Sojourn at the Heartbreak Hotel


‘Whitehall Watch’ might be a bit sporadic over the next month or so – two weeks ago I had a heart attack. I’m recovering well and the prognosis is good, but it’ll be a while before I’m back to full functioning.

Meanwhile, “never waste a good crisis” as someone said (it’s alright, I know who) – so I thought I’d record my experience – for good and ill – of the wonderful British NHS.

And it really is wonderful, imperfect, but wonderful.

Last September whilst in the USA I had a chest infection. It was something I’d had before and I knew what antibiotics I needed but (a) my travel insurance wouldn’t cover it because it was classed as a ‘pre-existing condition’ (cause I’d had it before) and (b) if I went to a US doctor I’d have to pay about $1,000 to get a prescription because they wouldn’t give me one (even though I knew what it was because it was ‘pre-existing’) without a whole battery of tests. So I just had to soldier through and get back to Blighty and the safety of the good old NHS.

So I dread to think what anyone who has a heart attack in the USA goes through and am once again proud the Brits are sensible enough to have the NHS. Which said, doesn’t mean it’s perfect. So here’s some imperfections….

First, the emergency service was great. I woke up with severe chest pains about 1.45 and an ambulance, with skilled and sympathetic paramedics, was at my house within 10 mins of us calling them. They were able to do an initial diagnosis on the spot, including hooking me up to an ECG. Amazing.

A&E at the hospital were equally quick and efficient, if a trifle less sympathetic. I got all the medical treatment I needed fast and effectively. But that’s also where things started to go wrong, at least from my perspective as a vulnerable patient.

Some background: English hospitals have been under a performance regime aimed at reducing waiting times, including in A&E, for years. As a result many have adopted rapid ‘through-put’ systems, including my local hospital. So A&E are fast and efficient, but in the process some of the empathy has gone. Not too bad, but it gets worse.

My hospital also now has ‘assessment wards’ where you are sent from A&E to get you out within the specified time-limit. From there, if needed, you then go to an actual treatment ward (which is what I did eventually). This throughput system may be efficient, and timely, but it also has its drawbacks.

From a patients point of view it introduces an element of uncertainty and insecurity, which is compounded by poor communications. So I was told I was moving from the assessment to the main ward ‘now’, for example, only to wait for 3 hours for ‘now’ to arrive. In four and half days I never saw the same doctor twice as I moved from ward to ward.

And of course in these circumstances records are crucial – and the records either seemed not to keep up with you, or were incomplete (I found I was constantly repeating the same detailed info that clearly hadn’t been recorded) or inaccurate (e.g. I found in my discharge papers I was recorded as a “smoker” when I’ve never smoked in my life and said so whenever asked. This may explain the somewhat disdainful, almost morally disapproving, reaction I got from at least one senior doctor who saw me).

The standard of nursing was medically competent but very variable when it came to care – some nurses clearly thought caring for people wasn’t part of their job and routine requests were frequently ignored, sometimes to the great personal distress of patients. All this was compounded by a general sense that no-one was in charge – either of your individual case or of the wards you were on. On the other hand their were some brilliant nurses who were both medically competent and caring.

All of which doesn’t negate that I got potentially life-saving medical treatment fast, effectively and free at the point of delivery. So my complaints are those of a ‘critical friend’. And to be fair to my NHS Trust, I have shared all this with its Chief Executive who is using it as a “patients-eye view” with his senior management team and Board as part of an effort to improve quality alongside efficiency. Which is fair enough.

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About Prof. Colin Talbot

Professor of Government (Emeritus). Universities of Cambridge and Manchester, England.
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One Response to Sojourn at the Heartbreak Hotel

  1. Richard Baldwin says:

    First and foremost best wishes for a speedy recovery.

    My own experience of the NHS led to the conclusion that the NHS should concentrate on emergency services to people in real need (such as yourself) with no questions asked re insurance but that the private sector should provide routine stuff (eg cataract operations)that can readily be insured as this would be delivered more efficiently.

    Secondly your experience reminds me of the old maxim – be careful what you measure because you get what you measure.

    Regards

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