London, Glasgow and the hospital. (for Sandra)

I remember when I was young, and my brother was getting engaged then married, in the early 80’s.

We lived up in Glasgow and my brother in London.

His soon-to-be wife and her family were down in London and there was an expectation that any events i.e. engagement parties and wedding would happen there.

That is how it happened, and I don’t want to go over what was, the thing however that sticks in my mind, and I can really say this freely now that my parents have gone is the discussion around the travels down South.

In those days I guess it was a bigger thing to drive or get the train all the way from Glasgow to London – it probably wasn’t any quicker than today and it almost certainly cost much less, but for whatever reason, folk didn’t get about as much.

Nowadays when I meet someone who hasn’t been to London, I am a little surprised, although as I have encountered more people and discovered the way in which folk tend to stay where they are, I am finding that this is relatively common.

‘Oh, I’ve been to Sheffield a couple of times,’ Says the Eric, 90 from Barnsley, or, ‘I once went to London, when I was a child,’ Enid, 88 from Rawmarsh.

We tend to think, because many of us get around so much these days that travel is a given, that a familiarity with Oxford Street and Charing Cross Road is what it means to be a citizen.

No.

Returning to my parents, something I can remember my dad saying; or perhaps better, complaining, was the issue of us having to travel down to London for the parties, nuptials, etc.

His phrase was, ‘The journey from London to Glasgow seems longer than Glasgow to London,’ in that, it was OK for us to tootle down the M1 but the reverse was more difficult, longer, more arduous.

I can’t remember whether my sister-in-law’s family ever made it up to Glasgow; I do remember our trips down which were fun. The final one in 1984, ending with my birthday and a ZX Spectrum.

Now, why dig-up old times? Why foray into the past?

Well, it relates to the situation we have nowadays with care in the UK.

There is a sense that it is easier for patients to get to the hospital to see the doctor or nurse than for the nurse to go from the hospital to the patient;

Mohammed must come to the mountain, kind of thing.

Yet, we know that there are far more folk ‘out there’ than in there; also, whilst most clinical people working in hospitals have cars, many of our patients have to struggle with public transport.

Yes, you could argue that the mileage relates to efficiency; there is no way a doctor could see 30 patients in a morning clinic if they had to travel round the community; that is true; equally, I might suggest, if the said doctor or nurse is rattling through 30 patients between 9 to 12 – that is, a patient every 10 minutes without break, is the quality of the encounter not such that it could probably be done another way – on the phone, Facetime, using an intermediary who could perhaps spend longer and liaise with the specialist afterwards.

I am not proposing answers here, just suggestions.

In the local hospitals where I have worked, consultants have special parking places; for they occupy the top of the pyramid. Yes, this out-dated system is still a thing. I remember, leaving my named parking spot in Doncaster with a sense of regret (matched by my sense of pride when I was appointed in 2007 and sent a photo to my parents of the ‘Dr Kersh’ sign).

In my current hospital I don’t park where the special people go – when I applied, there wasn’t room and I wasn’t persistent enough, preferring to throw my hat in with everyone else. I think this democracy is preferable.

And, yet, it does make it tricky at times when I arrive mid-morning for meetings.

Not as tricky as Enid or Eric arriving for their early morning appointment on the bus.

Not everything can leave the hospital – I am not calling for a revolution (well, I am, but not one that involved blood or explosives), we need our operating theatres, our specialised laboratories, but, how much else needs to sit there? How many clinics have to occupy the ivory tower of clinical and scientific remoteness?

I have a colleague who in a very forward-thinking manner, gave-up clinics years ago – his reviews take place in the homes of his patients; albeit working with a team of committed nurses and clinical support workers.

Few people DNA (do not attend) his sessions and consequently efficiency is increased and waiting times reduced.

Working as he does with people who have dementia, is it even worthwhile sending the GP a note – ‘Your patient did not attend the clinic this morning; we will see them routinely in six months.’ Or worse, ‘Your patient did not attend the clinic. We have discharged them.’

How much of this relates to traditional ways of working? Reluctance to change? Perception that me to you is further than you to me?

I think, with all the investment in community care that is promised, will need to be some time spent changing the hearts and minds of the folk who have not ventured outside of hospitals since they were medical or nursing students.

Sure, it is frightening; I am sure when Eric visited Buckingham Palace in 1956 he was a little overwhelmed, but it needs to be done.