Who missed out 'appropriate communication expertise' when contracting out a patient-facing referral system?

I have a duff shoulder which needs an ultrasound. This will identify the likely diagnosis and help my GP decide where to stab the steroid injection for best effect.

The ultrasound appointment letter I was sent was remarkably flaky. InHealth, based in Rochdale, provide the patient referral service responsible for the letter. They were happy, apparently, to leave patient communication to a junior keen bean, prepared to have a go. Seemingly, commissioners had not noticed that specifying some level of patient communications expertise in their contract might be needed - one that would take into consideration the varied audience likely to get such letters. That means writing for as many of them as possible, by considering style, content, reading and language skills, health literacy - and how accessibility of information can be improved (or destroyed) by design.

They sent me four sides of A4 that contained a significant volume of irrelevant content. The relevant content was badly formatted and badly written. I will be drawing the Information Standard and maybe the Plain English campaign to their attention in due course. I particularly enjoyed attempting to use their enquiry email address to complain. It bounced back as ‘undeliverable’. If, in spite of my best efforts, I copied it down wrongly, the unhelpful choice of what might be a 6 point font size is probably why. Alternatively, I did copy it properly and it just doesn't work..... great.

Luckily, I am a health professional, not given to any degree of anxiety about ultrasounds or life in general and with English as my first language.

There's more.

I am in Ealing, in London. The man whom I rang to set up the appointment was, from his accent, clearly a Lancastrian man of Asian extraction. He was very nice. It was only later when I got the letter confirming the details that I grasped he was actually in Lancashire. My data had travelled quite a lot further than I will for the appointment – to Fulham, about three or four miles away. There's more about my data later....

I could tell what they thought was the most important information in the letter because it was in bold. It consisted of two things. Firstly, I must not bring anyone under 16 with me. The other was that I should arrive 15 minutes earlier than the appointment time and if I was late I might miss my slot altogether. The date, time and place was not in bold or appropriately formatted for clarity or emphasis.

The instruction about the under 16s was fine but as they insist that I arrive 15 minutes early, just give me an appointment 15 minutes earlier. I wasted a moment of my life working out what 15 minutes earlier than 12.40 might be and then recorded my own time on the appointment letter. If the clinic has no clear idea why some of their elderly patients or anyone at all from their multi-cultural, multi-lingual catchment area consistently turn up at rather approximate times, I know the answer….. 

Then there was the essential information to read before my appointment. This was so important it got a heading which was bolded and underlined.  As it turned out, only one of the three items of 'essential' information was actually essential. The other two were so lacking in essentialness that they were totally irrelevant.  

One – there is a map enclosed. Yep, there was. Very small font, but manageable for me. But also know the ‘best practice’ standard is 12 point and this was nowhere near that big. This was the one piece of essential information provided.

Two – there were preparation instructions to follow, should I need them. Indeed there were. In fact, there were preparation instructions for four different ultrasounds, all on the one sheet, none of which I was having. This is not essential information. It does however have the potential to be highly confusing to recipients.

The shoulder ultrasound I am having does not require any special preparations.

And three – There might be a questionnaire included, related to some of the scans they do, that I must fill in, in advance. Not my scan. So it wasn’t included and so I wouldn't fill it in. So don't mention it.

Altogether, a masterpiece of poor format, poor explanation and the irrelevant.

Lovely. We pay for this.

More on 'scan preparation' - anyone who did need the instructions would have to be really confident about what scan they were having. We are all familiar with people who read and re-read important documents, so the chance to settle on the wrong information is an error that could be made and repeated many times over. An ultrasound scan will be worrisome to some people – in a diagnostic pathway for cancer, for example – so all the choices formatted in close proximity but mostly irrelevant, as three out of the four possibilities would inevitably be, increases the chances of patient error through anxiety.

There were separate instructions for 1) an abdominal scan, 2) a pelvic scan and 3) an abdominal and pelvic scan. I’m not sure how commonly understood the difference between an abdomen and a pelvis is, in the community at large. ‘Tummy’ covers both and is a word - or has an equivalent - likely to be in many patients' minds' eyes when anticipating an ultrasound appointment. I’m not sure all patients would avoid error in selecting which instructions to follow for that non-stress related reason.

The evidently vital warning about not bringing anyone under 16 with me was considered worth repeating in the ‘About your Ultrasound’ section. If I was someone with one or more ‘under 16’ likely to be in tow – a single Mum for example - I’d quite like the reason for not bringing any, rather than the sternest of warnings and no explanation. It’s less patronising and might improve my compliance. I’m guessing it is to do with space whilst waiting for the scan and staff for supervising children safely during the scan but I don’t actually know.

It goes on.... in a sentence beginning 'If you are likely to require a transvaginal, transrectal or testicular scan....' the fifth, sixth and seventh scans I also wouldn't be having, were introduced to me. Don't. Just don't. Besides, I'm never 'likely to require' a testicular scan. Ever.

And finally there was the bald statement that there would be a data sharing consent form to sign. Not on your nelly, my friends.

Signing a consent form means there must be a process for gaining consent. Such a process involves provision of information, of which there was exactly none.  My GP and I are the only ones who have an interest in my shoulder so there is no data sharing to be consented to. Mind you, as I know my data has already gone as far as Rochdale and my Asian clerical friend clearly had my GP’s referral in front of him whilst he commiserated with my sore shoulder, perhaps it’s retrospective consent.

I won’t be signing. Will I finally get to smash this daft system, if only very, very slightly?