Sunday, December 17, 2006

NHS in Poor Health?

The UK has for the whole of my lifetime been blessed by the institution
commonly known as the NHS which provides everyone with healthcare,
free at the point of delivery.

The NHS is still the heart of the nation's healthcare but the heartbeat
does not seem as regular as it once was, despite the £millions being
thrown at it by the current Labour government. In fact the NHS still
provides some excellent services and there are many wonderful
staff at all levels.
My own experience of the NHS in March 2005, led me to post the following
praise on Sharecrazy:
Our children bought Mrs maytrees a couple of cinema
tickets for a mothers' day pressie. We went to
the local cinema and had some non alcoholic
drink in its coffee bar while waiting for the film start

I began to feel faint and an ambulance was called.
the two ambulance crew could not have been more attentive
but I was wheeled out like Jo's disabled friend
in a wheelchair with oxygen to the ambulance where they
recommended casualty at St Georges NHS hospital.

On arrival there I was whisked into a state of the art
bay and attended to immediately by a large team of medics
etc - blood tests heart tests Xrays etc etc.

They then decided to keep me in overning "for observation".
Went to a small ward with constant supervision more tests etc.

Later to a slightly larger one when after NHS breakfast
a team of medics may be about 9 came round the bed. I assumed
most were students but they said not - they were the normal
medic team headed up by consultant down to
registrar etc. Each then personally introduced him/herself.

Diagnosis was merely very low blood pressure and a
tiny bit aenemic so I was discharged.

All free enthusiastic clean attentive service
with no waiting - I'm sure there are many more stories
like this.

NHS is great when the chips are or maybe down.
Even in other cases I'm sure it does its best.
Politicisation of NHS should be discouraged.
More TX and fewer moans should be encouraged"

However I have since learned from patients, NHS workers,
visitors and others that when the chips are not down,
the NHS service
can be far from excellent, as the following illustrate:

One junior NHS admin worker told me that he booked interpreters
at the request of a medic. The medic some while later came back to him
and asked for more interpretation services but to include one
interpreter that the medic had particularly liked. When asked by the NHS
admin worker for a name or reference or description of the interpreter
he sought, the medic said that he did not know but insisted that the
junior worker should be able to trace him. The admin time and
expense spent on performing such detection work might
have suceeded eventually, but hardly an efficient use of precious NHS admin time.

One elderly patient said that he was told that he would be discharged
from his hospital bed the next day at 8:30am and (as he had fractured bones)
would be minibussed home. He duly got ready at 8am. Was then told that
he would not be discharged until his medication was ready. He limped down
a couple of floors to the bus waiting room where others in similar condition
were all hanging around for the same reason. The medications were only
dished out 4 hours later so that those elderly
disabled patients who boarded the hospital bus had spent five hours
waiting around aimlessly without being provided with information let alone a meal.
More caring hospital administration could surely have either have arranged the medication
the night before or for the patients to have been given lunch first and
dicharged afterwards?
Despite the applicability of "Use it or Lose it" to elderly
people, he has yet to be contacted by the NHS about post
fracture physiotherapy or even given any information
or reassurance about such arrangements. Used car salesmen
can have bad reputations for poor after sales service and the NHS needs
to appreciate the importance of good admin in this area too.

A patient told me of nurse call button being pressed on his ward with
no discernible response for long periods. On one occasion
an elderly c. 94 yuears old confused patient, had urinated over his bedclothes
during the long wait.
When the nurses eventually arrived instead of apologising they berated him for the extra work that created.

MRSA has been well known as a problem for the UK NHS
One lady told me via another bulletin board that:

"But on my visit to my friend, I had witnessed something terribly bad, and had been wondering I should write about it since.

The woman was around 40-ish, so must have had some experience on home making...include cleaning!

She emptied the black bag by removing it from its holder and refitted it back. Then without washing her gloved hands, she squeezed out a cloth from a bowl on the trolley, and went and wiped the tap handle, etc, and the wash hand basin with it.

I was imaging the bugs being deposited there, as her wash cloth had been contaminated by her hands which must have picked up from emptying the thrash bin bag!

Then she'd dropped the cloth back into the bowl, and pushed the trolley carrying the cleaning stuff out of the ward, presumary into another ward and repeating the same procedure.

After touching and handling the thrash black bag and holder, she should have washed her gloved hands before touching anything or squeezing the cloth from the washing bowl! Such practices must be addressed, but how?

I am still shocked that from the same health authority, we could have such contrasting standards. Those cleaning staff at the hospital I was in, were so excellent and not here.

But even in the same hospital, proffesionism, courtesy and kindness vary with different individuals!

In my vast experience as a patient in the last four years, I had found night staffs worked the hardest and were the kindest.

I often felt so sorry for them as they were often short staff and more emergencies were at large at night.

Just a thought on nurses stations! they should not be in the middle of the unit, except for the central one, where only one person needed to mind it, and that could the ward clerk on office hours and the person in charge at other times.

And there should be a desk in a corner of every ward, where a nurse (there were five on the days of my visits), can sit and keep an eye on every patient, when they are not busy doing routine work.

On most of my visits, they were often sitting at the central nurses station, looking rather bored and disinterested!

And I am not speaking for a few ocassions as I visit people in hospital quite often. I have seen them to be most busy from 7am to before lunch and after 9 pm. There rotas could take into account of these periods and have less staff on (quieter times!)

There are some excellent people in the NHS: really proffessional, hard working, kind and compassionate and truly caring. But like in all things it is the luck of the draw when one gets bad and good services.

I wish we can order our needs for hospital treatment, so that we can go for it, like with super markets!

I'd always picked times when professional, nice and kind checkout staff were there.

Ocassionally, I had experienced those. whose hearts were not on the job!

So it's good when one's luck is always there."

The pay of nurses for example will never be enough but many of the problems
will not be resolved by money alone.
Hospital Admin is to many end users anyway, in need of a radical
shake up to give priority the clients that is the patients not just
say in A&E or in Surgery etc priority but also at the points of discharge
admission, waiting room comfort and after discharge admin. Staff morale needs to be boosted and maybe more customer
care training provided from the top down wards.

I could go on and on but this has already become my longest blog post so far so I will stop now. The gist anyway is hopefully clear enough.

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