Lansley promise 2011: “NHS patients will be able to pick consultant”. September 2015: Where are we now?


An article appeared in The Independent in October 2011 which reported that Andrew Lansley was going to make it possible to pick the hospital consultant of your choice. It seemed to me to be a moronic idea at the time and you can see why in a post I wrote at the time. (In fact, I discover that I wrote an earlier post pointing out the absurdity of promises made in the White Paper which then led to the Health and Social Care Act; it is worth looking at both these posts in view of where we are now.)

So where are we now? Let me tell you how it is for me, referring patients to hospitals in London. Yesterday I spent about an hour trying to arrange an appointment for two patients failed by the system, entirely predictably. One concerns Patient X who has chronic back pain who has had an MRI scan of her/his lumbar spine, and the report recommended referral for possible spinal surgery (I asked for advice from our local spinal orthopaedic surgeon, he advised referral); the other concerns a baby under 1, referred to a London centre of excellence.

I referred Patient X six weeks ago through the Choose and Book system (recently rebranded as the NHS e-Referral Service). What choice did Patient X have? Well, there are two avenues for this sort of situation: a spinal orthopaedic surgeon, and a spinal neurosurgeon. I tried the orthopaedic surgeon first. The wait for our local spinal orthopaedic surgeon at the Royal London Hospital was 185 days (that is, over 6 months); there were not many other options, with similar waits. So I tried spinal neurosurgery. Here the choice was even more reduced, but there was one option: an appointment in 41 days at the National Hospital for Neurology and Neurosurgery. I clicked this option, printed the form and gave it to Patient X to book the appointment online.

When Patient X tried to book the appointment, there were no appointments; Patient X was told that she/he would be contacted by the hospital within 2 weeks regarding an appointment. This did not happen. So Patient X rang the NHS e-Referral Service; they could not help her/him, she/he needed to ring the hospital. Patient X rang the hospital and was told the they would contact her GP to confirm that a referral was necessary (a strange step as I had referred Patient X in the first place). In any event, I did not hear from the hospital.

So yesterday I rang the NHS e-Referral Service. They could not help me, it was out of their hands. I did point out a generalised problem, which was illustrated by the individual case of Patient X. In my experience, whenever the patient finds there are no listed appointments and are told they will hear within two weeks, it usually means an appointment will not be forthcoming; & when the patient pursues it with the hospital they will eventually be told there are no appointments and to go back to their GP (!). And then what I do is start again: I raise another referral through the e-Referral Service but warn the patient not to choose an option that does not give them an actual appointment. So yesterday I spoke with a manager at the NHS e-Referral Service and I told her about this problem. Initially she was evasive and defensive, but then softened and agreed that in these cases the system did not work. I suggested she take this back to her organisation and ask that they at least be honest about this issue and warn patients booking with hospitals who do not have appointments listed.

I then rang the Hospital for Neurology and Neurosurgery. I explained the situation; that the patient had been told I would be contacted; that I had not been contacted. On the NHS e-Referrals system, Patient X’s referral is currently categorised as ‘Deferred to Provider’. The staff member at the Hospital for Neurology and Neurosurgery said that this meant me, her GP. I said I did not think so; I thought it clearly referred to the hospital to whom I had referred the patient. I was then advised to fax a copy of my referral letter to the staff member and that she/he would pass it on for vetting.

With respect to the baby, exactly the same thing has happened. No appointment. Parents told to go back to their GP. I have made a new referral, and chosen only providers who actually have appointments. (The hospitals without current appointments will be listed as ‘Unknown’ as the date of next appointment).

This situation is not unusual. With respect to my local hospital, the Royal London Hospital, many specialties have long waits or are ‘Unknown’. My impression is the ‘Unknown’ category is actually a way of avoiding these referrals appearing in the statistics; if the hospital were to give an appointment that is more than so many days, then that is a breach of the targets and there is a financial penalty. So if they do not give an appointment, if they tell the patient to go back to their GP, perhaps they avoid this breach. I think it is likely that this is what is happening. I could of course chase this up further and get to the root of the problem, but I am a GP, not an investigative journalist (not many of them around these days). Our CCG sent us Tower Hamlets GPs a letter recently advising us not to refer to certain departments at Barts Health since they are having considerable problems with capacity. This is all very well, but then we refer to alternatives like the Homerton Hospital; and it does not take a genius to realise that these alternative providers also face the reality of capacity and their waits will lengthen and possibly/probably go beyond the target and then breach and be financially penalised.

So there is quite limited ‘Choice’; what Lansley and the DoH promised was moronic from the start, the current situation was entirely predictable. Is it the hospitals’ fault? No, it is an absurd Herculean task. What we need is people to be honest about this, to fight back and point out the absurdities in the demands being placed on NHS services by Morons in Government.


For a picture of London spinal neurosurgery referral options as of yesterday, Spinal neurosurgery options on 25.9.15.


10. How can they be so stupid? Wishful thinking….


If you are offered something attractive by someone, you naturally hope that it is what you are going to get. You hope it ‘will come true’, that it will not be illusory.

The property bubble and the disastrous crash in 2008 was at least in part built on ‘wishful thinking’. Bernie Madoff’s ponzi scheme went on as long as it did at least in part due to ‘wishful thinking’ on the part of his investors.

If Andrew Lansley is going to offer you choice, why turn him down?

‘I mean choice, at no cost, it can only be a good thing, right? We have the Department of Health’s assurance on this, right? I’ve read the leaflet, what’s not to love about it? Sure, I’ll go with choice, it’s a no brainer.’

Choice of named consultant-led team: another moronic policy from Lansley & DoH


I was aware of this proposal, as it had been listed in the White Paper, in the same list as the right to choose your GP practice, no matter where you lived. At the time I thought it was a mad idea, and I still think it is mad. How mad? If the KGB had infiltrated the DoH and parliament with operatives whose mission it was to make various services within the NHS malfunction, then this would make sense. It is as moronic as asking a GP practice to register anyone wishing to register with them, irrespective of capacity. The same dynamic is operating here, the same muddled thinking. If a first year GCSE student handed this proposal in as part of his or her course work, one might reasonably expect it to be handed back for further amendment.

Essentially, the problem is this: as GPs we refer patients, when appropriate, to a hospital specialty service (say gastroenterology). Several years ago, we wrote letters to named consultants (usually, but not always, in a local hospital); or we would address it to ‘Consultant Gastroenterologist’, Local Hospital, Main Street. For a few years we have been referring through an online system called Choose and Book: this is, with rare exceptions, a referral to an unnamed consultant within a named hospital. This new development proposes to have the consultants named on Choose and Book so that patients can choose who to refer to. This is a perfectly welcome development because as a GP I often have a preference myself which I would suggest to the patient. However, we run up against the problem of capacity. If too many people request to be sent to Dr Popular’s team, then that team will not be able to continue the same quality of service. The quality will fall. The waiting times will lengthen; because there are maximum permitted waiting times, locums will have to be drafted in. And let me tell you, the quality of doctors you will obtain in this way is patchy: they might be excellent, they are more likely to be be mediocre. I have outlined this problem in more detail in a previous post, if you are interested.

On Wednesday October 12, 2011 I read the following brief article in the Independent (the online version has it at the end of another article, link below if interested):

NHS patients will be able to pick consultant

NHS patients needing specialist treatment will for the first time be able
to choose the consultant to whom they are referred, Andrew Lansley announced

In a significant extension of patient choice, hospitals will be required to
accept all “clinically appropriate referrals to named hospital
consultant-led teams”.

Patients will be able to travel to any part of the country to see the
consultant of their choice and hospitals would be required to publish
individual “success rates” for their specialists to help patients
choose, the Department of Health said.

The announcement, timed to bolster public support for the Health and Social
Care Bill during its Second Reading in the Lords, brings NHS patients into line
with private patients who already have the right to choose a named consultant.

But it marks a divergence from past policy which prohibited named
consultant referrals to keep down waiting lists.

Rating individual doctors’ performance has also been rejected in the past
on the grounds that modern medicine is a team activity and individual
performance measures would be misleading.

Sir David Nicholson, chief executive of the NHS, interviewed in 2008, said:
“It’s the team that makes the difference, not the individual. The days of
the heroic surgeon, like Sir Lancelot Spratt, are long gone.”


I can only assume that the text of this article is more or less listed verbatim from the DoH press release. Now I know as a referrer that this policy will simply not work, that it is moronic. But what made me shake my head was this idea that the announcement of the policy was “timed to bolster public support for the Health and Social Care Bill during its Second Reading in the Lords”. Now if the Lords were to be swayed by this news, then they too must be pretty moronic. The article is filled with very odd statements which don’t really make sense. For example,  the policy “brings NHS patients into line with private patients who already have the right to choose a named consultant.” Of course they have a choice, it is a private arrangement and they are able to see the consultant of their choice provided their insurer has that consultant on their list. But what the press release fails to say is that in the private sector there is no requirement whatsoever for that private consultant to see all patients within a certain amount of time. There are consultants in the private sector who have long waiting times; people will wait because they want to see that consultant, or they will go to another consultant. And they will see that consultant personally, not some junior member of his or her team.


I had planned to email a consultant at my local hospital just to check with him whether I was missing something, whether there was new efficiency technology or ‘new physics’ which made this policy possible. I would have promised not to reveal his identity. But then I met had a conversation yesterday with a colleague on one of the London CCGs who told me that he had been told by a manager at one of the London hospital trusts that they were awaiting guidance as to how to implement this policy, who felt it was just not possible, that it was Kafkaesque.

So if there are any hospital consultants out there (or, indeed, a DoH operative) with a comment on this issue, this would be most welcome. I promise to maintain your anonymity, as I understand that those working for a trust may feel there are pressures not to speak out freely, honestly. But without an honest look at the policies, without a sensible methodology, we are doomed to failure. If the emperor is wearing no clothes, what are we to do?


Link to:

Independent article

Contract implementation guidance: Choice of named consultant-led team