At the End of the Day

Down and out in the NHS

When visitors come to see their relatives in hospital, the first question they are always asked by the patient is, “Do you know when I’m going home?” This tells us two things about hospitals: first, they never tell you anything reliable when you’re in there; and second, people don’t like being in hospitals.

“Oh, but it’s far better than it used to be,” people say in response to that. Well, I’m here to tell you that it isn’t. There has been a superficial attempt to make life nicer for the patients, but the modus operandi in these places is pretty much unchanged since the last time I was in one –  over thirty years ago, in 1971.

It isn’t that there’s no information to be had. On the contrary, everyone you see tells you something….and there are legions of people to see – all wearing differently coloured uniforms, and all with a different version of what lies ahead.  ‘You’ll be having a scan tomorrow morning’ turns into a shock Gastroscopy this afternoon. ‘It’s OK to leave for the weekend’ becomes ‘we’ve booked you in for an important procedure on Saturday’at midday’. Saturday at midday then morphs into 5pm….and you’ve had nil by mouth since 6am.

If the illness is very specialist, rare and/or complicated, nobody will ever tell you what avenues have been exhausted and what they most expect to find. Ring the consultant, and his secretary will tell you that the nurses and doctors on the ward will give you a progress report. But on the whole, the middle to lightweight nursing ranks can barely remember what hospital they’re in (so many of them are agency staff) and the doctors are perpetually  in “I’ll be along in a minute” mode. The doctors, to be fair, look mostly rushed off their feet.

The lie is given to the supposed reliability of this ‘system’ whenever one says to a registrar or consultant “I’ll leave a message with the nurses”. There is a thinly disguised note of panic in the response, “No…um…don’t do that”. In short, nurses never pass messages on. And they’re right: they don’t.

All of this nonsense happens for two reasons that I can discern. First, most doctors simply do not like giving out information : it has always been like this, and I suspect it always will be. This syndrome can in turn be divided into two parts – one, I’ve got a secret and I’m not going to tell you; and two, a terror of being sued. This latter is apparent in almost every hospital procedure there is, and it costs the taxpayer billions every year. Not that much from legal suits – mainly in the inefficiency and over-staffing that emerges naturally from fear of the bewigged vultures.

Second, most hospitals are far too big and very badly run. If like me you’ve ever run a large organisation (and I will hold my hand up and confess that I hated every day of it) you could walk round a hospital and ask the odd question here and there as to why people are doing stuff. Some of the answers would render you catatonic from a mixture of amazement and horror. Management – and the introduction of it by first Heath and then Virginian Bottomless, the whole being turned into fab-mod-gear-happening thing involving meetings by Moral Tone – is rapidly ruining the NHS. They’re incapable of working out the size of car park required, of matching workforce strength to need, of putting patients first, or even of spotting why a solution might be achieved both more cheaply and effectively.

But again, in about four cases out of ten, fear of litigation is behind the madness.

The usual problem – too many chiefs – also produces the familiar experience of dealing with it as a carer. The junior levels are unfailingly helpful but know nothing, and the senior ones you practically have to wrestle to the ground to make them talk to you, so hastily are they on their way to another meeting. Last week I went into the superbly appointed Patient Information suite on the ground floor of one hospital, and asked two Bighairs if they could tell me what all the different uniform colours designated.

“N0,” the first one said, “to be honest, I’ve no idea.” And the second lady added helpfully, “We used to have a guide, but then they changed everything so now we don’t.”

I’ve seen more logic in cow excrement than that response. First of all, who are they? I thought they were in charge of being ‘they’. And second, change = update doesn’t it? Well, in software and hospitals, no it doesn’t. So what staff, patients and visitors are left with is a cacophony of shibboleths, many of which are based on the ‘case where £5 million was awarded in 1995’ which may itself turn out to be an urban myth put out by the Daily Mail.

Is the experience of being hospitalised better than it used to be? I suppose it depends on who you are. If you like watching daytime telly at a cost of £20 a day, if you can’t get enough of the person in the next bed expectorating in every direction, and if you get off on long, dark corridors covered in expensive photographic art, then hospital is the place to be. For most people, I suspect, it is unutterably awful: noisy, bewildering, constantly interruptive (lawyers again), and the feeling when dealing with many of the nursing staff that they’re trying to run a ward and quite frankly you’re being a bloody nuisance.

The telly/radio/internet innovation is classic crack-papering. First off all, the equipment has clearly cost a fortune; second, it represents very poor value to somebody who is, let’s face it, not feeling that great; and third, you just know that the contract will have been badly negotiated, and the local Trust is paying through the nose to have it. I’ve been going into this hospital four times a week now for nearly five weeks, and my observation is that most patients are either too ill to bother with the entertainment – or too intelligent to be paying these kinds of prices to watch crap, repeats, or crap repeated.

But while all this capital expenditure rips ahead, the unthinking finger of the bean-counter is guaranteed to be absolutely miles off the pulse….and his braindead decisions to add to costs and patient discomfiture. It becomes apparent fairly quickly that expensive procedures are left until the cheap ones have been tried. Much as it would be nice to think that the cheapo things like taking a temperature can produce a diagnostic breakthrough, usually they don’t. The really accurate readings and prognoses come from PETscans, MRI scans and biopses. Any biopsy involving a tricky or remotely-located organ requires highly-skilled staff to do it, and involves a small degree of risk. So to appease the accountants and the lawyers, they’re often the last test to be done.

They should of course be the first, because that would free up beds in, say, six days rather than five weeks. Words like nose, end of, can’t see and spite face come to mind.

And one final dig at the legal ‘profession’, a descriptor that gets more Orwellian as the years pass and ethics become a distant memory. To ensure that nobody aged 97 might have a heart attack over the weekend and die from a lack of instant defibrillation, agency doctors ‘cover’ the weekends. This means that Sister has to waste half a morning briefing them on the 30 odd patients being left in their care. And it raises costs enormously. Worst of all, they know nothing about anyone even after that briefing. The response one gets from them is either “Ask the nurses, they’ll know” (they don’t) or “Sorry, I’m only here on cover”.

I love the exculpation of that ‘only’ there, don’t you? I’m only doing this for the money, so don’t expect me to know anything. Rota systems properly designed alongside nursing skill upgrades could obviate the need for any of it. Except that Management sees its job as target hitting, arse-covering and budget-shaving…not ensuring the best outcome for patients. Lest we forget, it is Management that takes decisions like closing wards because the Trust can’t afford to run them. Dear oh dear. It’s a hospital you half-baked cretinous wombat: tell you what, let’s lock the entire place 24/7, and earn mega-bonuses by handing all the budgets back intact.

I hope you’ve enjoyed this little first-hand account of life in a directly taxpayer-funded public health system. The speed and resource thrown at serious health problems remain what they’ve always been: truly outstanding, and still the best in the world. The reason is simple: those who run and staff such services are dedicated, talented and retain a sense of calling. They often get well paid (I’m told) but whatever they get it’s not enough…and anyway, I severely doubt if money is that important to such people.

As for the rest of it, it’s crippled by bureaucracy, penny-pinching, litigational obsession, doctor silence, poor quality nursing staff, and silly priorities. So yes, something needs to be done….and I remain a devoted fan of mutualising the whole kit and caboodle and  then severing all links between it and Government.

But this article is academic, really. You see, Lansley wants to auction off all these problems to private providers, preferably American insurance companies – or, if that fails, teeth-flashing billionaires with long hair and Pacific islands. The thousands of civil servants who were involved in running the service will not lose their jobs (we’ve been lied to from the start about this, but it is obvious that the mandarins have insisted on the survival of the thickest) and so the Department for Health will morph into some sort of toothless watchdog, while patients will pay more for any form of health therapy as the BMA goes whoopee and starts a radical climb in fees.

Anyone who doubts this should go and see the insurance schemes available in the States. For most Americans, the options available are far worse than those of the NHS, but the major difference is that they pay through the nose to have the same frustrations we do. Only the privileged 7% plug into five-star corporate health cover.

To ‘solve’ this problem, Obama has passed a Medicare act that can only mean one thing: what blue-collar Americans save on lower medical bills will be more than wiped out by the rise in their taxes. The US clearly needed something to plug its health service gap, but this was the last thing it needed…and 2010 was probably the worst year since 1776 in which to introduce it.

The Ed Miller Band, however, would do what the Black Dude did, minus only the sense of trying to make things better – however misguided the execution of that aim might be. The Conservatives want money for the shareholders, and Labour wants jobs for the Unions. Both these will produce money for their respective Parties, and nothing for us. It is the way the world goes round in 2012.

Related: Either get the money out of politics, or get out of Britain.