Thursday, February 5, 2009

The UK. Choose and Book: learning lessons from local experience. Taken Directly from Hansard UK - 4 Feb 2009

NHS Appointments
2.30 pm

(Pour yourself a virtual glass of port and enjoy this blow by blow description of one patient's experience with the UK's Choose and Book system)

Andrew Stunell (Hazel Grove) (LD): I am pleased to have the opportunity to bring this important issue to the House and look forward to the Minister’s response. It has affected the medical histories of many of my constituents.

The system has been a problem for me and my constituents ever since it started. In turn, I have been in touch with the local foundation trust, the primary care trust and NHS Direct, and I have asked parliamentary questions—in fact, because my December question was too long, Mr. Speaker kindly offered an Adjournment debate. I shall try to do the issue some justice.

After I was told last week of the time of the debate, entirely serendipitously, the British Medical Association produced a report entitled, “Choose and Book: learning lessons from local experience”. I am not so arrogant as to think that my probing put the BMA up to it, but the report is interesting, and I hope the Minister addresses it when he responds to the debate. It talks about learning lessons from local experience, and I want the Minister to learn from my constituents’ local experience.

I will start with a disclaimer: MPs hear of the worst cases. Nobody writes to me and says, “I had a brilliant experience of choose and book” or indeed of public transport or any other public service. The scheme provides a comparatively easy route to medical care and treatment, but there is a significant minority for whom it is a major problem. I want to bring the cases of a number of my constituents to the Minister’s attention, and to draw one or two national lessons from them.

My worst case illustrates many of the features of choose and book that drive patients to distraction. Mr. I was first sent to choose and book on 19 July 2007, and first contacted me on 9 August 2007. Nine and a half months later, after much correspondence in many directions, he wrote to me again on 12 May 2008 and said:

“Me, I’m giving up but if you wish to carry on the saga be my guest!!!”

I suppose that the debate is me being Mr. I’s guest. I spoke to him yesterday, and I can report that he received his treatment last month. For him, the saga that started with a doctor’s diagnosis in July 2007 has now been completed with treatment in January 2009.

As I said, Mr. I is my worst case. What happened? On 19 July 2007, his general practitioner referred him to choose and book, gave him the telephone number, the address of the website and the password, and told him what to do. When he phoned the number, he was told that he should phone again because of a high volume of calls. He repeated that experience many times. He was referred to the website, but it did not respond to him. He did what many patients do, much to the irritation of their doctors: in frustration, he went back to his GP, because he thought that he might have got the number or password wrong. Having established that they were correct—he had a letter of confirmation from the system in due course—he tried again. Once again he was told that he should try the website because of a high volume of calls.

He eventually got on to the website, but it told him that no bookings were available for the period he had chosen, and that he should try again and seek another date. He did not want to make it hard for choose and book, so he did not try to make an appointment for the week after; instead, he tried to make an appointment for three months after his first choice. Anyone who knows choose and book knows what that means. The system would not give him an appointment because the date he selected was beyond the 18-week period in which it will accept an appointment.

Mr. I is articulate and persistent. After that trouble, he went to his GP for a third time. His GP said, “I’ll tell you what. Why don’t you phone up NHS HealthSpace?” That sounded like something to do, so Mr. I did it. What did it tell him? It told him that no appointments were available.

On 1 August, he got the first of his letters from Appointments Line criticising him for failing to book a choose and book appointment—that was when he first wrote to me. He told me that he wanted to tell Appointments Line that he had been trying to book, but he could not do so because the standard letter from Appointments Line has no address on it—he showed me a copy of the letter to prove it. The only way in which a patient can contact Appointments Line was by phoning the number that tells them that they cannot get through. It is absolutely ridiculous.

Patients might not be able to write to Appointments Line, but MPs can. I now know that it is run by NHS Direct. The chief executive of NHS Direct, Mr. Matt Tee—that is not an abbreviation—sent me a letter. He invited me to comment on the application of NHS Direct for trust status. I told him in no uncertain terms that until he sorted out Appointments Line, it would not be sensible to give it such status. The letter he wrote back to me is interesting in many ways, but I like this bit:

“The Appointments Line takes over 280,000 calls a month and at present receives 0.56 complaints for every 10,000 calls.”

I thought that that was an interesting way of expressing things, but I marvel at how half a complaint managed to sneak through. How would Appointments Line know that people wanted to complain if they cannot write or phone? There is no address to write to. People have to know that it is run by NHS Direct before they can get anywhere.

I also marvelled at another part of the letter that delightfully passes the buck for the problem:

“I agree that services should be user friendly and less bureaucratic and will do all I can both to ensure that this is the case for the services I control (such as The Appointments Line) and to encourage others to do so with the services that I do not control (such as the national Choose and Book system).”

I thought that that was a pretty neat sidestep from my constituent’s concerns. Who runs the national choose and book system? Mr. Tee said:

“We are working closely with colleagues both in the Department of Health and (specifically) in Connecting for Health, to promote improvements to the systems and software associated with Choose and Book”.

So it is not his problem; in his view, it seems to be the problem of the Department of Health, NHS Connecting for Health and the software manufacturers. Evidently, choose and book has nothing to do with the Appointments Line and everything to do with everybody else.

I would not want the Minister to think that, because I started with a case from 2007, he can respond by saying, “Yes, there were some initial teething difficulties, but everything is fine nowadays.” It is no better now. Calls still go unanswered, appointments are still unavailable and infuriating reminder letters are still sent. Unanswered calls are a problem for my constituents.

Last November, my hon. Friend the Member for North Norfolk (Norman Lamb) asked a parliamentary question and received a briefing in the Minister’s reply saying that last October, 338,000 callers tried to access the Appointments Line. According to the figures in the reply, 27,000 were not answered. One must read the small print carefully to find out that 17,000 callers found the line engaged and 10,000 found it playing Vivaldi. One in 16 calls made to the Appointments Line is unsuccessful. That is from the Minister’s own figures for last October, which show 27,000 calls not answered last October. That works out at 324,000 missed calls a year. A third of a million calls, according to his own figures, fail to get through to the Appointments Line.

The astonishing thing is that the Appointments Line met all its key performance indicators. I do not know whether any other call centre in the country, commercial or public, would meet all its key performance indicators if it left out a third of a million callers a year. If so, I hope that the Minister will brief us on which one it is. I suggest to him that the key performance indicators for the Appointments Line are not sufficiently rigorous. He is not getting his money’s worth.

The second big problem is that appointments are not available when people do get through. There are two causes for that. Well, there may be more than two causes—the BMA report suggests quite a range of them—but I will focus on just two. The first, and perhaps the one that the Minister could most easily do something about, is the 18-week waiting period, which creates a black hole beyond 18 weeks when appointments are not taken. If appointments cannot be booked more than 18 weeks ahead, when a particular clinic or consultant is fully booked, they are taken off the list of appointments available. They do not even appear. Of course, at the call centre, they cannot say, “Well, that’s because they’re booked up for the first 18 weeks”; what they say is, “They’re not on the system.” They disappear into a black hole.

SIIM Announces 2009 Resident Scholarship Program

SIIM Announces 2009 Resident Scholarship Program
Deadline: March 2, 2009
Recipients to Attend SIIM Annual Meeting in Charlotte, NC, June 4-7

February 4, 2009 - Leesburg, VA - The Society for Imaging Informatics in Medicine (formerly SCAR) has announced the fourth year of its scholarship program for radiology residents interested in imaging informatics. The scholarship is open to all trainees in North America who intend to pursue a career in radiology or imaging sciences.

"The SIIM resident scholarship program enjoyed another successful year in 2008. Our two winners had a variety of useful educational experiences at the meeting. The essays in 2008 addressed the educational impact of imaging informatics of trainees. This year, we are broadening the essays to see what software trainees find valuable outside the PACS. We are looking forward to some exceptional essays, just like those we have had the pleasure of reading in past years," said Barton F. Branstetter IV, MD, chair of the SIIM Resident & Fellow Education & Training Subcommittee.

Travel expenses and meeting registration for the SIIM 2009 Annual Meeting, as well as a one-year SIIM membership, are included for the recipients. The SIIM Annual Meeting takes place in Charlotte, NC, June 4-7.

Applicants are asked to submit a 500-750 word essay on the following topic: "Besides PACS, what one piece of software most improves workflow efficiency for radiologists?" The winning essays will be published in the Journal of Digital Imaging or SIIM News.

Topics of interest to SIIM members include PACS (monitors, networking, and storage), digital teaching files, speech recognition, computer-aided interpretation, reading room workflow and ergonomics, and communication technologies. "Residents who already have an interest in computers will find SIIM to be a welcoming group of like-minded radiologists," said Branstetter.

For more information and to see the online application:

The application deadline is March 2, 2009.

About SIIM

The Society for Imaging Informatics in Medicine (SIIM) is proud to be the leading health care professional organization representing interests and goals of those who work with and whose work is affected by the rapidly changing world of information and imaging technologies. SIIM seeks to spearhead research, education, and discovery of innovative solutions, and to explore new technologies and applications to improve the delivery of medical imaging services and the quality and safety of patient care. For more information, visit

For more information about the SIIM 2009 Annual Meeting and to view and download the preliminary program, visit

Caroline Wilson
Director, Publications & Media
Society for Imaging Informatics in Medicine (SIIM)
703-723-0432 ext. 315

Monday, February 2, 2009


The Public Health Association of Australia (PHAA) has today released a new report – A Future for Food – which calls for a complete overhaul of food policy in Australia in order to more effectively address the national priorities of chronic disease prevention, climate change and social inequality.

According to Michael Moore, CEO of the PHAA “Food is a critical issue across public health, the environment, social policy and the economy – and yet we have a fragmented approach. It is imperative we act now to establish a national, integrated whole-of-government food policy.” “We have a food supply skewed to inappropriate and overly processed foods that are high in sugar, fat and salt; there is inadequate understanding of the environmental impacts of food choices; and we have people struggling to afford healthy food to feed their families.” “We cannot afford to continue to do business as usual. And with the National Health and Medical Research Council (NHMRC) currently reviewing dietary recommendations in this country, it is imperative we act now,” said Michael Moore.

A Future for Food: Addressing public health, sustainability and equity from paddock to plate, states that the selection of foods for Australian guidelines has been largely based on nutrition science, which emphasises the adequacy of specific nutrients rather than whole foods. “But we eat food not nutrients,” said Mr Moore.

The PHAA is concerned that current guidelines offer inadequate consideration of: the chronic disease risk of certain foods despite their capacity to provide adequate nutrients; the environmental impact of those food choices; and cultural and equity issues – including at the very minimum affordability for all Australians.

“In reviewing the research on chronic disease, environmental sustainability and social equity, we believe it is imperative that food recommendations have a stronger emphasis on whole, or minimally processed, and plant-based foods,” said Michael Moore. In addition to calling on the government to establish a national integrated food policy, the PHAA is calling on the NHMRC to address these issues in its current review. “We want public health and food professionals, food industry and consumers to join our call for action at We must work together and act now,” said Mr Moore.

Contact: Michael Moore CEO PHAA 0417 249 731

For more information and a .pdf copy of A Future for Food visit

The Public Health Association of Australia (PHAA) is a non-party-political organisation with a membership drawn from more than 40 health-related professions. The Association makes a major contribution to health policy in Australia and has branches in every State and Territory.

A Future for Food is an initiative of the PHAA, developed with specific input and guidance from the PHAA Food and Nutrition Special Interest Group, presentations at the Population Health Congress held in July 2008 and the PHAA Nutrition Round Table held in June 2008. It was made possible by an unencumbered educational grant from the Sanitarium Health Food Company.