A Deteriorating Shambles?
What on Earth is wrong with the NHS? For years successive governments have tinkered unsuccessfully with this leviathan and yet still it is a basket case, sucking in vast sums of money and spitting out in return long delays, poor service, screw ups and a rapidly degenerating reputation. And yet still the demands for more money continue! As if that is a magic wand which will solve all the problems.
Well, having had the good fortune to live my life without recourse to the NHS, recently my luck changed and I found myself in hospital for three weeks recovering from a major operation. It was a real eye-opener and I saw many things I had never seen before or wish to again. I was in a four-man room over Christmas and New Year and saw many other patients' treatment as well as my own. And of course I could assess manning levels during both normal and holiday periods. That said I had nothing but praise for my surgeon, who bent over backwards to explain everything to me, and all the other senior doctors who visited me during my stay. Similarly most of the nurses treated me very well and behaved professionally throughout, despite at times being under-staffed and over-tasked. Several were exceptionally helpful and knowledgeable and I made sure that for the length of my stay I was always well-informed about my illness, prognosis, and even (fortunately) the drugs I was taking! Several British and one Romanian nurse were exceptional. As my seven to ten days dragged out to become twenty-one a few marked me down as a malingerer and paid me much less attention, but unfortunately my body had just refused to start up again after surgery so I was unable to speed up my recovery.
So what did I see? Well, many small mistakes such as incorrect doses of medicine being given (double that instructed by doctor), extra nurses being rostered to cover sickness who were totally inept (agency nurses or from a nearby hospital), many long delays when patients were being discharged, thereby blocking beds, junior doctors not being adequately supervised, and occasionally "experimenting" with simple tasks like taking blood, or being incorrectly briefed before giving a pre-op meeting (mine!). I RARELY saw all the beds in my four-man room being used at the same time, so lack of beds? Don't believe it, although on a couple of occasions there were delays!
Regularly instructions given at morning ward rounds were not transmitted to nursing staff by the junior doctors on the ward. In my case I had to brief oncoming night staff nurses on many occasions concerning the lack of drips which were ordered by Registrars but not written up as required. The night shift then had to pressurise and persuade the doctor on call to authorise the drip, there being nothing on record to show it was necessary!
I looked at my own records many times and regularly found my fluid intake and output figures were fabricated - presumably because of lack of time to fill them in accurately. Blood pressure, temperature etc was always correct. And also on many many occasions call buttons were ignored, the record being about 30 minutes. Usually this was due to the nurses being elsewhere but it was noticeable that many times the buzzer would be going off at the nurse's station while several senior staff and junior doctors were sat there chatting. It appeared only the nurses responsible for our room were allowed to answer the buzzer, same with warnings from the drip equipment, also largely ignored so I maintained it myself - not rocket science. But the main point I wish to make was a general feeling of malaise, lots of administrators but no administration, lots of staff, but not when and where needed to complete routine procedures. Plenty of procedures to ensure administrators are covered against negligence claims but these are often ignored in practice or just not practical. And waste....when discharged I received two large bags full of drugs to take home with me. Most of which was binned shortly after. Why? Because everything I was prescribed during my three week stay was sent home with me - without it the pharmacy would not sign their box for my release. Nobody checked whether I was still taking these medicines, or indeed if they were still needed. After release my GP reviewed my medicine list and deleted all the items which were not being used. Boxfuls of unopened pills, liquids and even syringes were thrown away, probably hundreds of pounds in value. And I watched many others discharged with similarly large stocks of unrequired drugs.
So my opinion is that there is just a massive job to do to get the NHS working efficiently - more money would achieve little, reducing the waste should be a first step. And here I have focused on one hospital - I also have experienced long delays and duplicated appointments with my GP - but that is another story...!
Well, what a difference a few months makes (not!) After four months I returned for a "routine" and simple follow-up operation to remove the ileostomy bag fitted in the first op. Three or four days in hospital and then recovery at home. But no! After the operation all looked good, very small additional scar and feeling good, but still there after four days as recovery was slower than expected and my temperature was beginning to fluctuate. Next day a scan was ordered, following which I was rushed back to the theatre. I was mortified, could not believe such a simple procedure had gone wrong. Woke up in intensive care feeling dreadful and stayed two days then back to the ward, left after ten days. Large vertical wound which was slow to heal at home and a long recovery as my body recovered from this unexpected extra op! What went wrong? My consultant visited soon after I came round to apologise in person, apparently I had been stitched up previously with a hole in my small bowel and the large extra wound was the result of having to find the hole and repair it. I shudder to think how that was done. And I was never told who was responsible for the damage, although the consultant took responsibility. No points for the apology, IT SHOULD NOT HAVE HAPPENED! And I would have expected an apology from both the doctor who caused the damage AND the consultant, who failed to properly monitor his colleague.
Follow-up 2 (early 2016)
It never ends! Seven months after my third operation and I now have a hernia. Where? At the top of the large incision made to repair the hole left after the "routine" operation number two! The hernia is high up so not desperately serious and nobody wants to fix it due to my previous three ops, so I must live with it for now (it's growing) and have it monitored.
These are my experiences of the NHS - but they are repeated every day across the UK. I find now that everybody with whom I share my experiences has a similar tale to tell, either their own or a friend or relative. We NEED a 24-hour NHS, I saw what it is like with skeleton staffing over holiday periods and weekends - but more than anything we need to know we are in safe hands, and that is not what I experienced.
Follow-up 3 (mid 2016)
Not happy with my now large hernia, a direct result of the emergency operation, and therefore have made an official complaint and received my patient notes. It now turns out the operation was performed by a trainee, my consultant was just observing! And obviously not that well. Several other concerns arise from the notes including a lot from the Monday of the emergency op, when my consultant returned after the weekend. He states "I cannot understand why a CT scan was not done earlier" and "I cannot understand why blood cultures were not taken earlier". Shortage of staff or lack of interest at the weekend maybe? Also problem getting a short-notice CT scan done on the Monday but he overcame this and as a result I went to theatre about 17:00. Upshot of this is litigation as I am very upset with events and the now conflicting views of three different doctors over how to tackle my hernia.
Constant talk in the media about lack of money and queues in A&E. Well A&E stands for Accident and Emergency, not Can't Wait For GP, which would be CWFGP. So why not charge everybody arriving at A&E (except those arriving in ambulances or in obvious need of immediate treatment) £50, payable at Reception on arrival. For those admitted the payment would be cancelled or reversed, for others such as drunks, sportsmen, drug addicts, malingerers and those wanting sick notes the payments would stand but treatment would be given. An appeal process could be initiated for refund if supported by your GP. This would either bring in extra cash for hospitals or reduce the pressure on A&E, or both, either way a win win result.