Caring Enough to Wait: Bureaucratic Care and Waiting Time Standards in an NHS clinic for Adults with ADHD

Abstract

The drive in the UK National Health Service (NHS) to reduce the amount of time patients spend waiting to be assessed is generally accepted to be of positive benefit to all and remains at the top of the UK political agenda. In this article I examine how waiting is also done by administrative and clinical staff by drawing on ethnographic observations made in an Attention Deficit Hyperactivity Disorder (ADHD) diagnostic NHS clinic for adults. According to the criteria in the American Diagnostic and Statistical Manual (DSM), pervasive forgetfulness is recognised as part of ADHD symptoms, and in its persistence through consecutive life stages, it can become seriously disabling. Thus individuals referred to a clinic may repeatedly miss their appointments and delay their assessment and treatment. In this article, I look at how an NHS policy that facilitated the rescheduling of missed appointments due to the 'nature of illness' was superseded by the desire to shorten waiting lists. Thus two competing NHS narratives, which I term ‘the time to care’ and ‘the speed of access,’ became enacted in the administrative organisation of the clinic, resulting in the potential abandonment of the very patients who were meant to benefit from such change.