A hospital diary, June-July 2007

At least six cheers for the National Health Service!  That's my rather unexpected verdict on a week as the guest of Mr Alan Johnson (Secretary of State for Health) and his predecessors, even including Ms Hewitt; a consultant endocrinologist and his sizeable medical team; countless nurses and health assistants and cleaners, and not least a personage called the Ward Hostess who delivers meals at bizarre times – some hospital traditions die hard – and offers tea and coffee throughout the day with unfailing cheerfulness.  She was in no way to blame for the lamentable quality of most of the food, another old hospital tradition that refuses to die.  My treatment, for a very severe leg infection, was impeccable from admission to discharge, with intravenous antibiotics in elephantine doses pumped into fugitive veins every couple of hours and exhaustive monitoring of every bodily function capable of being measured.  With very rare exceptions, the nursing staff were splendid: friendly, efficient, sympathetic, often funny.  Along with many of the younger doctors and technicians, they were a collective United Nations, from just about every continent and racial group.  Now that a few NHS doctors and other NHS medics from foreign parts have taken up murderous terrorism as a hobby for their spare time, any attempt to cut back on non-indigenous NHS staff would effectively mean closing down the NHS. 

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One old hospital tradition that does seem to have died is the restriction of visiting hours to a couple of hours a day, generally when most ordinary people are at work.  Nowadays there's effectively unrestricted visiting, despite menacing signs in the corridors forbidding visiting at particular times (I suppose these signs are displayed to remind everyone of the bad old days).  As a result many patients' morale is boosted by frequent visits of relatives, often seemingly of entire extended families, creating something like a party atmosphere in the ward.  The downside to this new-found freedom is that the unrestricted flow of visitors must sharply increase the risk of introducing infections by one or other of the potentially lethal superbugs, such as MRSA and C Difficile, which plague almost every NHS hospital and often convert even the most trivial medical conditions into life-threatening (and too often life-destroying) crises. 

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BLB as patientHappily, it's been a good many years (until last week) since either my spouse or I have been an NHS in-patient, but a comparison between J's experience eight or nine years ago and mine last week in the same hospital is instructive and extremely positive.  She was condemned to days and nights of filthy sheets, no available pillows, impossibility of attracting the attention of a nurse even in moments of crisis (most of the nurses then were indifferent agency staff with no commitment to a particular hospital or ward), often missing meals because the food and tea trolley had run out before it reached her, indescribably dirty wards and unspeakable loos, nurses refusing to undertake any cleaning task on the grounds that it was for the cleaners (mostly off duty) and not for them, and virtual inability to communicate with the outside world because of the ban on using a mobile telephone (ban justified by the mendacious assertion that mobiles interfered with electronic medical machinery).  Now, if my experience last week is anything to go by, every one of those gruesome manifestations has been removed and reversed, with huge gains for patient morale and indeed patient health.  Those who grumble that the tripling of expenditure on the NHS has produced no proportionate benefits for patients, only for consultants, must be very healthy people indeed, with no recent first-hand experience of treatment in an NHS hospital.

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One tiresome long-standing feature of hospital life is the impossibility of watching television (or of maintaining telephone contact with family and friends if the patient has no mobile telephone of his own) without paying the exorbitant charges imposed by the ubiquitous and iniquitous 'Patientline' system.    The advertisements for this plastered all over the wards proclaim that the fee for use of the television set comes with "free" radio, telephone and internet facilities, although the small print reveals that the cost of making or even receiving a telephone call on this system is horrendous, and getting a refund of unused credit makes rocket science seem like a game of tiddlywinks.  Fortunately the lifting of the ban on mobile telephones, and the ready availability of small pocket radios with a headset or ear-pieces, enables all but the most seriously addicted television-watcher to raise two fingers to Patientline.  One tip, though, to anyone planning a spell as guest of an NHS hospital:  take in a good quality pair of headphones for the pocket radio (Sennheiser recommended, although not cheap).  It's possible to use the earphones provided by Patientline without having to subscribe to that system, but the Patientline earphones are almost completely useless – even worse than the ones you get on aeroplanes.  My iPod, too, hitherto used mainly during gym workouts to relieve the tedium of the treadmill and the exercise bike with Brahms, Shostakovich, Miles Davis, Mahler and Billie Holiday, really came into its own (but don't forget to take in the charger).

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It's a truism that a patient typically gets admitted to hospital suffering from one disagreeable medical condition and later comes out with three.  In my case the two new conditions were not infections caught from other patients or their visitors, but new problems revealed by various routine tests automatically undergone by in-patients.  Both concerned organs far removed from the infected leg and probably unrelated to it, although further tests were naturally required to eliminate that possible connection.  Those done, yet more tests were ordered to establish the exact nature and causes of the two new problems.  So the monotony of lying on the bed in the ward, waiting for the next pump-in of concentrated antibiotics through the needle permanently lodged in a vein in the back of my hand, was mercifully relieved by batteries of X-rays, ultrasound and other scans, and echocardiographs, all involving hair-raising expeditions in the wheel-chair up and down in the enormous lifts and hurtling along miles of crowded corridors, with metaphorical sirens blasting a way through.   Modern technology has developed a raft of machinery capable of penetrating the darkest recesses of the human body and its organs, immortalising the resultant Technicolor videos and statistics as data in the hospital servers;  and since it's possible to use it, there's obviously no reason not to.  As a result the hospital computers now know more about me than I either know or want to know about myself, and the coming months will be fully occupied by appointments at clinics to assess the many test results and to debate the pros and cons of available treatments.  None of the new problems seems to be life-threatening or even particularly exciting, but following them up will help to pass the time freed by retirement, and at least it gets me away from the computer.

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Those, if any, of a masochistic disposition may care to view a picture of the offending leg, and another of the leg with its owner, here and here.  And, as a postscript for the benefit of American and other non-Brit readers, all this, including the tests and the drugs and the ghastly food, even including the bulging bag of drugs to take home to cover the next month's medication needs, all of it is completely free, as Nye Bevan originally conceived it.  Of course foreigners who come to Britain with a pre-existing condition in order to seek treatment for it under the NHS have to pay;  but we natives, and foreign visitors needing emergency treatment after their arrival, get it on the house.  Hillary Clinton please note.



7 Responses

  1. Good to have you back, Brian, and  best wishes for a continued recovery.

    Almost my only experience of the NHS is through my GP’s surgery which is excellent.  Where the NHS fails us, it seems to me, is in dentistry. My former dentist started out with the NHS, but many years ago began to offer only a private service. We went along with that – shelling out hundreds of pounds along the way – because he was good. Now he’s retired, I’m transferring to another NHS practice which I’ve been fortunate enough to find.
    But how have we got to this state where a large number of people, having contributed to the NHS through their taxes, have to pay the full whack for dentistry?

  2. Ronnie says:

    Welcome back.  I remember – why now ? –  being in hospital when I was 9 with scarlet fever, 24 of us, lads, in a ward, no girls, but from all kinds of backgrounds.  It was perhaps the nearest I ever got to National Service.  Everlasting memories are of peeing into a bottle and of the smell of lovely toast which the night shift nurses made very early every morning before going off duty.  Parents visited on Sundays and watched us through a glass  screen, eating egg sandwiches, still a favourite.  Much more recently, coming out of a prostatectomy with some post-operational problems, I remember the nurses consulting one another, and the books, and others by telephone before adjusting my treatment.  I felt woozily grateful for their concern, and I was visited at all times of day and some times of night by friends with books and goodies from a nearby delicatessen.  It may not always be so but in the meantime I’ll join you in six cheers. 

  3. Tony says:

    Welcome back!
    BTW, my mother’s experience, not so different from your own, can be read here

  4. Glad to hear that you’re on the mend!  Yes, it gets a lot of flack but the NHS is still a wonderful beast.  I had a malignant melanoma cut out of my arm two years ago.  The post-op support was lacking but they cured me as quick as you like.

  5. Ken says:

    Glad to know you’re free of hospital – pity not free of tests also.  A hazard of modern medicine – there’s enough testing equipment around to make sure something will be found to be wrong with you.  Or rather, something will be found for which a ‘treatment’ is available – and the temptation to submit to it is hard to resist.

    The difference between your experience and J’s in the same hospital may be due to govt actions of the last ten years. May be not.  Ten years ago I was in a large old-fashioned ward in a large London teaching hospital (not yours) and had splendid nursing. (And incidentally I liked the food – but that perhaps says more about my standards than the NHS’s.)  A few months later I was back again, this time in a modern small ward.  Everything was different.  Indifference everywhere.  I commented later to the Chief Nurse, who replied "It all depends on the Sister". 

    Morale I guess is crucial.  The last ten years have certainly seen valuable improvements, especially the increased statutory emphasis on clinical standards (which has led in some trusts at least to medical staff being more involved in management).  But there have been morale-sapping actions as well.

    It might have helped if when Tony Blair (frequently) spoke of "reforming the NHS" he had specified more clearly what he wanted to change.  And what he wanted to leave alone.    (And had recognised the force of Onora O’Neill’s Reith lectures on trust.)

  6. Michael says:

    My experience of my local NHS hospital is that of an out-patient over the last 12 months and not as an in-patient so I do not know what happens in the wards.After endless testing I was diagnosedwith a lymphoma nearly a year ago and have heen closely monitored by specialsists ever since. My visit rate to the hospital has doubled since lJune following a cataract operation which went wrong.

    My firm impression is that the consultants I see are rushed off their feet.Their clinics are always full and appointments are made at 10 minute intervals which seems to me inadequate when discussing complicated blood disorders. It is like being on a conveyor belt . I do not know whether this is because of government’s waiting time targets,  because of the weight of pateintsor because the consultants have to give time to their private patients. Perhaps there are not enough consultants although not long ago I read that hospital trusts were no longer recrruiting them.

    Another impression is that information storage and retrieval is a problem. There is a great deal of rapid note making in patients’ files which generates piles of paper. Nurses are regularly hurtling round the hospital complex with armfuls of files distributing them to various departments. There appears to be no sign of the electronic exchange of information long promised by the government. But all this note recording is not matched equally by note reading. I am often asked questions by consultants the answers to which are  in my file. Could it be that the reason for all the recording is to provide protection against being sued by aggrieved patients?

    I have reservations about unrestricted visiting hours. It would drive me nuts to be in a ward with cavalcades of visitors in and out all day and into the evening especially with bored kids in tow. I agree these hours do not help the battle against infection. The French who have  greater success than we do against MRSA etc have limited visiting  and follow other neasures too e.g. nurses do not go on duty wearing clothes they travelled to work in..

    Parking at my hospital is totally inadequateand very expensive to use if one finds a space. Nothing is done about it. Indeed the trust is resigned to letting it get worse. A large cancer unit has been built on site with virtually no additional parking for users . Nevertheless contracts have been signed with other trusts to send patients there , thus bringing more people to the hospital.It could happen only in dear old England. I understand that the government will not allow addtional parking to be provided as part of its campaign to reduce traffic congestion and pollution.I suppose the elderly and infirm are easy targets. Meanwhile the people who operate the absurd Dome are allowed to lay down some 2200 parking spaces.

    There is no NHS dentistry in this part of London. I don.t think this will change under New New Labour.  No problem over financing Trident though.


  1. 8 July, 2007

    […] Wesley Clark Link to Article hillary clinton A hospital diary, June-July 2007 » Posted at Ephems of BLB on Sunday, July 08, 2007 A hospital diary, June-July 2007 July 8th, 2007 (No comments yet) At least six cheers for the National Health Service! That’s my rather unexpected verdict on a week as the guest of Mr Alan Johnson (Secretary of State for Health) and his predecessors, even including Ms Hewitt; a consultant endocrinologist and his sizeable medical team; View Entire Article » […]

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