City Of Queues

06 Sep 2005

My appointment is at 3.20pm, so I set out half an hour earlier for the trek. This time I take a good book. For others, the three hour wait is an ordeal, but, resigned to the waste of time, Iím still happily reading on the bus back at 6.30 pm. In my fourth decade Iím hitting NHS traffic big time. For twenty years, like most young males, I hardly had a sniff of a doctorís surgery. Now, with my first child, plus a couple of unlucky breaks of bones, the New Edinburgh Royal Infirmary is becoming all too familiar.

The queues begin at reception. Then you are directed to waiting area 1. After an hour, a distant voice adds you to a list of names. We shuffle, the first-timers too hopeful, to waiting area 2. If you need an x-ray thereís a fourth wait, this time in a small room with not enough chairs. Then its back again to 2 for a fifth, before finally seeing a doctor.

But we are the lucky ones. For the old and the seriously sick, the waiting and discomfort has been going on for weeks and months, sometimes years. Then there is the staff. Tired looking, overworked and always behind, they somehow stay cheerful and apologetic. This is not a problem of personnel, who are usually excellent. Informative and polite, they know their stuff. The trouble is one of organisation.

I think of a relative who has retired to France. A couple of weeks ago he felt his sight going in one eye. 24 hours later, a loose retina had been diagnosed, and 48 hours after that he was being offered beer or wine with his post-operative meal.

Iíve already waited longer than that just for someone to look at my x-rays in the fracture clinic.

The queue reminds me of other waits. There are a hundred details that could make things better. Forget beer or wine, even the water dispenser is broken. Why not give you a ticket, like at the cheese counter in a supermarket? Then at least youíd know whether it was fifteen minutes or ninety.

Like a grim 1970s airport, the new Infirmary is a city of queues and corridors. Soulless and plastic, they stretch out in confusing sameness. The new hospital epitomises all that is worst about public sector monopolies. It was built in a blank field on the city bypass to cut costs, and is meant to serve a whole region. Apparently the maternity unit pumps out more babies than any hospital in Europe. But all it does is transfer those costs to the patients, who must travel, spending money, time, comfort, and sometimes even their health, to reach its already broken doors.

Like an old style Soviet supermarket, the NHS is alright in a pinch. It keeps most of us alive, except the unlucky thousands who catch superbugs or die on waiting lists. But it could be so much better. In other Western countries, competition and variety among providers constantly drives standards up, and waiting times down. The state remains as a funder of healthcare, but leaves provision to the experts. Patients choose which hospital they what to be treated by. Which is the nearest to my house? Who has the shortest wait for my cataract operation? Which has the nicest waiting rooms, and yes, the best wine list? And for staff, which pays the best and offers the most flexible working hours and holiday arrangements?

In England Tony Blair has admitted the historic mistake Britain made after the war in nationalising health and education provision. Read carefully the press and youíll see his Labour government furtively unpicking the damage. Blair is copying reforms which were implemented successfully in Sweden and elsewhere a decade ago. Foundation hospitals are being freed up to compete for patients with privately run Ďtreatment centresí.

Itís a hard message to sell. Because few voters receive medical care abroad, they canít tell how much scope for improvement there is. But in England, actions and results are speaking louder than words. Waiting lists are starting to fall already.

Not so here. Our devolved politicians look like being the last to get the message. Wait here. Wait in Scotland. Wait in the City of Queues.