THE NHS is about to undergo yet another major reorganisation.
Having, in the past year, had to take, urgently, two family members on two separate occasions to the Royal Blackburn Hospital, I wish to make the following comments:
1) NHS Direct staff have to ask a list of questions to try to assess the severity of a patient’s condition. When I first used this service, an ambulance was immediately dispatched and paramedical management was excellent. Sadly, on the more recent second occasion, when told the patient’s condition was rapidly deteriorating, showing well marked signs of a pneumonia as assessed by his medical father-in-law and his own medically qualified wife, the NHS Direct nurse insisted on speaking to the ill, breathless patient, after which she advised a hot bath and two Paracetamol tablets “see how you are in the morning” – advice, frankly, both stupid and dangerous.
2) Continuity of patient care has largely disappeared – four different ward transfers under at least three different consultants in a six-day hospital admission for pneumonia superimposed on Swine Flu, leaves both patients and relatives bemused.
3) Protocols have their place, but must not supersede common sense. What is the point of performing an ECG heart trace on a previously healthy and fit young man who is deteriorating by the hour with pneumonia? Do an ECG trace later, but get on with urgent anti-biotic treatment. Oxygen was correctly given for low oxygen blood levels, but monitoring of these was later, somewhat haphazard.
4) Box-ticking of treatment charts can be grossly and dangerously misleading. Because an anti-biotic has been ticked off as having been given at, say 6 a.m. and noon, this is simply untrue if the patient’s intravenous infusion line has clotted at 5 a.m. and is not re-sited until 1 p.m. In my experience this was by no means an isolated event.
5) A patient in isolation without access to a toilet or shower should not have urinals, washbasin and sputum mugs left to sit on his bed table for hours on end. Furthermore, relatives should not have the responsibility of providing toilet rolls to a sick patient whose repeated ward requests for such were not answered.
6) It should not surprise anyone that hospital mortality increases at weekends or on Bank Holidays, medical, nursing and cleaning staff are hard to find at these times.
7) Care of the patient and continuity of that care must be urgently restored to the NHS. Surely, it is not too much to expect a patient to be cared for by a single consultant throughout their hospital stay; that consultant must be supported by a conscientious and well-trained junior staff. They must ascertain that patients’ infusions are working and, if not, re-site them as soon as possible. Senior staff must check that drugs, if marked as given, have truly been given. Cleaning staff must be held responsible for the cleanliness of both wards and rooms and not neglect patients in isolation units.
8) Far too often patients find themselves in “limbo” in admission wards. Clear and firm decisions must be made as to where and by whom they are to be looked after. A consultant and his/her team should then manage the patient’s care throughout their hospital stay. Discharge letters should be accurate and long waits for discharge medication (if needed), hopefully, be avoided by earlier notification of the hospital pharmacies.
9) Compassionate and effective patient care by All hospital staff must be the aim of every NHS hospital. This ideal needs a certain amount of hard work, good organisation, proper and thorough medical and nursing training and a lot of common sense. It must not be lost in a welter of “mission statements”, unrealistic protocols, poor decision making and dubious league tables.
ROBERT LAWSON FRCS (Retired Cardio-thoracic surgeon)
CATHERINE M. POWELL MRCP