I recently had some experience of the NHS, a topic that attracts lots of passion on all sides of the political debate in the UK. I’m broadly supportive of a public health service, although would tend to think that it’s too big, delivers far more than it should and suffers from trying to be all things to all men nationally. Public expectation of what can be delivered is very different from what the economics allow. But this is intended to capture some thoughts on the experience.
My partner started exhibiting some serious symptoms, that worsened over a couple of weeks. We had two interactions with the GP towards the end of that period, a telephone and then in person consultation. Both were pretty reasonable, although needed further investigation and lab testing to nail the problem. Therein lies the first problem, information management, it needed me to communicate the results of that testing from the GP to the hospital, despite the testing having been done in the hospitals lab. To me that’s indicative of a much broader problem about joining up care in the service. It shouldn’t take someone outside the system to know how to ask the correct questions to pass the information on in a meaningful way.
After another week we ended up calling out an emergency doctor for a home visit, while it was a very stressful time the initial phone consultation and subsequent visit were good. We were then sent to the local hospital, getting there at about 2100. The main observation I would make around that would be that we needed to rehash the same administrative information several times. As a consumer of the service that becomes extremely frustrating, since it undermines confidence in the medical and clinical care. There is a need to talk through the symptoms several times, to pick out details and explore how the symptoms or the reporting of symptoms changes over time. Clinicians aren’t prescient, they need to analyse the problem, test and adjust conclusions and prescribe treatment based on those conclusions. Sometimes the treatments are wrong, and need to be amended, but that’s all part of the investigative process.
So into hospital. We were very lucky, triage was quick and relatively painless although there was then a protracted period of sitting in Accident & Emergency while decisions were made. The main observation that I’d make would be on resourcing, the surgeons, nurses and ancillary staff were busy, and although A&E wasn’t running at capacity I’m not entirely convinced that the staff level at the time would have coped with much more demand. Clearly the hospital manage staffing levels for different levels of demand throughout the week, so it may be that resourcing for that evening was tailored. I spent nearly four hours there, so had plenty of time to take note of the working practices, and some of the information and planning boards. Working practices appeared quite inefficient, although that could have been a function of staff numbers, and it looked as if the total pot of people available wasn’t really big enough to meet their staffing needs.
All that was followed by another week of care and further investigations. The total time was probably beneficial, but from a purely investigative perspective it could have been a lot shorter. The investigations needed were invasive, although not surgical. Getting access to that resource took nearly three days, each of which was filled with promises of ”today” and an escalating seniority of clinician sorting rattling cages until it happened. It all looked as if access to these resources was pretty ad-hoc, with no scheduling or prioritisation of access.
Once that investigation was done, we had the answer. The treatment from then on was very clear and allowed us to get home complete with a big bag of pharmaceuticals.
the time in the ward demonstrated similar issues around staffing, under-resourced and with a number of inefficient working practices. But also putting up with a lot from verbal abuse in A&E to more insidious casual racism elsewhere, and a more general lack of gratitude from both patients and visitors. The former uncalled for and the latter tending to grind them down over time.
Throughout the whole saga the staff that we experienced were good at their jobs committed to their vocation. Both nurses and doctors have a tendency to treat patients a bit like children by default, although if doctors are engaged in a professional, informed, way their approach sharpens up and the exchange is a lot more productive. We’re both very appreciative of their efforts and support throughout.
So my two main criticisms of our recent experience centre around how the information is managed, and how the resources, both people and facilities, are managed. Both of these made the patient experience far more frustrating and challenging than it should have done.
- Repeating the same administrative details to different people should be unacceptable.
- Not being able to get clarity around when resources can be used, or have good reasons around delays, should be unacceptable.
Fixing both of these needs some positive leadership from the centre, not something that we’re seeing at the moment and not something that I’d expect to see in a new government following the general election, regardless of its hue.