My 20 Hours in A&E and 48 in a Ward
Discussion
As per title, I had a recent hospital experience after a kidney stone - two in fact - folded me over in acute pain.
My experience at one of two hospitals I attended was a bit of a surprise having been a patient, although previously I'd always heard or read the conversations about how underfunded the NHS was and that they were understaffed and the staff they so have are overworked, underpaid etc. No surprise in that sense but an eye opener for someone who doesn't really get involved in political discussion or has an opinion on how it the service is run.
On Thursday night, approaching midnight, I found myself in a position which meant I had to seek urgent medical attention. I'd had three nights of what turned out to be a two kidney stones giving me gyp and I got to a point where it was unbearable. I didn't meet the blue light criteria and made my way to the Emergency Department of Barnet General Hospital. It was Halloween, so a mixture of injured kids, drunk adults bleeding from their limbs and a scattering of older folk were waiting to be seen when I got there.
There was one triage nurse on duty, and one room (as opposed to a booth or cubicle) he was operating in. After around 20 mins waiting, I was called in. The nurse went through all the necessary questions and identified that pain relief was the first step, and handed me a suppository (along with a container to produce a urine sample in) and directed me to the waiting room toilet. Fast forward through a further 30 minutes or so and someone from the Same Day Emergency Care team invited me in to give a blood sample and administer a cannula. Overall, a after less than a couple of hours of arriving I was receiving care. Brilliant. There was some time needed for the test results to return and I was eventually seen by a doctor who said that I needed to be referred to the Royal Free hospital where there is a specialist urology team. By now it was around 8am so I'd been there all night. But no complaints as I did manage to get some shuteye while I was hooked up to a drip. By 9am I was at Royal Free. the doctor's parting words were, 'they are expecting you'.
On arrival, there was nobody waiting to be seen in the reception area. Behind the desk were two members of staff, both of whom were engaged in mobile phone activity. Giving them both the benefit of doubt (it could have been work related) I waited and stood patiently (in my pyjamas and T-shirt, holding my abdomen as it was just too uncomfortable to be stood). After what felt like five minutes, I shuffled to a central position (to them both) and after a further two minutes of them not event twitching, I stepped as far forward as I could. They were both scrolling social media reels. I cleared my throat and you could have counted to 20 before one of them looked up. I was in too much pain to do or say what I might have if I wasn't, and calmly stated my reason for being there. She mumbled a few words which sounded like she was asking for my name and date of birth. As soon as I furnished her, she got up and walked to a room behind the desk. A couple of minutes later she returned with a sheet of paper, slid it under the perspex screen and muttered, 'take a seat' as she picked up her mobile phone again.
About 15 minutes of further waiting, I was invited in by a triage nurse who took my temperature, blood pressure etc as we discussed why I was there. It became clear that she wasn't privy to my notes from Barnet and as much as I tried to explain that someone from urology is expecting me, I was guided to a very large and empty waiting room of the Same Day Emergency Care department. I remained calm and patient (no pun intended).
People started to arrive. All looking ill or injured. They too had been through triage and within about an hour, the waiting room was full, but more to the point, these people were being called in, not me. I decided to make a call, but the reception was non existent which meant I had to go outside in my jammies. I returned to the SDEC waiting room and continued to wait. Three hours: nothing. Did they even know I was here? I was hungry too, and a cuppa wouldn't have gone amiss. at 12.30pm I thought, f
k this and went in search of something to eat and drink. Bingo! I found a vending machine. You could pay by card, but the display read: CASH ONLY and below that was a scrolling second message: NO CHANGE GIVEN. Huh? Why can't I just tap? It has the gadget for it, FFS! Further foraging led me to the restaurant where I bought a bottle of water and probably the worst cheese and tomato sandwich ever.
I hurried back to SDEC and resumed my position. At last! A nurse called my name. He guided me to a bed where I was greeted by members of the urology team who restored my faith, and I quickly put aside my disappointments thus far. They set out a care plan which would be monitored over 24 hours after which another assessment would be made and if no progress (iow, if I hadn't passed the main 6mm stone from my right kidney by that time, they would then discuss Phase 2 of that plan which included the possibility of inserting a stint via an opening that has only ever seen one way traffic). Ouchies indeed. Phase One was to get 3 litres of fluid through me, potassium citrate (to help break the stone down) and monitor my BP and temperature throughout. By 2am I would have had to go nil-by-mouth in preparation for any procedure that might be necessary after that. In the meantime, I would remain in SDEC under observation (on a drip) as I waited to be admitted to a ward.
In the ensuing 15 or so hours in SDEC, I was like a fly on the wall. The pain was under control so I could relax somewhat. I was very tired but you simply cannot sleep without being woken by a new patient in the bed behind the dividing curtain either in pain, or moaning about why it's taken so long for them to be seen (it's also incredible to hear some of the issues people are coming in for, like the well-spoken lade explaining how pushing her trolley when she's in Waitrose is uncomfortable, but she hadn't seen a GP before arriving at A&E!). What became patently clear, very quickly, is just how hard the nursing staff work. I watched nurses attend to patients, comfort them, check thei BP and temperature etc; administer cannulation or whatever is required and prepare them for a visit from a consultant or doctor. As soon as they see a bed has been vacated, they grab the next bit of paperwork and head for the waiting room to bring the next patient in. They work tremendously hard and it's relentless. To think that they do this for 12 hours before handing over to the next shift...
My care wasn't going so smoothly. The pain started to creep back in (the Diclofenac suppository had worn off) and my bag of fluid was empty. The potassium citrate hadn't materialised and I hadn't passed a drop of water past my lips since buying the small bottle of water from the canteen. I couldn't see my nurse, (a nice chap from the Philippines). He was busy, somewhere but I didn't want to distract anyone else as they too were busy like ants in a nest. Eventually, I had to. I had myself to think of and to my delight, a nurse (from Singapore) came to my call and was happy to help; she was very pleasant despite how busy she clearly was. I noted where she got the water jug from and rather than distract anyone else, I felt I could help myself when needed. Meanwhile, no potassium citrate materialised.
As the time approaced 7.15pm, there was a calmness. The beds were full, but hardly any staff to be seen. It was handover time. Understood. They have to makes sure the change of staff does not disrupt anything or anyone. By 8.30pm I became aware that I was about seven hours into my care plan but no further forward in its execution: no second bag of fluid and no potassium citrate. I started to become anxious that the urology team would be arriving in a few hours and see that the stone was still lodged and quickly enter Phase Two and ram a wire coat hanger through my willy. Eventually a nurse came to take my BP and temperature. I asked her if she wouldn't mind checking my status etc. She (from India) too was lovely. Really helpful and caring, but obviously - clearly - stretched. It was now around 1030pm and I was told a bed in the ward was being prepared. A second bag of fluid had been connected to my drip, but still no potassium citrate had materialised.
I wish I was happy enough to be humming a rendition of Wilson Pickett's Midnight Hour as was I finally was transported (on a wheelchair) to the ward. The porter was a cool guy - from the DR of Congo - and as much as I tried to insist on walking, he stuck to protocol, 'no sir, you must allow me to take you there'. Fast approaching my NBM cutoff time, I was now in a room of four patients (me included) and rather than feeling like we - the nursing staff and I - had done everything we could to ensure Phase One had been executed to its fullest, I was nervous that in only a few remaining hours the renal team would be arriving to confirm my worst fear. But first, less than two hours before I'm declared NBM! I needed food; I was Hank Marvin! I asked if there was a vending machine on the (9th) floor but both (Nigerian, one Yoruba, the other Igbo) were not aware, but they did go out of there way to make me a cup of tea and not only prepare toast, they found me some cheese to go with it. I've had better tea and toast but at that moment, it was the best tea and toast I'd ever had in my life.
To cut an already long story short, my care plan was not executed and not because any one individual failed, the system did. The nursing staff were simply amazing people. People that have come to this country to work in these roles. They seem to be grateful in as much as they are determined to do well in their careers. But they are overworked. One nurse is performing the role of two or maybe three. But to their they soldier on. The flip side to that is that if I focused on me, my care fell by the wayside, so the system isn't providing full and proper patient care. The specialist teams in terms of the RF being a center of excellence are incredible; world class. However, they too are being pulled from pillar to post. In a non racist, non xenophobic way (I am the mixed heritage son of an immigrant) I did not see one English nurse. There were English (and Irish) consultants and doctors but rare. This was just from what I saw I must add.
In the time I was there, noted that the stainless steel stand from which my fluid were hanging had never, ever been cleaned. It was manky. In fact, so dirty, it was sticky. The toilet in my room was dirty the whole time. The only time it was clean was when I took some tissue and wiped the bowl before using it (conscious of not wanting the next person to think it was me that had dirtied it). My bed had its own screen, provided by Hospedia. That too was filthy. Never mind cleaned thoroughly, I would argue that it has been wiped every now and then as a gesture given how the crud in the corner of the screen was built up like snow on a window during winter. And on the note of entertainment, Hospedia will allow a free call (from the same unit) for 2 minutes. Quite handy, right? But that two minutes is no good. You can receive a call but the caller pays a bit more for the privilege. The entertainment is offered at around £9.00 a day depending on which package you might opt for. I mugged myself off by buying a package to watch some footy and rugby and that set me back £21 (for the 24 hour period it covered). Hospedia have a targeted market of a captive audience who are receiving medical treatment. Someone signed that deal thinking it was a great idea.
On Sunday morning I was woken up at 6am by a Croatian nurse. She took my BP and temperature and her (Nigerian) colleague followed this up with a request to give me an injection. I asked what it was and she simply said I had to take it because that's what the notes said. 'It is good for you'. It turned out to be a blood thinner. Why was I being given a blood thinner? I hadn't been under the knife? It didn't sound right to me and with all respect to that nurse who was doing her job, I needed better, more qualified justification for that jab. On that basis, I refused and this in itself made me feel anxious and nervous about my welfare.
I was now on Day 3 of my care plan and I insisted that if all I am doing is trying to pass the bleedin' stone naturally, I'd like better control of my own care rather than rely on overworked nurses (as much as I have total empathy for how hard they work). I wanted to go home and look after myself. It took 12 hours for the system to process my discharge. I'm not sure if that's normal of that it was a Sunday and 'nothing happens on a Sunday'. Part of my discharge was see me off with a package of dispensed medicine (the potassium cirtate by now had arrived). I couldn't get out of there fast enough (and i feel bad for stating this because the nurses - or medical teams - are not at fault in any of this). I've been at home for a little over 24 hours and I'm taking fluid and meds on time. On the subject of meds, my package should have had three different meds, but when I opened it at home, one was missing. They want me to go back in and collect it.
I'm still in the rough; still on a care plan and hopeful of passing this stone naturally. The next few days will be telling but at least I'm not stuck in a hospital bed.
Thanks for reading. I just needed to vent.
In summary, medical teams and nurses work extremely hard, through long shifts on low pay. But they're pleasant people and clearly love caring for sick and injured people. Of the two hospitals, I rated Barnet very highly, but unfortunately, the Royal Free was a dreadful experience for me and I'm glad to be out of there. I cannot understand how you can have world class specialists but sub optimal aftercare on the basis that there aren't enough personnel. The ones working there are incredible.
My experience at one of two hospitals I attended was a bit of a surprise having been a patient, although previously I'd always heard or read the conversations about how underfunded the NHS was and that they were understaffed and the staff they so have are overworked, underpaid etc. No surprise in that sense but an eye opener for someone who doesn't really get involved in political discussion or has an opinion on how it the service is run.
On Thursday night, approaching midnight, I found myself in a position which meant I had to seek urgent medical attention. I'd had three nights of what turned out to be a two kidney stones giving me gyp and I got to a point where it was unbearable. I didn't meet the blue light criteria and made my way to the Emergency Department of Barnet General Hospital. It was Halloween, so a mixture of injured kids, drunk adults bleeding from their limbs and a scattering of older folk were waiting to be seen when I got there.
There was one triage nurse on duty, and one room (as opposed to a booth or cubicle) he was operating in. After around 20 mins waiting, I was called in. The nurse went through all the necessary questions and identified that pain relief was the first step, and handed me a suppository (along with a container to produce a urine sample in) and directed me to the waiting room toilet. Fast forward through a further 30 minutes or so and someone from the Same Day Emergency Care team invited me in to give a blood sample and administer a cannula. Overall, a after less than a couple of hours of arriving I was receiving care. Brilliant. There was some time needed for the test results to return and I was eventually seen by a doctor who said that I needed to be referred to the Royal Free hospital where there is a specialist urology team. By now it was around 8am so I'd been there all night. But no complaints as I did manage to get some shuteye while I was hooked up to a drip. By 9am I was at Royal Free. the doctor's parting words were, 'they are expecting you'.
On arrival, there was nobody waiting to be seen in the reception area. Behind the desk were two members of staff, both of whom were engaged in mobile phone activity. Giving them both the benefit of doubt (it could have been work related) I waited and stood patiently (in my pyjamas and T-shirt, holding my abdomen as it was just too uncomfortable to be stood). After what felt like five minutes, I shuffled to a central position (to them both) and after a further two minutes of them not event twitching, I stepped as far forward as I could. They were both scrolling social media reels. I cleared my throat and you could have counted to 20 before one of them looked up. I was in too much pain to do or say what I might have if I wasn't, and calmly stated my reason for being there. She mumbled a few words which sounded like she was asking for my name and date of birth. As soon as I furnished her, she got up and walked to a room behind the desk. A couple of minutes later she returned with a sheet of paper, slid it under the perspex screen and muttered, 'take a seat' as she picked up her mobile phone again.
About 15 minutes of further waiting, I was invited in by a triage nurse who took my temperature, blood pressure etc as we discussed why I was there. It became clear that she wasn't privy to my notes from Barnet and as much as I tried to explain that someone from urology is expecting me, I was guided to a very large and empty waiting room of the Same Day Emergency Care department. I remained calm and patient (no pun intended).
People started to arrive. All looking ill or injured. They too had been through triage and within about an hour, the waiting room was full, but more to the point, these people were being called in, not me. I decided to make a call, but the reception was non existent which meant I had to go outside in my jammies. I returned to the SDEC waiting room and continued to wait. Three hours: nothing. Did they even know I was here? I was hungry too, and a cuppa wouldn't have gone amiss. at 12.30pm I thought, f
k this and went in search of something to eat and drink. Bingo! I found a vending machine. You could pay by card, but the display read: CASH ONLY and below that was a scrolling second message: NO CHANGE GIVEN. Huh? Why can't I just tap? It has the gadget for it, FFS! Further foraging led me to the restaurant where I bought a bottle of water and probably the worst cheese and tomato sandwich ever. I hurried back to SDEC and resumed my position. At last! A nurse called my name. He guided me to a bed where I was greeted by members of the urology team who restored my faith, and I quickly put aside my disappointments thus far. They set out a care plan which would be monitored over 24 hours after which another assessment would be made and if no progress (iow, if I hadn't passed the main 6mm stone from my right kidney by that time, they would then discuss Phase 2 of that plan which included the possibility of inserting a stint via an opening that has only ever seen one way traffic). Ouchies indeed. Phase One was to get 3 litres of fluid through me, potassium citrate (to help break the stone down) and monitor my BP and temperature throughout. By 2am I would have had to go nil-by-mouth in preparation for any procedure that might be necessary after that. In the meantime, I would remain in SDEC under observation (on a drip) as I waited to be admitted to a ward.
In the ensuing 15 or so hours in SDEC, I was like a fly on the wall. The pain was under control so I could relax somewhat. I was very tired but you simply cannot sleep without being woken by a new patient in the bed behind the dividing curtain either in pain, or moaning about why it's taken so long for them to be seen (it's also incredible to hear some of the issues people are coming in for, like the well-spoken lade explaining how pushing her trolley when she's in Waitrose is uncomfortable, but she hadn't seen a GP before arriving at A&E!). What became patently clear, very quickly, is just how hard the nursing staff work. I watched nurses attend to patients, comfort them, check thei BP and temperature etc; administer cannulation or whatever is required and prepare them for a visit from a consultant or doctor. As soon as they see a bed has been vacated, they grab the next bit of paperwork and head for the waiting room to bring the next patient in. They work tremendously hard and it's relentless. To think that they do this for 12 hours before handing over to the next shift...
My care wasn't going so smoothly. The pain started to creep back in (the Diclofenac suppository had worn off) and my bag of fluid was empty. The potassium citrate hadn't materialised and I hadn't passed a drop of water past my lips since buying the small bottle of water from the canteen. I couldn't see my nurse, (a nice chap from the Philippines). He was busy, somewhere but I didn't want to distract anyone else as they too were busy like ants in a nest. Eventually, I had to. I had myself to think of and to my delight, a nurse (from Singapore) came to my call and was happy to help; she was very pleasant despite how busy she clearly was. I noted where she got the water jug from and rather than distract anyone else, I felt I could help myself when needed. Meanwhile, no potassium citrate materialised.
As the time approaced 7.15pm, there was a calmness. The beds were full, but hardly any staff to be seen. It was handover time. Understood. They have to makes sure the change of staff does not disrupt anything or anyone. By 8.30pm I became aware that I was about seven hours into my care plan but no further forward in its execution: no second bag of fluid and no potassium citrate. I started to become anxious that the urology team would be arriving in a few hours and see that the stone was still lodged and quickly enter Phase Two and ram a wire coat hanger through my willy. Eventually a nurse came to take my BP and temperature. I asked her if she wouldn't mind checking my status etc. She (from India) too was lovely. Really helpful and caring, but obviously - clearly - stretched. It was now around 1030pm and I was told a bed in the ward was being prepared. A second bag of fluid had been connected to my drip, but still no potassium citrate had materialised.
I wish I was happy enough to be humming a rendition of Wilson Pickett's Midnight Hour as was I finally was transported (on a wheelchair) to the ward. The porter was a cool guy - from the DR of Congo - and as much as I tried to insist on walking, he stuck to protocol, 'no sir, you must allow me to take you there'. Fast approaching my NBM cutoff time, I was now in a room of four patients (me included) and rather than feeling like we - the nursing staff and I - had done everything we could to ensure Phase One had been executed to its fullest, I was nervous that in only a few remaining hours the renal team would be arriving to confirm my worst fear. But first, less than two hours before I'm declared NBM! I needed food; I was Hank Marvin! I asked if there was a vending machine on the (9th) floor but both (Nigerian, one Yoruba, the other Igbo) were not aware, but they did go out of there way to make me a cup of tea and not only prepare toast, they found me some cheese to go with it. I've had better tea and toast but at that moment, it was the best tea and toast I'd ever had in my life.
To cut an already long story short, my care plan was not executed and not because any one individual failed, the system did. The nursing staff were simply amazing people. People that have come to this country to work in these roles. They seem to be grateful in as much as they are determined to do well in their careers. But they are overworked. One nurse is performing the role of two or maybe three. But to their they soldier on. The flip side to that is that if I focused on me, my care fell by the wayside, so the system isn't providing full and proper patient care. The specialist teams in terms of the RF being a center of excellence are incredible; world class. However, they too are being pulled from pillar to post. In a non racist, non xenophobic way (I am the mixed heritage son of an immigrant) I did not see one English nurse. There were English (and Irish) consultants and doctors but rare. This was just from what I saw I must add.
In the time I was there, noted that the stainless steel stand from which my fluid were hanging had never, ever been cleaned. It was manky. In fact, so dirty, it was sticky. The toilet in my room was dirty the whole time. The only time it was clean was when I took some tissue and wiped the bowl before using it (conscious of not wanting the next person to think it was me that had dirtied it). My bed had its own screen, provided by Hospedia. That too was filthy. Never mind cleaned thoroughly, I would argue that it has been wiped every now and then as a gesture given how the crud in the corner of the screen was built up like snow on a window during winter. And on the note of entertainment, Hospedia will allow a free call (from the same unit) for 2 minutes. Quite handy, right? But that two minutes is no good. You can receive a call but the caller pays a bit more for the privilege. The entertainment is offered at around £9.00 a day depending on which package you might opt for. I mugged myself off by buying a package to watch some footy and rugby and that set me back £21 (for the 24 hour period it covered). Hospedia have a targeted market of a captive audience who are receiving medical treatment. Someone signed that deal thinking it was a great idea.
On Sunday morning I was woken up at 6am by a Croatian nurse. She took my BP and temperature and her (Nigerian) colleague followed this up with a request to give me an injection. I asked what it was and she simply said I had to take it because that's what the notes said. 'It is good for you'. It turned out to be a blood thinner. Why was I being given a blood thinner? I hadn't been under the knife? It didn't sound right to me and with all respect to that nurse who was doing her job, I needed better, more qualified justification for that jab. On that basis, I refused and this in itself made me feel anxious and nervous about my welfare.
I was now on Day 3 of my care plan and I insisted that if all I am doing is trying to pass the bleedin' stone naturally, I'd like better control of my own care rather than rely on overworked nurses (as much as I have total empathy for how hard they work). I wanted to go home and look after myself. It took 12 hours for the system to process my discharge. I'm not sure if that's normal of that it was a Sunday and 'nothing happens on a Sunday'. Part of my discharge was see me off with a package of dispensed medicine (the potassium cirtate by now had arrived). I couldn't get out of there fast enough (and i feel bad for stating this because the nurses - or medical teams - are not at fault in any of this). I've been at home for a little over 24 hours and I'm taking fluid and meds on time. On the subject of meds, my package should have had three different meds, but when I opened it at home, one was missing. They want me to go back in and collect it.
I'm still in the rough; still on a care plan and hopeful of passing this stone naturally. The next few days will be telling but at least I'm not stuck in a hospital bed.
Thanks for reading. I just needed to vent.
In summary, medical teams and nurses work extremely hard, through long shifts on low pay. But they're pleasant people and clearly love caring for sick and injured people. Of the two hospitals, I rated Barnet very highly, but unfortunately, the Royal Free was a dreadful experience for me and I'm glad to be out of there. I cannot understand how you can have world class specialists but sub optimal aftercare on the basis that there aren't enough personnel. The ones working there are incredible.
Badda said:
Ironically, had you seen your GP in the preceding days, you may have been managed at home anyway (dep on presentation, med history etc).
You are probably right. The pain started on Tuesday and I didn't know what it was. Got through the night and woke up slightly better albeit a tad sore (I'd vomited from over indulging at a Brazilian rodizio for my son's birthday that night). Wednesday night the pain came back and I managed it with paracetamol after speaking to an OOH GP.
The advice I was given by the GP that if on the third day (Thursday) it's no better, get yourself to hospital.
I think you have identified the core NHS issues:
Competent Doctors at all levels
Competent nurses and other care workers
Incompetent management
It is the role of management to ensure that processes take place, that staff aren't sitting on their phones on social media, etc.
The NHS has ballooned in numbers of people on the non medical teams, but the competence of that side seems to get worse...
Competent Doctors at all levels
Competent nurses and other care workers
Incompetent management
It is the role of management to ensure that processes take place, that staff aren't sitting on their phones on social media, etc.
The NHS has ballooned in numbers of people on the non medical teams, but the competence of that side seems to get worse...
akirk said:
I think you have identified the core NHS issues:
Competent Doctors at all levels
Competent nurses and other care workers
Incompetent management
It is the role of management to ensure that processes take place, that staff aren't sitting on their phones on social media, etc.
The NHS has ballooned in numbers of people on the non medical teams, but the competence of that side seems to get worse...
If I could isolate one aspect to use as an example. Culture. If I use any equipment, I should return it to a station, or designated area in a state ready to be used by the next person. When the next person does arrive to use it, it's ready to use and not dirty/tangled up/needs fixing before it can be used. It should also be clean/cleaned by someone at some point. Competent Doctors at all levels
Competent nurses and other care workers
Incompetent management
It is the role of management to ensure that processes take place, that staff aren't sitting on their phones on social media, etc.
The NHS has ballooned in numbers of people on the non medical teams, but the competence of that side seems to get worse...
Great read thank you for posting.
You've captured my opinion of the NHS, too busy treating too many people for nothing serious, whilst having too many people either doing nothing or doing something pointless.
People run around like headless chickens, triage is limited and not effective and many people are working so hard they're completely ineffective.
Through no fault or your own, or any of the staff trying to help you, you added to their workload and your pain, when an effective triage system would have you given the stuff and on your way.
Mobile phones should be banned in the workplace, all workplaces pure and simple, if you need immediate contact or web access you should be provided with suitable devices.
The NHS is simply too big and it's users (us) are poorly trained as to which service to use.
You've captured my opinion of the NHS, too busy treating too many people for nothing serious, whilst having too many people either doing nothing or doing something pointless.
People run around like headless chickens, triage is limited and not effective and many people are working so hard they're completely ineffective.
Through no fault or your own, or any of the staff trying to help you, you added to their workload and your pain, when an effective triage system would have you given the stuff and on your way.
Mobile phones should be banned in the workplace, all workplaces pure and simple, if you need immediate contact or web access you should be provided with suitable devices.
The NHS is simply too big and it's users (us) are poorly trained as to which service to use.
akirk said:
I think you have identified the core NHS issues:
Competent Doctors at all levels
Competent nurses and other care workers
Incompetent management
It is the role of management to ensure that processes take place, that staff aren't sitting on their phones on social media, etc.
The NHS has ballooned in numbers of people on the non medical teams, but the competence of that side seems to get worse...
A lot of the cutbacks in the NHS have been the 'incompetent managers'. These are the folk that should be ensuring that the doctors don't need to spend their entire day doing admin, or ensuring there is decent capacity planning etc.Competent Doctors at all levels
Competent nurses and other care workers
Incompetent management
It is the role of management to ensure that processes take place, that staff aren't sitting on their phones on social media, etc.
The NHS has ballooned in numbers of people on the non medical teams, but the competence of that side seems to get worse...
There is a good bit of analysis from John Burn-Murdoch on FT about this very topic. It seems that stripping out managers from healthcare has turned it to s
t, rather than the usual daily mail narrative of overuse due to overpopulation / immigrants.dundarach said:
Great read thank you for posting.
You've captured my opinion of the NHS, too busy treating too many people for nothing serious, whilst having too many people either doing nothing or doing something pointless.
People run around like headless chickens, triage is limited and not effective and many people are working so hard they're completely ineffective.
Through no fault or your own, or any of the staff trying to help you, you added to their workload and your pain, when an effective triage system would have you given the stuff and on your way.
Mobile phones should be banned in the workplace, all workplaces pure and simple, if you need immediate contact or web access you should be provided with suitable devices.
The NHS is simply too big and it's users (us) are poorly trained as to which service to use.
There is a very valid case to be made to have a small charge when using the NHS. You've captured my opinion of the NHS, too busy treating too many people for nothing serious, whilst having too many people either doing nothing or doing something pointless.
People run around like headless chickens, triage is limited and not effective and many people are working so hard they're completely ineffective.
Through no fault or your own, or any of the staff trying to help you, you added to their workload and your pain, when an effective triage system would have you given the stuff and on your way.
Mobile phones should be banned in the workplace, all workplaces pure and simple, if you need immediate contact or web access you should be provided with suitable devices.
The NHS is simply too big and it's users (us) are poorly trained as to which service to use.
For example in Singapore healthcare is heavily subsidised by the state, however when you see a doctor it cost £7, and a consultant would be £20. A&E costs about £70.
Something along these lines would drop pointless visits overnight, and more importantly force a behavioural change towards healthcare. The NHS isn't free, we pay monumental levels of tax for it.
Edited by Jiebo on Tuesday 5th November 12:24
Jiebo said:
There is a very valid case to be made to have a small charge when using the NHS.
For example in Singapore healthcare is heavily subsidised by the state, however when you see a doctor it cost £7, and a consultant would be £20. A&E costs about £70.
Something along these lines would drop pointless visits overnight, and more importantly force a behavioural change towards healthcare. The NHS isn't free, we pay monumental levels of tax for it.
Agree completely. The only caveat being that there needs to be an appropriately staffed primary care network in place that can provide timely appointments. For example in Singapore healthcare is heavily subsidised by the state, however when you see a doctor it cost £7, and a consultant would be £20. A&E costs about £70.
Something along these lines would drop pointless visits overnight, and more importantly force a behavioural change towards healthcare. The NHS isn't free, we pay monumental levels of tax for it.
Edited by Jiebo on Tuesday 5th November 12:24
Years ago, ED matrons would say 'When did these symptoms start?' and if it was over 24 hours ago - they'd get booted out to speak to the GP. In most cases, it would be completely appropriate for primary care to manage people self presenting to ED.
Jiebo said:
akirk said:
I think you have identified the core NHS issues:
Competent Doctors at all levels
Competent nurses and other care workers
Incompetent management
It is the role of management to ensure that processes take place, that staff aren't sitting on their phones on social media, etc.
The NHS has ballooned in numbers of people on the non medical teams, but the competence of that side seems to get worse...
A lot of the cutbacks in the NHS have been the 'incompetent managers'. These are the folk that should be ensuring that the doctors don't need to spend their entire day doing admin, or ensuring there is decent capacity planning etc.Competent Doctors at all levels
Competent nurses and other care workers
Incompetent management
It is the role of management to ensure that processes take place, that staff aren't sitting on their phones on social media, etc.
The NHS has ballooned in numbers of people on the non medical teams, but the competence of that side seems to get worse...
There is a good bit of analysis from John Burn-Murdoch on FT about this very topic. It seems that stripping out managers from healthcare has turned it to s
t, rather than the usual daily mail narrative of overuse due to overpopulation / immigrants.One of my wife's secretaries / PAs (she is a consultant across two hospitals) was chatting to me a short while ago - she is nearing retirement age - when she joined there were 2 layers above her - a manager - the bod who ran the hospital... - there are now 7 layers above her - what are all those other 5 layers doing? She is incredibly good, but now wastes a certain amount of her time dealing with contradictory requests / pointless / requests / etc. rather than doing her job...
there are examples of people who refuse to be managed by 'x' so the NHS puts in another person as an intermediate manager - a totally wasted role
there are examples of admin systems which work well, but are replaced by the management side of the trust with no reference to the medics - one such system used to have one screen to log into - there are now 7 different systems each with separate logins and probably at least one of them down most of the time - how is that enabling the medics?
we don't need to even explore the diversity managers on huge salaries who decide when to change the colour of your lanyard and insist that men can change in the same changing spaces as the women...
there is a huge issue in the NHS - it is partially in the medical side, but almost entirely in the non-medical / admin management side
I was away from home and in London where I had a kidney stone cause trouble, despite being ambulanced into ED with a dose of morphine as well I got kicked out with no fault found and some pain killers at 2am.
Stayed locally but struggled with pain killers so couldn't drive, the RAC recovered the car and me home, poor chap had to listen to me groaning in pain for 3 hours but by midnight I had called for an Ambulance.
Ended up in ED again, then on a ward for a week while they investigated, had a surgeon come round a couple of times to work out how he was going to carve. Luckily an MRI revealed the problem kidney stone.
The morphine was great
but the rest not so, gave me stuff to expand the tubes to hopefully flush it out and plenty of diclofenic stuff. Spent a week on the toilet (imagine the worst curry you have ever had and multiply by a googleplex).
Stayed locally but struggled with pain killers so couldn't drive, the RAC recovered the car and me home, poor chap had to listen to me groaning in pain for 3 hours but by midnight I had called for an Ambulance.
Ended up in ED again, then on a ward for a week while they investigated, had a surgeon come round a couple of times to work out how he was going to carve. Luckily an MRI revealed the problem kidney stone.
The morphine was great
but the rest not so, gave me stuff to expand the tubes to hopefully flush it out and plenty of diclofenic stuff. Spent a week on the toilet (imagine the worst curry you have ever had and multiply by a googleplex).Spare tyre said:
I had cancer a few years back, the NHS treatment was truly awful or truly truly amazing
No middle ground
They do seem to be good with cancer. However, my sister was diagnosed in September, first chemo is mid December. The oncology appointment only happened recently due to a few calls to PALs. No middle ground
I had an operation in November 2020. The (non English) nurse was playing Candy Crush while sat at the desk. I wish I had taken a photo. Another nurse failed to get blood from my arm and ended up taking it from my wrist. That hurt.
^ even worse is from the back of your hand by a trainee doctor who has failed to get blood from several other sites because you are dehydrated from being told “nil by mouth” many hours earlier…
Then the phlebotomist turns up, points to a big visible vein inside your elbow and tells the trainee “that’s where you should be taking it from” - exactly as I had told the same trainee half an hour previously…
Then the phlebotomist turns up, points to a big visible vein inside your elbow and tells the trainee “that’s where you should be taking it from” - exactly as I had told the same trainee half an hour previously…
Edited by dobly on Tuesday 5th November 22:32
Edited by dobly on Friday 8th November 08:52
Glassman --- can i strongly recommend that you contact PALS (patient advice liason service) and provide them with your story..... although yours is not a complaint - all hospitals have a PALS service whom welcome patient feedback.
Please email them on : rf-tr.bcfpals@nhs.net
or goto their PALS website : https://www.royalfree.nhs.uk/contact-us/patient-ad...
and you can provide the feedback online.
On a side note about mobile phone usage by staff -- there are now many apps that are installed on Mobile phones that staff use regularly regarding patient care. examples of information now available on app - blood test results / scans / patient notes / AE information......
There is a big push to have staff use hand held devices instead of pen and paper.............
Hope this helps..................
Please email them on : rf-tr.bcfpals@nhs.net
or goto their PALS website : https://www.royalfree.nhs.uk/contact-us/patient-ad...
and you can provide the feedback online.
On a side note about mobile phone usage by staff -- there are now many apps that are installed on Mobile phones that staff use regularly regarding patient care. examples of information now available on app - blood test results / scans / patient notes / AE information......
There is a big push to have staff use hand held devices instead of pen and paper.............
Hope this helps..................
happie33 said:
On a side note about mobile phone usage by staff -- there are now many apps that are installed on Mobile phones that staff use regularly regarding patient care. examples of information now available on app - blood test results / scans / patient notes / AE information......
There is a big push to have staff use hand held devices instead of pen and paper.............
Hope this helps..................
Thanks. There is a big push to have staff use hand held devices instead of pen and paper.............
Hope this helps..................
The mobile phone use I saw was them both scrolling social media reels. One reception desk member was dressed in an Ajax (FC) tracksuit top, and the other was casually dressed. I have no issue with down time, especially during quiet periods, but I got the distinct feeling that attitude was, 'I won't look up until you request my attention'.
Hopefully the clinical side will improve with the caps now on Agencies being put in place. Meaning all the NHS running off to agency to do the same job for increased pay will stop.
Needs to start somewhere, Can’t recruit staff cause they are all on agency but cut the money spent on agency and the staff will have no where to go.
Needs to start somewhere, Can’t recruit staff cause they are all on agency but cut the money spent on agency and the staff will have no where to go.
Glassman said:
It took 12 hours for the system to process my discharge. I'm not sure if that's normal of that it was a Sunday and 'nothing happens on a Sunday'. Part of my discharge was see me off with a package of dispensed medicine (the potassium citrate by now had arrived).
This is the worst part of the process. I have been in hospital a fair few times recently (cancer and associated ailments) and every single time the discharge was the longest part.Advice for anyone in the same position.. Always order your lunch and dinner, you will be eating it in the hospital.
Last time I was told I would be discharged when the consultant visit was completed (9am). I was still there 11pm that night when they finally gave me the bag of meds and doctors letters.
Care throughout had been generally very good but do spend a lot of time waiting for the nursing staff to come when called on the buzzer. I was only calling as the machines pumping me full of drugs (which at the time were keeping me from dying) kept stopping and beeping.
My Dad became really badly sick two years ago and ended up in hospital. Was there for weeks and then after about 6 weeks was moved to a care home. He went back to the hospital two more times before eventually passing away.
The treatment by the hospital was nothing short of utterly appalling. The nurses, the environment, it was truly horrifying.
To be honest, I try not to think about it now as it just depresses me. I remember clearly going into see my Dad during the two hour Covid visitng window and always being scared on what I'd find. Things like him with food down him or vomit that had dried. His breakfast on a tray without being eaten (he couldn't use his arms properly).
Getting information from doctors and nurses was impossible most of the time. There was just no communication and no one had time for us. Even things like being told "Visiting hours are only between 12pm and 2pm" only to find the next day that they had a notice on the door changing it to 9am to 11am and wouldn't let me in (I'd driven two hours to see him).
I remember my Dad's final night. His wife was there and his two step-daughters, and me. The nurse refused to allows us all into his room at once due to Covid issues (this was November 2022). Very sad times and it meant that as his family, we were unable to spend that time with him all together.
I dread the day I became sick or a close family member. I have almost no respect for the NHS at all.
I acknowledge some nurses and doctors are great - I hear a lot of praise. But my experience over abotu 6 months was just horrible.
Hope you get better soon OP
The treatment by the hospital was nothing short of utterly appalling. The nurses, the environment, it was truly horrifying.
To be honest, I try not to think about it now as it just depresses me. I remember clearly going into see my Dad during the two hour Covid visitng window and always being scared on what I'd find. Things like him with food down him or vomit that had dried. His breakfast on a tray without being eaten (he couldn't use his arms properly).
Getting information from doctors and nurses was impossible most of the time. There was just no communication and no one had time for us. Even things like being told "Visiting hours are only between 12pm and 2pm" only to find the next day that they had a notice on the door changing it to 9am to 11am and wouldn't let me in (I'd driven two hours to see him).
I remember my Dad's final night. His wife was there and his two step-daughters, and me. The nurse refused to allows us all into his room at once due to Covid issues (this was November 2022). Very sad times and it meant that as his family, we were unable to spend that time with him all together.
I dread the day I became sick or a close family member. I have almost no respect for the NHS at all.
I acknowledge some nurses and doctors are great - I hear a lot of praise. But my experience over abotu 6 months was just horrible.
Hope you get better soon OP
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