My 36 hours in an NHS on the edge
PUBLISHED: 11:48 12 March 2018
PA Wire/PA Images
For all the dedication of its staff, the NHS is a frighteningly defective service, says GEOFF SUTTON, as he recounts a routine hospital experience
The unusual mobile number rang in the middle of a Skype call. I ignored it the first time, but answered the second. It was a paramedic and they never have good news. My 82-year-old dementia-suffering mother had fallen in the street outside the library in Harold Wood, Essex, and had suffered a bad open fracture of the right wrist.
She had been found by a bus driver, who dialed 999. She was going to be taken by the ambulance to Queen’s Hospital in Romford. “Is she always this confused?” the paramedic asked. And so began an experience that is normal for thousands of Britons up and down the country every day, but is strange, comic (if you like black comedy), almost Kafkaesque, and utterly exasperating: the NHS emergency admission.
I am writing this story not because it is unusual. Quite the opposite, actually, and this is certainly no big undercover expose or ‘elderly patient stuck in corridor for five days’ headline. This is one admission among many – and a very normal one. An old lady falls down in the street and needs medical care.
But the NHS and its problems are never far from the centre of British politics. It was the Big Bus Lie by the Leave campaign which did the most to win them critical votes, so, I believe it is right to keep sharing what really happens to ordinary people in our health system.
I arrived at Queen’s Hospital an hour after receiving the call. Mum had arrived at 1.30pm. I thought I had walked into a fancy dress party where everyone had to dress as a paramedic. There were loads of them everywhere. They were queuing along a tight corridor, two paramedics to every battered-looking patient on a trolley. It was really disconcerting to be in the midst of so many ambulance workers. I wondered what they were all doing there, rather than being out in their vehicles.
I found my mother Doreen, who looked like she had been in a boxing match, but was otherwise reasonably cheerful. We were in the queue to be seen by a doctor who would decide what happened next.
Everyone was chatting and having a laugh. One of the themes of the next 12 hours or so was the fun everyone was having. There are Essex character traits that are not often called out in the endless old jokes: a strong sense of humour, a willingness to get the job done and an ability to gently take the mickey out of people.
It was all there among the ambulance and hospital staff, sharing sweets, catching up on gossip, making sure the patients were OK. My mum was fully part of it. We laughed about why she was going shopping to buy apricot jam when she had jars of it in the cupboard. Her coat had been cut in the arm and was thrown away. She laughingly threatened to sue the staff. Maybe the morphine helped her mood.
We were queuing for ages to get into a tiny space that was rammed full of doctors, nurses, paramedics, medical assistants, porters, patients and family supporters like me. It goes without saying that these Essex staff were of every colour and hue: Black, Asian, Chinese, European, Turkish, Australian, all corners of the globe now crammed into this tiny unit. But somehow they have all gained a bit of the Cockney Essex character and gallows humour.
Everyone was calm, no-one raised their voice, a doctor was directing operations at a computer. There were curtained bays where patients had little dignity: using bedpans, half-naked as they were being examined, all on display.
The thing that is amazing if you haven’t seen it before is that the paramedics have to wait to sign over their patient to the care of the hospital. This is eminently sensible from a medical perspective, except that at least a dozen paramedics (or six ambulances-worth) are always in the queue.
A paramedic told me later that one crew had waited for seven hours in Queen’s that day because there was no bed for the patient. I was told that the same queues are constantly in place at King George’s and Newham, the two other hospitals serving this part of East London.
These queues have ramped up from December and have been consistent, day and night, meaning at any one time in the Romford and Havering area, at least six ambulances are unable to go to the aid of sick people because they are queuing and chatting in the warmth of a hospital corridor.
A fellow relative was as stunned as I was by the MASH-style scene: “This is madness.
“Where does all the money go? It’s not political. It doesn’t matter what government is in charge. This has been going on for years. Where does all the money go? We are not a poor nation.”
The idea that the NHS is “not political” is clearly nonsense for anyone who saw Boris’s Brexit Bus, but he had a point about how the money is being spent.
Doreen was handed over from the ambulance people after around three hours in the corridor queue. They returned to duty with a cheery wave. Good, caring, human professionals, like everyone we met in the NHS.
Next, a nice lady with tattoos gets to work, taking blood, sorting out mum going to X-ray and CT scan, changing her out of her blood-soaked clothing, cleaning mum up, chatting about her family.
She kept an eye on her for the next few hours, never far away, making sure the doctors and nurses were doing the right thing, always asking: “Are you alright, Doreen?” The porter was lovely too: “Hello beautiful,” he said to mum. “I’m not beautiful at the moment,” mum grumbled. “Oh, yes, you are, darling. I’ll look after you.” And so he did, with effortless Cockney charm.
A doctor told me that the whole process is even more broken than was in evidence before my eyes, with the army of paramedics in green hanging around for hours and patients sitting on trolleys waiting to be processed.
“The problem is that they all need to be found beds in the hospital, but they are medical patients. So the medical patients are put in surgical beds as there is nowhere else for them to go. This means that patients coming in for surgery will have no bed, so the operations are cancelled at the last moment. We are all just kicking the can along the road.”
It turned out that Mrs Sutton shouldn’t have been at Queen’s at all. They don’t do open fractures, so she was going to be transferred to the Royal London Hospital in Whitechapel. Clearly this added a level of complexity to the whole hospital admissions process, not least that the orthopaedic surgeon needed to straighten her horribly broken wrist and plaster it before she could go.
Doreen was moved to the ‘Resus’ unit and an orthopaedic surgeon let me see the sheared wrist bones on the X-ray. Some things are probably best left unseen. I felt sick and slightly amazed at how stoic my mother was being through all this.
We waited for an anaesthetist. A key part of the NHS is the waiting game. She eventually arrived, and I used the time to telephone all the right people and update them on mum, granny and sister’s condition.
Now we got to the next part of the NHS game – and this is in no way an insult to NHS staff, who are uniformly excellent, professional and cheerful. They are almost all of them liars. Liars by omission, but liars all the same. And it is entirely understandable and perhaps even desirable.
My mum needed to be transported by the London Ambulance Service to the Royal London Hospital, 16 miles away. We already knew that ambulance crews were basically stuck in a queue all day.
It was now 8pm. A nurse told us that the ambulance would be with us in “about an hour, but no guarantees”. That wasn’t the case, but he finished his shift and went home before the white lie could be exposed. The next nurse chased up the LAS after two hours of waiting. “They are coming soon, they say. But no guarantees.” He is doing that half-lie, but I don’t know that yet. “There is a bed for you at the Royal London.”
We were taking up an important bay in Resus, so we were moved to the Majors area, a sort of dumping ground for everyone we had seen throughout the day who didn’t yet have places to go to. I saw the poor old guy who was admitted with a stroke at the same time as my mum; the chap with his wife who hadn’t thought the NHS was political, a 40-year-old guy in pain, being comforted by his mother. No-one had been taken anywhere yet.
Mum was placed in a bay and looked after by a super-funny nurse. I asked if she had any idea when our ambulance would come. She laughed out loud: “No idea. Could be hours.” This was a rare example of an NHS staff member bluntly telling the truth. “We’ve got a patient over there who has been waiting since 9am. It was now past 10pm. I was tired. My mother was exhausted and not in pain, only due to more painkillers. The nurse turned out to be wonderfully cynical when I asked if mum could have a pillow. “We’re not allowed pillows in A&E because no-one is supposed to stay in A&E for more than four hours,” she cackled. “And there is no staff toilet here. We are not allowed to go to the toilet according to whoever built this!”
It’s all done with a gentle, good spirit. Someone described it as ‘the Blitz Spirit’, but I don’t buy that. The Blitz was an extreme and uniquely violent event. This is just normal life, day after day, for hospital staff who are simply doing their jobs in trying circumstances.
The nurses and porters swapped banter with the ambulance staff. Patients were treated with respect, kindness and a genuine interest in their lives. It was tiring, inefficient but actually quite good fun, if that can make any sense at all.
I had given up on us moving to the Royal London before dawn, when suddenly our crew arrived at midnight. One of the crew chatted to mum. “Did you have a fall, Doreen? Were you drunk?” “I’ve never been drunk in my life,” said my mum, which is probably true. “A bit tipsy, occasionally.”
She was still smarting at her clothes being cut off by the earlier paramedics: “You lot messed up my favourite coat.”
We were on the move, driving slowly through the East End, all the areas where I grew up and had my first job. The paramedic chatted with us all the way. She conceded that the ambulance worker’s life had changed a lot: “This isn’t the job I signed up for – all targets and paperwork and management. Not enough looking after patients.”
At the London A&E, we were handed over immediately and got another one of those lies that I am getting used to. “You will be seeing an orthopaedic doctor shortly.”
We were shuffled to different bays in a truly gloomy area of the hospital. Eventually a couple of ‘bone doctors’ as they describe themselves arrived, checked out the wound and told us that mum would be operated on the next day between 12-1pm and would be taken to a ward to sleep soon.
She could finally have something to eat, having had nothing since breakfast before she went out and fell over. It was after 2am. She needed to eat before 3am so I dashed across the Whitechapel Road to a 24-hour Budgens for a ham and cheese sandwich.
She wolfed it down, despite the pain in the arm and total confusion over where she was and what had happened to her. “I’ve been here before, you know,” she said. “For a fete one Saturday.” That’s Alzheimer’s for you.
At around 3am, I asked the head nurse when my mother would be taken to the ward. She had an inexplicable attack of honesty: “Oh, no, there is a shortage of beds in the hospital. She won’t be going anywhere for hours. Your mum will have to sleep here.”
I found myself staring at her, open-mouthed. And then could only smile. “No problem. Let’s get her settled.”
By the following morning, she was on a ward, in a comfortable bed, waiting to have the operation to plate, pin and plaster her wrist. The operation happened at 6pm, but that was OK. It lasted more than four hours and was successful; by the next day she was sitting in a chair, asking where she was and when she could go home.
Once you are in the system, it will all work itself out. It’s just getting in there that seems to be such a mess. I came away from the admissions experience with three overwhelming feelings: firstly, that the whole process is totally messed up and so inefficient as to be almost unsustainable. Secondly, it is only sustainable because of staff who are overwhelmingly humane, professional and committed. Thirdly, as has been pointed out over and over again, Brexit will likely be a catastrophe for NHS staffing. My unscientific guess from my mum’s experience is that ambulance workers are predominantly British nationals (probably around 80%), while hospital staff are the reverse – around 70% non-UK, especially medical staff – doctors, nurses. I would guess that around 30-40% are European citizens, so that is a big chunk of professionals that may well disappear.
My mother is recovering well now, thanks to the NHS, which somehow muddles through. But seeing inside it is pretty scary.
Geoff Sutton is a journalist, digital media veteran and chairman of Virtual Reality company Spinview