Being Some Rambling Observations Touching on My Recent Experiences of the NHS and Some Thoughts on the Future. (V2.0)

I am not sure if this is the best platform for this blog.? But I will publish it anyway.

I have recently been discharged as an in patient in a large District General Hospital after a stay of nearly two weeks.? I am pleased to report that my problems are mechanical rather than anything too serious.? My time as a patient has allowed me to think on several things although in this period I have not watched anything on television or read anything longer than a newspaper.? My attention span has been short largely because of my consumption of opiates.? I have had plenty of opportunity to watch the NHS in action.? Everybody has a view on the NHS, indeed we all seem to regard ourselves as experts on this most complicated subject.? My views are worth no more than anybody else’s.? But I would like to record a few general observations:

1.????? There is obviously an issue of capacity.? Few problems are solved by simply spending cash, but increasing capacity to bring things more in line with demand requires spending money NOW.? I was not able to go to hospital by car.? Medical opinion was that I needed to travel by ambulance.? I waited over 12 hours.? The triage system that left me on my kitchen floor was a sound one.? My ailments were not going to kill me.? I was safe and warm, although in pain.? Rationing means that providers must make difficult decisions. Even the right decision can lead to pain and discomfort. ??In my case the issue was simply one of demand outstripping supply.? Let us not kid ourselves.? Increasing capacity means increasing taxation.? I don’t mind paying more income tax so long as the money is spent on national priorities.? Health, social care, education and defence are not cheap, but they are the touchstones of civilised communities.

2.????? The ambulance service and the local hospital have worked hard to improve the ‘hand over’ process.? It was not perfect but it was much improved on what I have seen before.? People have clearly been working in the background to tackle this and numerous other issues.? No complete solutions have been achieved but progress has been made. The paramedics who cared for me were brilliant (although at that stage anybody providing morphine would have been welcome).? Their professional knowledge was impressive and their sense of humour perfectly pitched.?

3.????? The A & E Department (or the ED as I suppose we should call it, at least I have moved on from describing it as ‘Casualty’) was gruesome, although I did not spend long there before being moved to ?another waiting area.? I could not tell how much (if any) of the problem was caused by inappropriate use.? I counted 145 fellow patients in waiting and that I overtook most of them pleased me at the time but leaves me now with a lingering guilt.? The sight of people in pain on trolleys in a corridor does not match my idea of what a rich country can achieve for its citizens.? Should not freedom from pain be achievable most of the time??? There is no dignity in public suffering.? I don’t know how staff can work in such circumstances on a daily basis.

4.????? My problem needed fast time communication with another hospital.? This was achieved efficiently and was clearly a matter of routine.? It was impressive to observe specialists in different fields in different locations quickly coming together to make informed professional judgements.? This piqued my interest in decision making processes and I will seek out some of the literature in relation to this in a medical context when I am a little less befuddled.? I am interested in the crossover with decision making in other crisis situations.

5.????? The ward I was admitted to was modern, clean, comfortable and well equipped.? The patient to staff ration was clearly an issue with an obvious reliance on bank staff.? Without exception the nursing and care staff were kind and efficient, without a whiff of compassion fatigue.? It is very easy to get dewy eyed about nurses (etc) being angels on earth (having known many in a non clinical setting I know this not to be always the case) but their kindness and care has left me with a deep sense of indebtedness.? Their job is tough and their levels of responsibility very high.? The drug round alone carries more responsibility than I have had for most of my working life.? Nursing and its allied professions provide a case study in individual, team and organisation resilience.??? All that clapping in the pandemic did not generate any extra income, nor did it lighten the workload.? I suspect that the Royal College of Nursing will vote against the 2.7% pay increase.? I will not surprised.? Managing such large numbers of people from many professions is an enormous task.

6.????? I was struck at the sheer scale and complexity of a hospital.? In the middle of one night I found myself thinking about the procurement challenges that must face hospital managers.? At the time I was staring at a piece of disposable equipment that I will describe no further.? Suffice to say that when people are critical of the NHS for having so many non medical staff I wonder if they have considered the complex logistics of running such an organisation.? While being wheeled into a waiting area for a scan I overhead a snippet of a conversation about the maintenance schedule for a piece of kit that looked to me like it could be part of a new space programme.? Such things do not get sorted by themselves.? Much has changed since I first read the Ladybird Book of the Hospital (Nurse/Doctor and other titles). In amongst all of this there will be some inefficiency – just as there is in the electricity company that sells (but does not actually generate or distribute) the power for my domestic heating and in my local supermarket that believes that Christmas starts in September. Overall the NHS looks pretty lean to me.

7.????? In the dark hours my thoughts also turned to emergency planning, response and management.? I have had the privilege of working with emergency planning specialists ?across central and local government, industry and the emergency services.? My much missed association with the Emergency Planning College gave me an insight into many sectors outside of my own narrow professional experience.? Yet nothing I saw compares to the challenges that face EPRR colleagues in the health service.? I found my drug addled mind contemplating everything from the impact of an aeroplane crash through to a full scale influenza pandemic with a bit of terrorism thrown in.? There are good reasons why EPRR professionals are worth poaching in the emergency planning job market.

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No startling insights then but plenty of food for thought for me personally.? The NHS was one of the great achievements of the post war period.? Its importance has not diminished but it has been neglected.? Who every thought that we need fewer doctors, nurses or beds per head of population than other western European countries?? We are an ageing nation.? Generally (but not universally) increased life expectancy is good news, surely?? There are some things that can’t be done on the cheap.? But there is a debate to be had about how we plan for the next five, ten and fifty years.? Political opinions rightly inform part of this debate but it would be great if the discussions on this most important of subjects can be conducted respectfully and in the interest of the common weal.

I have found it quite difficult to concentrate over the last few weeks.? Even this cathartic wordy discharge has taken me several days to write (and re-write, my first attempt set the wrong tone entirely).? As I settle into the NHS waiting list I can now consider my own professional future – a positive, necessary and overdue process.? Trying to decide what to do next is a little bit exciting.?

Philip Trendall

December 2024