By John Henwood
OK, so I’m a grumpy old man with diminishing patience and a propensity for calling out problems in the public sector; it’s tough, but someone has to do it.
Recently I was in the Hospital having a minor procedure. The first thing to be said is that from the reception nurse to the consultant everyone involved with the process was marvellous – kind, solicitous and helpful while being as professional as one would expect. The business done, the consultant said he was writing a prescription which would be dispensed by the Hospital pharmacy; he added, apologetically, that there was likely to be a wait at the pharmacy, but he would ask the reception nurse to send the prescription by “tube” to help speed the process.
A little later, after checking everything, the nurse gave me the relevant discharge paperwork including the prescription.
“I thought it was being sent by tube,” I said. Apparently, the tube was not working. “Anyway” the nurse replied, “we’ve found it’s just as quick and maybe quicker if patients take them.”
The “tube” incidentally is a system of pipework that operate under a vacuum – the type used in department stores in the days before debit and credit cards. On making a purchase one would give the money to the counter assistant, who would put it in a capsule with the bill and pop it into a tube. After a while it would come back from a central cashier with your change and a receipt. That was way back in the days of Grace Brothers and Are You Being Served, and the system is long gone from retailing, but apparently is still used in the Hospital – when it works.
The pharmacy is in a corridor between the Hospital’s Parade and Newgate Street entrances. It is set back slightly with enough room for a few chairs against each wall. There is a letterbox with a notice advising patients they could post prescriptions, but they would not be available for collection for two days. There are also two small windows. In one of these is a notice telling people to queue at the other window. When I arrived, there were about a dozen people in the queue, which spilled into the corridor. It seemed to be moving very slowly, so I began timing the period each person waited at the window. It varied: some people left in less than a minute; others stood at the window for four or more. I calculated at an average of three minutes per person, and with eight people still ahead of me, I would reach the front of the line in about 24 minutes – and so it turned out. I handed in my prescription; it was logged and I was given a numbered receipt.
“I’m afraid it will be about an hour and a half,” said the assistant. I decided to return later.
In the event, I was not able to return until the following day. To my dismay there were already 23 people waiting, some seated with eyes on a screen indicating the numbers of the prescriptions that were ready for collection, but most formed a line snaking down the corridor. Even if one or two people got fed up and left it would have taken me an hour to get to the front. Coming back a couple of hours later I was relieved to find a shorter line, but still tailing down the corridor; needing the medication and having experienced longer lines, I decided to wait. It was another 30-minute stint.
Suffering from arthritis, which is not unusual in people of my age, makes it uncomfortable and eventually painful to stand for long periods and there were older people in line, some evidently in poor health and clearly in discomfort. One very elderly person asked if it really was necessary to queue up just to hand in a prescription. Afraid so, but find a seat and I’ll keep your place in the line, I told them. Asking around it seems my experience was not at all out of the ordinary. Remember, we are talking about people most of whom are, by definition, not in the best of health. There is almost always a better way and, in this instance, a couple come to mind.
First, make sure both windows are open and operational all the time. Better still, make one window for receiving prescriptions, the other for dispensing. The former is quicker and if there are none incoming that window can help speed the dispensing. While it is clearly vital that qualified pharmacists make up the prescriptions and double check that they are bagged and labelled for the right recipients, the jobs of receiving and giving out can be done by any sensible person. It does not take a skilled individual to log a prescription and issue a receipt, or to hand over a bag or box of medication having checked that the number on the receipt matches that on the drugs. Observation of the process of collecting one’s medication – the assistant disappears behind a screen often for much longer than it should take to match a receipt to the prescription – suggests there is some arcane we’ve-always-done-it-this-way procedure going on.
Another better way, if the hospital pharmacy is so badly stretched, would be to outsource some of the dispensing of medication to external pharmacies? There are plenty of them employing equally well qualified pharmacists and, in my experience, much more efficiently.
I suppose we shall be told in due course that a new facility, planned as part of the overall new-hospital project, will deal with the problem, but how long will that take? Meanwhile, every day, people who are not in the best of health are being made to stand in line for unacceptably long periods, not once but twice, in order to get the medication they need. The good that the clinicians elsewhere in the Hospital are doing is being let down at the point of delivery of medication by a very poor administrative system.
In terms of all the problems faced by our health service, getting this right is low-hanging fruit and sorting it would help a great number of people.
