I have not written a blog for a long time now, and that is principally because I was anxious to complete my new novel The Porcupine’s Dilemma and gave myself an arbitrary deadline of Easter. The Book is done. Unfortunately, I forgot to take into account the physical realities of an aging woman with heart problems.
Few of us, I imagine, want to test the restricted resources of the NHS by being whisked off to hospital by ambulance in the middle of the night. A week ago, to my dismay, this did happen to me: and I was in the wonderful John Radcliffe Hospital, in Oxford, for long enough to develop some very firm opinions about the state of our beleaguered health service.
Without exception, the numerous doctors and nurses I encountered were courteous, kind, gentle and considerate, and, as far as one could tell, thoroughly competent. Their endurance and forbearance were particularly tested during the eight hours I spent in A&E (under surveillance, having tests, waiting for a bed), for some of the patients brought in were not patient at all.
By the time you are wheeled into a curtained cubicle in A&E, you have received any necessary first aid, your needs have been assessed and processes put in place to make sure what needs to be done will be done. It should be clear to anyone capable of thinking beyond their own immediate needs that instant treatment is simply not possible. Yes, there are a lot of nurses and nursing assistants around, and occasionally quite a number of doctors, but they are all busy. Occupied. Dealing with other, more urgent cases. Whenever I needed immediate attention, I got it. But those who scream for treatment when left alone and then yell abuse when someone comes should not be surprised when they have to wait.
“I pay your salary,” shouted one angry elderly man with a painful leg, in the cubicle on my right. “I shouldn’t be left here like this.” His wife agreed: “It’s a disgrace. We employ you. You should be looking after us.” To my surprise, the doctor on the receiving end of this attack tried, quietly and gently, to explain what had been done for him and what he could expect. To little effect. This soft answer did not turn away this wrath.
Meanwhile, on my left, another unhappy woman whimpered for attention like a spoiled child for hours. Mental illness was clearly the main issue here. I got the impression that psychiatric help was not available in the small hours of the morning, despite the obvious probability that this might be exactly the time when such help would be most needed.
Conclusion? Surprise, surprise – A&E is functioning on a shoestring. Functioning well, as far as I could tell, but I was there on a Thursday night, not on a Friday or Saturday when drunkenness disrupts everything (yes, I’ve experienced that too!). Everyone I saw appeared to be working flat out, so there was little if any leeway for an emergency, like a motor-way pile-up, for instance. And provision for mental health emergencies appeared problematic.
Up in the Short Stay wards, the situation appears much the same. Doctors, nurses, nursing assistants all quiet, kind, helpful, all busy all the time. We patients wondered what would happen if the computer system in the hospital broke down. Nothing existed if it was not ‘on the record’. A doctor changes your prescription, tells you (the patient), but if the junior doctor taking notes fails to enter that change quickly enough in the official record, it didn’t happen. (Well, actually, it did happen to me – but was promptly sorted out by a very competent nurse who made a phone call.) I have no doubt that computerising records is sensible, but total reliance on a technological device can be dangerous. This change of drug was important for me – what if that doctor had NOT treated me like an intelligent human being, and not told me of the change?
There is a sense in which computerisation is being treated as yet another cost-cutting exercise. And we did experience a lot of that, most especially in the quality of the food and drink. As an experienced cook, I would say that all the ingredients, from teabags to carrots to bread, were the cheapest possible. Sometimes cheapest is a false economy: some of the food we were given was uneatable. I particularly remember a ‘quiche’ I tried – the ‘chopped onion’ appeared to be bits of chopped plastic, if there was any egg, it was overwhelmed by flour as thickener, and there was little sign of cheese. (I didn’t touch the pastry.) On the other hand, a plate of salad – chopped iceberg lettuce and a tomato – was unexciting but good. I was not alone in wishing Jamie Oliver could come and give a hand.
Just in case anyone out there has the ear of our Chancellor, he does need to register that the NHS appears to have cut costs to the bone. It functions, thank heaven, but there is clearly no more room to cut more. Any emergency will take resources needed elsewhere. And meantime, we all get older, there are more of us. It makes no sense to cut back any further. On the contrary, more funding is clearly needed just to keep it from collapse. And if we care about keeping our NHS as a National Health for all Service, then it needs a great deal more money immediately.
Of course, he knows this. But he undoubtedly has private health insurance himself, so ideologically speaking, why would he worry?
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Elizabeth Mapstone