Category Archives: Nhs

Just Another Day in A&E

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A&E isn’t called that any more, it’s been re-branded as the Urgent Care Unit, though everyone, staff, patients, taxi drivers, police etc, still universally call it A&E.

The foyer has been barricaded by a detachable crowd barrier, with a home made laminated sign saying ‘Wait Till You Are Called’ in red lettering. A queue stands in the short entrance hall. There is no seating. There is no room for any. People coming out have to push through the queue. The shiny new reception desk is visible at some distance ahead.

Everyone coming into the hospital (other than for a pre-arranged appointment) has to be processed through this medical Checkpoint Charlie. The wide modern atrium (thank you PFI & a permanent financial deficit) is next door.

The A&E entrance, sorry, Urgent Care Unit, is tacked on at the side as a kind of brick hut afterthought.

We make it to the desk. The receptionist can’t hear or understand. Grandpa has a hoarse post surgery voice and can’t speak loudly. There is smeared perspex security screening and no microphone. I speak loudly and clearly. She asks me Grandpa’s religion. I say C of E for the sake of simplicity. She can’t find it. “Church of England?” “Christian?” “What choice is there?”

Hopelessly I explain that he was told to go to General Surgery who are expecting him, but I already know the answer. Everyone has to be processed through A&E, sorry, Urgent Care. We’ve been trapped in this Kafkaesque hell-hole of a system before.

We wait 2 hours to be seen by a nurse who takes bloods, puts in a cannula and tells us we will have to go back and wait to see a General Surgery person who will be called off the ward. We know what that means. Getting surgical staff off the ward is like prising barnacles off a ship’s bottom.

“It will be a bit of a wait,” nurse warns gloomily.

Thankfully Grandpa does not feel very ill. He just has a pain, which of course might be serious, but he doesn’t feel awful, unlike others amongst the trapped humanity sharing a space too small for the seating squashed into it. He isn’t actually bleeding or nursing a broken bone or collapsing against a carer or throwing up. (There is a stack of cardboard sick bowls considerately placed beside the reception screen.)

The soft drinks machine is out of order. Little children accompanying their ill siblings run around. Teenagers are sent off to the posh atrium shop next door to fetch supplies.

We wait for hours, as do most of the others. To be fair, the lady who is half carried in, actually unable to stand, is allowed through the security door quite quickly.

The television screen above reception plays a loop of information about how well the hospital is doing and how much it has improved, alternating with warnings about seeking treatment for TB.
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The collapsing lady’s elderly husband comes out & is directed by reception to a public telephone on the wall. It doesn’t work. The man waiting next to it gives him his mobile phone.

We are seen by a doctor at 4.15pm.  He does a thorough examination. He says the blood results seem normal, but he would like a scan to be absolutely sure. He tells his trainee junior doctor to set it up.

We are directed to a cramped seating bay in the Observation Area where a homeless man in a hospital gown is fast asleep in a chair. He coughs restlessly . He has not washed for a very long time. I think of the TB warnings on the screen in reception. We wait in the corridor.

At intervals I ask at the nurses’ station what is happening about the scan. I know that after 5pm the department shuts. It’s on emergency call only.

No, it operates 24/7 I am assured.

In the end I go in search of X-ray, sorry, Clinical Imaging. It is deserted, apart for a young man waiting for his discharge from a  disappeared doctor. I return to Grandpa’s nursing station. Nobody can enlighten me. A new nurse didn’t realise Grandpa was there. She enters something on the computer.

I go back to X-ray. The young man, showing initiative, has gone on a doctor hunt and lured one back to the department. I grab him. He kindly checks up for me. No scan has been requested. Grandpa has by now waited 3 hours in the Observation Area.

I go back. There has been change of shift. Nobody at desk. I check computer screen. Grandpa registered as entering at 6.35pm, 2 hours after he got there. Status – awaiting scan. The scan nobody has requested.

A junior doctor appears for another patient. I insist she deal with Grandpa. She apologizes. He can stay in overnight & have scan tomorrow. (Hang on – What happened to the bed shortage? What about the other really ill people waiting there for beds i? What about the homeless man nobody has been near for hours, still peacefully asleep in his chair out of the nurses’ station eyeline?)

“No!” we shout simultaneously. “We’ll go home and come back for the scan tomorrow! Take his cannula out and we’ll be off!”

Young doctor now terribly worried. We can’t do that. We’d have to self-discharge. She can’t authorize a scan for tomorrow. She can only keep Grandpa hanging around somewhere in the hospital till at some point, possibly tomorrow, they might find a gap for him in X-ray, sorry, Clinical Imaging.

If we self-discharge we will have to go through the same A&E route again tomorrow.

“We’ll risk it!” Grandpa says. He’s had enough nights in hospital, to know there’s no rest as you hang around in corridors & chairs being pushed around, as drunks and emergencies are noisily admitted, till someone locates you a bed. “Take the canulla out and show me where I sign!”

As we make a run for the exit, he notices blood dripping down from his jacket sleeve. We rush back to the nurses’ station. Grandpa’s arm looks as though he’s been stabbed.

As the nurse mops him up, she cheerily inquires if he’s on aspirin.

“Yes” he replies.

“You should have told us!”  she says reproachfully.

I bite my tongue, but keep silent. It’s been a long day.

“Perhaps you should have asked?”

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This Ain’t Just Business, It’s Personal

Last thing yesterday, before I got into bed, I read Sara’s blog.  This morning I woke up realising, that for all my Grannie wisdom, in the past I’d been wrong.

You see, I’d always hoped that the whole sorry Sloven business wasn’t just aimed vindictively at one person.  I’d very seldom come across such actual malice during a lifetime’s experience of working in various branches of public service.

I’d come across plenty of bad practice – sloppy procedures, chaotic administration, hopelessly out of their depth managers, arrogant trend-driven consultants, sheer basic incompetence and plain simple idleness.  All of these were bad enough, but at least they were open to remedy, given the will, the time and the determination.

And of course families caught up in such Kafkaesque nightmares suffered, but they weren’t targetted.  They were a sad, innocent part of a big mess that needed sorting, and at one time many people entered politics, or the public services or local government, in the hope that they could help clear it up.

My Dad was one of them. He wouldn’t even accept a bottle of whisky at Christmas in case it looked like corruption.  Having taken on the job as a young man in the Depression, largely because it offered security,  he faced up to a career of sorting out corporate mess. He never made a song or dance about it.  He went about it quietly and steadfastly, simply because he believed it was the right thing to do.  

As I read Sara’s latest blog, I had to admit that my Dad’s world was dead.

A public service, part of the NHS, could whine about criticism from a bereaved family, and seriously cite this as a reason for not carrying out their own procedures efficiently. It was this that finally forced me to see that the principles my Dad lived by have become things of the past.

Nowadays, like some D list celebrity complaining about her Twitter following, a public body states  (and presumably believes) that social media coverage of a preventable death is somehow unfair to them. 

They choose to home in on a single blogger, one honestly outspoken citizen, as the unacceptable cause of their staff problems and their procedural difficulties.

So I apologise to Sara for ever doubting that the treatment of her family was more than awful indifference, maladministration and incompetence. I finally have to admit that the only rational explanation for the intransigence of the Health Trust in consistently laying their failings at her door is that they seriously believe her to be at fault.  They resent her stubborn unwillingness to be silent in grief, her friends’ determination to meticulously research and record corporate failings, the support of all who campaign and fund raise on her behalf.  All these people must be in the wrong and Sara Ryan is the wicked ringleader who stirs them up!

This isn’t just business, it’s personal.

Welcome to public service in the UK today!