Wednesday, 15 May 2019

Alive and kicking

I'm very probably the luckiest man alive. I've never been in a hospital in my adult life. Until now. Two nights ago I felt my throat swelling up to the point where I could no longer swallow and was gagging on my own saliva. The NHS 111 hotline was pretty useless with a long list of annoying questions and at the end of it the operative did not seem to get that I was suffering quite badly. I hung up. Some moments later my call was returned, this time by a chap who seemed to think it might be something serious and advised me to go to Southmead A&E.

Southmead is a new hospital in North Bristol. It's clean, extremely efficient and actually quite pleasant. I was seen in a timely way, first by a triage nurse who had a reasonable good guess what was happening. I was then directed to be examined by a doctor once I'd been fitted up to an IV or paracetamol. Instead of beds they had large leather arm chairs with motorised reclining and wide enough so you could curl up and sleep. I have to say the staff were brilliant. If all hospitals ran like that then you would say there simply isn't a problem with the NHS.

But my condition was a bit more serious and needed to be transferred by ambulance to Bristol Royal Infirmary in the city centre. That was an eyeopener and more in line with what I had imagined a hospital to look like. BRI is a bit of a cavern of despair, especially when delivered to the subterranean bunker like ENT ward, where there were some seriously poorly people from all walks of life. I actually felt like an imposter, thinking I should just go home. The nurse practitioner told me not to think like that and that I would be seen to.

My initial consultation was in the corridor as the ward had no beds. They were at capacity and there were others on trolley beds being treated in the somewhat grubby corridor. They had to activate their winter emergency procedure even though it's a warm mid May. It would seem they have problems adapting to unanticipated surges. When I was finally seen, I was seen by a very smart, very credible doctor of African origin and a trainee doctor. Diagnosis was quick, and was soon allocated a space for treatment albeit at the opposite end of the hospital in an unrelated ward. They put me wherever they could find room for me.

In fairness, once you move out of the emergency reception wards, the rest of BRI is tolerable and clean enough. It's true what they say about the NHS being dependent on immigrants. There were a lot of foreign nurses, mainly agency nurses from Hungary to Africa and beyond. The Hungarian nurse was great. Very jaded but very funny and very kind and turned a blind eye to my vaping. That really made a difference. They really did treat you like an adult human.

If I had any complaints, I'd say there were long waits with no information and I wasn't really being properly informed, and the nurses had only basic information. But then they were busy and had more urgent cases than me, so I waited my turn. I think perhaps some who complain about the NHS have over-inflated expectations and a belief that their own case is more important than anyone else's. I can understand that to a point. When you are in a hospital your first and main concern is to get treated and get out as soon as you can.

The sense you get is that a hospital is a universe of its own and its own ecosystem where it's only as good as the people in it and results will vary from hospital to hospital. I think Bristol is very lucky. I don't think it's the sort of thing that lends itself to miracle solutions where every customer has requirements that differ to the next. Politicians on all sides will tell us things are worse than they are because they have their own agendas. Some want it to be cheaper and more efficient but this business is by its very nature inefficient and very very expensive.

From the high tech snake camera they rammed up my nose to the multimode beds and monitors, you're looking at tens of thousands worth of equipment and man hours and that's before you get into the expensive treatments. Ensuring everyone gets the treatment they need, whoever they are, when they need it, on a a walk in basis is actually something to be in awe of. Whether or not the NHS is the only way to deliver this is another question, and though I had an entirely satisfactory experience, one can see how those with special requirements may fall between the cracks.

Casting my mind back to the Mid-Staffordshire scandal where we heard reports of patients drinking water from vases seems wholly plausible. There are times when all the staff are busy and even if you press the summon button you can be waiting a while to be seen for something even as basic as a glass of water. It could be argued that some wards are understaffed and could benefit from a few more gophers to deal with basic care needs. When you have no relatives nearby to call on the whole process can be quite frightening and when you're conscious you're taking up space, your instinct is just to wait your turn. There seems to be two extremes of patient. The overpolite and the totally impolite. Sometimes you need to be a bit of both to get what you need.

I therefore arrive at the conclusion that the NHS question is one much like Brexit, where anyone offering up simplistic and pleasing solutions is one who hasn't really understood the issues and is probably not even interested in them. Improvements happen with multiple intelligent policies from HR to care policy. In many ways the NHS makes life harder for itself by having incredible high care standards. They follow process to the letter and though this could be interpreted as unnecessary bureaucracy, very often it preempts the sort of errors that could be made otherwise and is a life saving influence. A well functioning administrative system makes all the difference and there is always room for improvement.

Of course, one stay in an NHS hospital does not make me an expert on the NHS, nor indeed is this post meant to influence the debate one way or the other. All I'll say is that the system worked when I needed it and all this experience cost me was £16.50 in parking and I'm not now having to fill in a stack of forms and guessing what will or won't be covered. The NHS most certainly needs its critics and the cult like devotion to it is politically unhealthy, but a system with those outcomes has intrinsic social and economic merit which is perhaps not factored in by beancounting Tory economists. Either way, I'm alive and on the mend. And I am thankful for that.

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