Some Hidden Costs of Scotland's NHS

Last week I emailed Nicola Sturgeon's office to ask if the Scottish NHS had any plans to change to a 111 system which is being introduced in England. I received a pleasant reply, from the Primary and Community Care Directorate of the Scottish government, which informed me that NHS Direct is not available in Scotland and the equivalent service here is provided by NHS 24.

Also I was emailed a copy of the letter recently issued by Ms Sturgeon to follow-up the public annual review of NHS 24. Very thoughtful of the PCCD.

It was while studying this letter I became aware of an organisation called NHS Inform. Have you heard of it? If your answer is in the negative then here is the press release issued by the Scottish government.

My correspondence continued as I felt there were more questions requiring answers and suddenly the replies came from someone with the grand title of Head of Patient Focus & Equalities, Directorate of Healthcare Policy and Strategy. My questions concerned the new NHS Inform, would it replace the quango Health Scotland and where did Care Information Scotland fit into the great scheme of things.

The Head of Patient Focus and Equalities (HoPFaE) insisted that Health Scotland is not a quango. It is 'a national health board - or special health board - whose specific area of work is on health improvement/health promotion. They grew out of 2 previous organisations, the Public Health Institute for Scotland and the Health Education Board for Scotland.'

' ... www.healthscotland.com is just their organisation's website rather than an organisation or project in its own right. They have patient and public information on there as well as lots of information about the different projects and activity they undertake. The money for the health scotland website comes from their own budget.' The HoPFaE offered to find out how Care Information Scotland is funded. Other information was that 'all patient/public facing health information will come under NHS Inform so anything that is to do with patient information from www.healthscotland.com should be transferred over and reduce the costs of lots of different websites. This is one of the key aims of NHS Inform'.

The above didn't answer my question which was if NHS Inform has been set up to provide a single point of contact for all health information needs will healthscotland.com and Care Information Scotland, (another I hadn't heard of until I started this research), be disbanded as I see no reason for three organisations to be covering the same information. It would seem from the reply that it's only the cost of the different websites which will be a financial saving and the separate organisations will continue.

The HoPFaE was most insistent that the costs of the development and delivery of NHS Inform - 'rather than a quango it is a national project' - are in the region of £500,000 per annum and the equivalent service in England, NHS Choices, cost £27 million to set up. I pointed out that NHS Choices is one quango - oops national project- whereas we presently have at least three doing the same job.

My final question was why the word 'Scotland' wasn't included in the title of NHS Inform. Having Scotland in the title makes it so much easier for search engines to find. The explanation is: 'The name was chosen through public consultation, so not much we could have done there! However from the look, feel and indeed map on the front page, hopefully it is clear that this is a service for Scotland'.

Ah the mysterious public consultation again. Also I'm not sure if HoPFaE is aware, but when people search they read the description on the search page. This is the Google entry for NHS Inform and Scotland isn't mentioned:

Health information you can trust | NHS Inform

NHS inform is a new national health information service. Providing a co- ordinated approach and a single source of quality assured health information for the ...

www.nhsinform.co.uk/

Look at the home page. Does the word Scotland jump out at you and does the map immediately make you realise this is a website relating to the Scottish NHS? What is instantly noticeable is that the site is translated into 5 different languages. Is that necessary when Google and other search engines have a translation facility? Google 'health Scotland' and NHS Inform isn't even on the first page, although you will find another NHS 'project' called ISD Scotland which is the Information Services Division of NHS Scotland, probably one of the more informative health websites.

There you have it. Many 'national projects' - all with their own administrations - are accessible online if you know what you're looking for and if you don't? Can I suggest you pop to your GP's surgery, explain your problem and I'm sure someone there will slip you a telephone number or website URL within minutes. Just like the old days when costs were managed sensibly and money was used for front line health services rather than numerous expensive websites.

Once the PR side of Scotland's NHS is costing us a sensible amount then Professor David Bell can revise his arithmetic.

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The Scottish NHS and Red Tape

I've a long term eye condition which I manage well without much help from the wonderful eye clinic in Ninewells Hospital, Dundee.  But I urgently needed help around 6.30 this evening and realising it was 'out of hours' I phoned NHS 24 for the first time.

What a dreadful experience.  My medical history was told to five people, all who openly said they knew nothing about eyes, but when I suggested I just to to Ninewells A & E, I was informed I would not be treated as I required to be seen initially by a GP who would refer me. In fact I was told to go to another hospital to see a doctor and he would refer me if he thought it necessary to Ninewells - a 22 mile journey from his hospital!  Can you believe I told him he was daft?  I most certainly did.

Eventually we agreed I would visit a small hospital not far away and a nurse there would telephone Ninewells to ask advice.  This happened and the advice was I was to go to ward 25 at Ninewells right away.

What I never asked during my evening out was why are foreigners treated at A & Es without doctor referrals.  When I was hospitalised a couple of years ago queues formed outside the A & E department every morning from around 6.30am and when I chatted with the reception staff, I was informed 95% were eastern Europeans and they never bothered registering with a doctor because they knew they would be treated at any A & E.  But that doesn't apply to British nationals, strange isn't it.

I'm typing this with a pad over one eye, the other eye is being most sympathetic and wants to close, but I'm furious at the complete waste of time and money my small problem has cost the taxpayer. It was an emergency and I was treated quickly, efficiently and with kindness once I met the ophthalmic doctor, but so much time and money was spent on silly red tape. Fortunately the kind doctor gave me the direct line for the ward and now, should I require help, all I have to do is telephone to say I'm on the way. That's the type of NHS service we need in Scotland.

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