a personal choice where your duties, your commitment to another does not end at 5 p.m. and with few (I'm being optimistic!) weekends off. No time for you for reflective practice and yet many patients and carers have kept diaries that tell of and teach lessons for all. The value of your time and experience in complementing the 'professional' team is paramount.

What your health team would admit - is that 'they' as a service are just that service centred. This amidst waiting areas adorned with leaflets emphasising the person-centred focus of the service and team. As you soon as the situation you find yourself in becomes medical, health, or clinical, you are entering a funnel...

$abstract fractal funnel$

The patient (and carer!) journey

Returning again to the patient journey, much positive work is ongoing within the UK and internationally, mapping the journey patients and carers make. Not from the perspective of the healthcare team, but investigating and capturing your views, what happens to you subject to the service routine. Modernisation includes projects specifically focused upon the patient journey, obtaining accounts of your experiences on audio or video. How many trips to out-patients? How far to travel for a 10 minute appointment - a blood test? Services need to learn how they can go that extra mile to make your journey seem if not shorter than it really is, then at least more bearable.

The aim is to educate and increase the awareness of staff throughout the health services about how to make policies work. This means addressing problems, bottlenecks and delay, plus less than positive attitudes. It also means strengthening those aspects of the service you appreciate. Efforts to modernise services are ongoing and will not end. There are a constant stream of challenges that face us all.

Services are examining the journey patients (and your carers) take:

you may have to visit your GP regularly
you attend several out-patient clinic appointments
tests are ordered
you have contact with several healthcare professionals
who may be from public, private or voluntary agencies.

Efforts continue (really) to make the funnel as short as possible, to ease the journey, from problem identification to the evaluation of delivered care. Short or long all parts of this process invariably contribute to the quality of the journey you must make.

In the waiting room

For all the actors involved time, attitude, and awareness are of the essence. Approaching your family doctor you are suddenly aware that you are one among 6-8,000 patients or more. Doctors are busy people. Those 6-8,000 people are not all there in the waiting room with you, but they may as well be. Unless you are the 'last-in', once in the consulting room you become aware that the waiting room is - well still waiting! Even if you are the last-in, the emergency visits, preceded by the paperwork that you have contributed to taps not only you on the shoulder, but the receptionist, the doctor and practice nurse too.

There you are waiting, in the waiting room. You and your complaint, symptom or problem. If circumstances permit old jokes echo in the walk from your name being announced, to opening the surgery door. You check - if the previous patient has left - to bump into a receptionist dashing out piece of paper in hand, having dashed in, to sort a quick query.

The Consultation

You proceed to relate your concern, ask your question, await the news. The process of which depends upon your existing relationship, class, education. On the same wavelength you leave symptom explained, anxiety reassured, a new prescription, or investigation pending: your mind put a little at ease. Alternately, you be faced with another round of clinic appointments.

If you are anxious part of this anxiety stems probably from the knowledge that if you must tread that longer path you are faced with many detours and obstacles to negotiate. There are organisational boundaries to hurdle, appointments pending, to receive and keep.

How well you can communicate with each other is crucial to what follows. How well you convey the relevant information, that is then allied with the expertise of the professional, added to the data accumulated from any tests you have had.

Beyond the surgery

For all travellers the direction prompted by health is always significant because of the uncertainty it provokes. Patients are so frequently unclear about the distance to be covered, are there any stopping points, who will be met along the way, and how much time will this take? Underpinning all these questions is the basic one of how much can I control what happens to me? Some people can channel this uncertainty positively, as it can have an appeal in the face of desparate times - diagnosis or prognosis. Of course these are not associated with routine one-off care transactions, but more complex circumstances such as chronic medical conditions.

Along the way the next professional you meet will probably be completely new to you. As a result you may need to repeat information. This is where developments such as electronic booking should help everyone.

Hey... They're joining the dots...

If you need to be referred on, it is at this point things become more complex. Largely because of local variations which the Government is seeking to iron out - improving efficiency and effectiveness across the board. Concerted efforts are underway to avoid unnecessary duplication of effort on your part and clinicians. Patients and carers should only need to give their story and details once. The Single Assessment Process and Common Assessment Framework are central to make this a reality, but there is more...

This effort is concentrated on electronic records. As the public have noted for years - why don't health and social services copy industry and commerce and make effective use of IT? Now in the UK the National Programme for IT is well underway. This is a large scale, long term project to provide a national electronic patient record. There are many challenges to be overcome, but together we will get there...

Now you are a dot too!

Health and education are constantly under pressure to change. Pardon the analogy:, but health care workers are punch-drunk from change. If health does not change the future will deal the knockout blow. The population is ageing quickly, so health needs to be fit for purpose, leaner, with faster foot work, greater reach and accurate focus.

Self-care and education is being emphasised. This does not mean getting on with it, or being left to fend for oneself, but it does mean patients and their families being equipped with the skills to manage problems, symptoms and the risk of relapse in a more effective, safe way. The advent of personalised care, will also mean people have a budget to plan and organise their own care. This will include access to your own electronic summary record - HealthSpace.

A sense of closure

Although, we began the patient's journey in the waiting room, of course this is not the true starting point. Your decision to seek professional advice is usually supported by the opinion of a family member: "yes, I think you should ring and make an appointment." Even this stage is being examined to improve your access to help, and begin that filtering process much sooner. Amongst many options, this includes NHS Direct, trusted internet sites and very soon digital TV.

If our ability to communicate is our greatest asset, then when this falters communication becomes a major weakness. It is omissions or misunderstandings that can become the irritations, frustrations, personal, family tragedies and legal concerns of tomorrow. Safety is key. Complaints must be dealt with properly: acknowledged, reported and actioned as necessary can avoid the escalation that often follows.

In the 21st Century health & social care services need all the help they can get. I believe there are many benefits to be gained from using Hodges' model. The model can help provide FOUR-warning and FOUR-sight. A tool that means something not only to the health and social care team, but you too.

Thank you for your visit and interest.

back to page 1

Whether a patient, carer, advocate everybody needs:

help-2c-more - help-2-listen - help-2-care

Visit the blog -

Welcome to the QUAD