Joined up at the hip?

It is an added pleasure this time to write in conjunction with Leah Desmond our recent 5^th year medical student here at the Peacock Surgery in Nottingham. Leah hails from Ireland and is a graduate entry medical student; with experiences of work abroad in health care services. Her perspectives are refreshing for me in the sunset of my career in General Practice in England.

The basis of integrated health must be joined up thinking. Do our patients in our forever modernising Health Service continue to receive integrated health care or are we fragmenting the processes so much that both recipients and providers of this fundamental need of life- health care, become cheated, bewildered and frustrated?

I was surprised to see Ronald who is 87 years old in my ‘late’ evening surgery meant for ‘workers’ the other day. ‘He insisted on an appointment ‘ the receptionist apologetically explained. Ronny, as he likes to be addressed, had an endearing explanation too! He was suffering from serious pains in his thigh and the analgesics I had previously prescribed were not enough.

He is the main carer for his 90 year old wife (wheel chair bound), his gardening was suffering and he was getting more and more upset that the hospital was taking so long (despite his telephoning them) in giving him review appointment after surgery for fracture of his hip 6 months previously! He was most unhappy that the orthopedic follow up was by ‘telephone call’ and ‘that too by a nurse’. In fact ‘I cannot understand doc’ he said. ‘And I had to come to see you tonight or else me son was going to take me straight up to the hospital’!

Acknowledging Ronny’s wise decision to make more appropriate use of health services, I said I would straight away write to the consultant who did his operation asking for review.

He seemed pacified but then began my struggle with the IT ‘system’. There was NO information about which orthopedic team had performed his operation – in fact only the flimsiest of discharge slips with what ward he had been on, and an illegible signature of a junior doctor signing the take home drugs! So much for providing continuity or basic integration of care. Recalling an update in my recent tutorial on just how many billions of pounds we have invested in the NHS Spine did not help make me feel any better.

Training, and serving in the NHS for nearly 35 years (70 between my husband and I) convinces me that we do have the basis to provide, and build integrated care provision to all our patients - and on a global scale, it's an enviable service. But the foundational values have to be maintained. Meanwhile we need the choice of more sophisticated, and appealing modalities of alternative, and complementary services to enhance not only patients’ journeys in search of health, but also to save resources while being holistic.