Mary Dejevsky: Too much choice is damaging to your health

'Choice' in referrals, it transpires, means you are essentially on your own
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The Independent Online

It was the Saturday of the August bank holiday weekend and I could not believe my luck. The nurses at the closest GP clinic were working and I had an appointment for a routine smear test. There was no wait - most people seemed to have fled town. The job was done and I went happily on my way.

Whether it made economic sense to have the clinic staffed that day is another question, but it was convenient for residents; it encouraged me to have my test, and it helped the clinic and local health authority towards their screening targets. It also gave me a glimpse of a new patient-friendly, preventative NHS. Alas, it was all too fleeting.

Since then, an invitation for a routine mammogram has landed on the mat. An appointment at a hospital an hour away from where I live, in the opposite direction from where I work, standard working hours only. Can I rearrange it? Only within the same health authority - presumably because the wrong authority would get the credit. Real choice? Zero.

Whatever happened to the van that used to do the mammograms not five minutes' walk from our flat? Apparently, no one is prepared to give it parking space, which stretches belief. My suspicion is that too few women turned up last time to justify putting the van on the road. But let me guess why they failed to come: because they needed an appointment; because the appointment cards went out more than two months before the date and there was no reminder; because the appointments were within standard working hours and the women were working.

The Health Secretary's recent suggestion - unfortunately dropped - was that people should be able to register with a GP near their work as well as near their home. But why can't we have even this degree of flexibility? Forget about ID cards, why can't we have an NHS card that is valid at any clinic and allows the doctor or nurse to access our records. "Choice" should be for our convenience at least as much as theirs.

The breast-screeners' suggestion was that I should ring up from time to time to find out the location of "the van", but it was highly unlikely that it would be coming our way - one of the most densely populated London wards. I regret to say that the mammogram has had to wait. And if I, with relatively flexible working hours, have delayed mine, how many others have done the same? Come to think of it, why are smear tests, mammograms and the whole gynaecological works not localised and synchronised? If managers don't immediately tweak to the number of lives that could be saved, how about the additional boxes that would be ticked?

Last time I went to my GP, it was to discover that the 48-hour appointment rule had spawned a first-come first-served system in the mornings (in practice, a milling throng at 8.30 and a two-hour wait the norm). There are appointments in the evening, but how many commuters arrive home by 5.30pm? Or even 6.30, when the doctors knock off. I bet commuter-friendly surgery times are not among current targets.

To give my GP his due, he gave me more than the average three minutes - not least because he noticed that my last blood pressure check was a while back. (It was for my own good, of course, but also another tick in another box.) After my return visit (a two and a half hour wait this time), I was referred. "Choice" in referrals, it transpires, means you are essentially on your own. The doctor taps his keyboard, names a few hospitals and gives you a print-out with a number.

It is up to you, the patient, to compare the locations, the waiting times, the departments' and the consultants' reputations, and fix your appointment - without, I learn, any guarantee you will see the actual specialist you selected. To extract maximum benefit from this "choice", it seems I must turn almost full-time internet researcher, then spend time and money on the phone. Even as my conscience reminds me that health is not to be trifled with, I am calculating how much time I am prepared to invest in this project and reflecting on how unqualified I am to choose.

The "choice" that would make the biggest difference to me - and, I hazard, to others - would be convenience: clinics with flexible hours, the right to use a clinic where you are not registered, and the concentration of similar services in one place. Oh yes, and clinic staff conversant with the mass of data now available on hospitals and consultants to sift the options for me.

In the "bad old days" it was the waiting list that pruned hospital admissions: some people died, others cured themselves, before their number came up. Very soon it will be "choice". The requirement to make choices which we are not qualified to make will leave us non-emergency cases befuddled, pondering our options until either the complaint goes away of its own accord or we have to call 999.