These days, even a good NHS hospital can be a frightening place

The little signs of a service being pared away

20 July 2013

9:00 AM

20 July 2013

9:00 AM

Let’s not pretend that it’s just those hospital trusts investigated, or put on ‘special measures’ by Jeremy Hunt that are the problem. On my weekly trot around the wards of a big London teaching hospital, everything seems fine, the patients reasonably clean and well cared for. But over the months I’ve noticed that, even here, the NHS service is just not what it was — so many bits are being pared away.

First I met one of the hospital’s ‘Friends’, almost all of whom are now doughty ladies in their eighties. She mentioned that they are using some of their hard-won charity money to fund an art therapist who has been having a very good effect on stroke patients. The NHS no longer pays for them.

I remember when becoming an art therapist was a good option for an art student. It was a long and involved training, in art, teaching and counselling, but it led to fulfilling well-paid work. Only four years ago I met a young woman who was going into it after art school in the hope of lots of work. I thought she was a little bit optimistic at the time.

I made my usual visit to a man of 93 who has vascular dementia. He was very happy today after a short walk assisted by a nurse. I noticed that his feet looked awful, with long, twisted toenails and rough gnarled lumps of nail accruing on some toes. He told me that his own doctor had made an appointment with a chiropodist for him, and he was still waiting. That was eight years ago. I asked the ward sister if they could get him a hospital chiropodist.

‘Oh, we have big issues with that,’ she said, meaning, no they can’t get them. ‘There are none on site these days,’ she said. ‘And it’s very hard to get them to come in.’

In the next men’s bay, I saw what looked like a woman, with bountiful, abundant white hair. It turned out to be an elderly man, an elegant moustachioed Robert Louis Stevenson lookalike, who had come in as an emergency after having a heart attack in his shower. His hair looked completely matted. I offered to comb it for him. He said he had not had time to bring in his comb or his phone charger, but he hoped a friend might bring the charger. As he had no phone he couldn’t request any toiletries. There are no combs or toothbrushes on offer to NHS patients.

Almost all the patients I see are longing to go home, but too weak to take care of themselves. They need building up — a hearty convalescent home on the south coast of the type we still had on offer in the 1980s might do it, or at least some robust good food. But in hospital I never see any evidence of dishes that could build up any living creature. A mouse would waste away on it. Relatives have to bring in appetising fare and fresh fruit.

In another ward the TV had been out of order for weeks. It needs a new digibox, but there is no one to get one. It reminded me of when I worked in HMP Wormwood Scrubs, when very little was available in terms of basic healthcare and if something broke down, such as the dentist’s chair, it was not repaired for months. But scarcity of resources is causing much graver situations than that.

I visit a lady who has a lethal cancer. After being misdiagnosed by her GP for two years, she now needs an operation urgently. She is turning yellow because her bile duct is blocked. She was supposed to have the operation to relieve this last week, but it was cancelled at the last minute. ‘The doctors ran out of time,’ the nursing sister told me with what seemed like genuine sadness.

Since then the patient has developed an infection which prevents the required operation, and she is in danger of a cardiac arrest. She is also very weak and not eating. ‘What can we do?’ said the sister, as if a whole giant apparatus of helplessness was bearing down on her.

‘It’s just postpone, postpone, postpone,’ said the woman when I saw her, her husband standing by her bed looking anguished.

He told me that he has a problem with one of his knees. I mentioned that I had once had a similar problem when I was walking to Machu Picchu in Peru. The woman suddenly seemed to become animated; her eyes lost their hopelessness.

‘That is what she wants to do,’ he told me.

‘I wanted to go there but I had the family to worry about,’ she said. ‘Now they are all grown up and left home, but instead of doing the things I wanted, I have this.’

I saw her sink into sadness again, so I described the place I’d stayed in the last time I was in Peru, the Inkaterra, right in the Andean jungle, where there are rescued bears pottering about eating bromeliads and abundant orchids. She made me write down the name of the hotel. By the time I left them I think I had brightened her up a bit. Hopefully she might even get to the Andes one day. Where there is life there is hope, even if your life hangs on the bare bones of the NHS.

Got something to add? Join the discussion and comment below.

Jane Kelly is a consulting editor at the Salisbury Review.

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  • Margot

    A relative with a chronic illness died as the result of hospital inadequacies. I think he was lucky. The change in the NHS from his first contact with the hospital several years ago to when he died was unbelievable.

  • Cymrugel

    I have had several encounters with NHS hospitals; some good some bad. Personally I think its down to a combination of good management and a committed highly motivated staff when they work well.

    Private medicine is great if you can afford it; you get to walk to the head of the queue basically, but let’s not kid ourselves . Its basically a racket where doctors get to charge a fortune for consultations. All training and research takes place in the NHS and private medicine is all about sticking plaster jobs.

    Basically if you need long term care they are just not interested. I had surgery and they would not pay for any follow up which had to be carried out by the NHS.

    Many people in this magazine and in the likes of the Telegraph seem to be arguing for the privatisation of the NHS. This would be a disaster. We would basically end up with a situation where a small percentage of people get high quality care while the rest get by with a very poor service or none at all.

    The NHS should be strictly monitored and certainly never beyond criticism, but the notion that privatisation is the solution is ridiculous.

    Its an idea that appeals to people,who basically assume that they will always be among the favoured few getting Rolls Royce treatment.

    The problem with the Spectator is that it is staffed by people,who are well off and yet seem not to know it – like the ridiculous Delingpole who affects to see himself as hard done by. People poorer or less affluent simply do not appear on your radar or are dismissed as lazy or irrelevant.
    The NHS is one of the best things every to happen for most people living in the UK and needs to be managed properly; not dismembered so a few Hooray Henrys can feel even more privileged than they do now

    • Tom M

      Why do you say privatising the NHS would be a disaster? Your conclusions about the consequenses are somewhat bizarre.
      It never seems to occur to anyone talking about alternatives to the current mess called the NHS that arguably the best health care system in Europe is only some 20 miles from the UK.

      The health care system in France is publically funded, in large part privately owned and operated and the comparison between it and the NHS is risable. To ignore this and to continually pronounce dire outcomes if we change the way the NHS works is just plain foolish. Do you think that French people (mostly about an inch from revolution at the best of times) would tolerate a health system that you claim a privately run organisation would turn into? At the slightest hint of mal-practice and they would be out on the street and they wouldn’t take prisoners. That they don’t is a tribute to the service they are provided with.

      The French people are very proud of their health service and, unlike the UK, and are gently reminded at all steps of care the costs being incurred.
      So I suggest that someone in the Ministry of Health jumps on Eurostar and borrows the workshop manual.

      • Cymrugel

        This is not France.
        The British public at present are apathetic and political leadership and social responsibility is absent.
        We are also ruled by an elite that has little interest in what is going on outside London and no interest in what affects most of the population.
        They quite simply buy their way out of the problems the rest of us will face.
        If the NHS is privatised we will end up with a system similar to that which existed prior to WW2 and which was nothing more than a money making racket. Quack doctors abounded as did private “clinics” where gullible idiots paid through the nose for sub-standard care.
        The attitudes common in this magazine are those of an aristocratic elite with a fine contempt for the rest of the population and salivating over the money making opportunities presented by a cannibalised NHS.

        • Tom M

          Well Cym. if you are saying we in the UK can’t run something like the NHS then I am in full agreement with you. The proof is in over 60 years of trying.
          When you say that people are “…..salivating over the money making opportunities…” then you are undoubtedly correct. But if someone were to handout five pound notes to passersby on Waterloo bridge who would the fools be? The giver or the takers?

          As in all Westminster run gambits, and the list is exceptionally long, wind farms and solar panels being my current favourites, why would any businessman not take advantage of these generous offers?

          The problem is principally the fault of the people we elect and following a close second the capabilities of those who arrange the contracts. We are out of our league.

        • Baron

          Together with Mrs. Richardson: “What are you talking about you silly little man” (apologies Cym, but it was irresistible).

          You reckon then licences issued by say, NICE wouldn’t weed out the baddies, do you?

          The people who are losing out are exactly the people for whom the NHS was set up. The monstrosity cannot be managed any more than the communist regimes could be. The good thing is it will collapse for one cannot run for ever a construct which has resources limited but demand for its services limitless. The sooner it happens the better, we aren’t rich enough to keep it going for long.

      • Baron

        Spot on Tom, after close to half a century of brainwashing that anything making a profit is an evil that’s what you get. If the majority think as Cym does we are truly and irrevocably fugged.

        • TheOtherTurnipTaliban

          I assure you they do and the NHS is way past saving, it needs taking out to the woodshed and given a quick release,

      • Jambo25

        The health service in France is also much more expensive than in the UK and probably, in the long run, unaffordable.

        • Tom M

          The health service in France 2008 (last figures I have) was 16% more expensive than in the UK at that time. NHS has been spending in excess of the EU average for some years now.

          All of the other EU health services are infinitely better than the NHS and note some spend less, hence the average. The comparison in health care by any measure has to be seen to be believed. I’ve seen it and I believe it.
          As to your point about the long term viability, I quite agree. Further, a country can only have the health service it can afford. As the UK slides further down the GDP charts an expensive “world class” (as politicians like to call it) health service becomes less and less affordable (whether or not you get Starbucks to pay more tax)

  • Piggly Wiggly

    This is what happens, eventually, to socialized medicine — state medicine.

    This is why turning medicine into a government department is and always was a bad idea. And this is why Americans have resisted it for so long, and some still do. I was a doubter until an American said to me “imagine the immigration service running a hospital”. Having dealt with the immigration bureaucracy — the pointless chest X-ray which no one bothered to look at (or needed to), the coffee breaks punctuated by a work day, the casual inefficiencies and mistakes costing months of further delay — which I paid for — I knew exactly the sort of nightmare he was pointing to.

    • Cymrugel

      I know.
      and people get such better care in the USA.
      Just so long as they are not too ill for too long

      • TheOtherTurnipTaliban

        Out of interest are they killing tens of thousands of people on schemes like the Liverpool Care Pathway? Seems tough to top that particular scandal

  • paulme

    Some interesting anecdotes. I too have recent experience of London teaching hospitals, most recently The Chelsea and Westminster where I was admitted as an emergency with no phone charger, no toiletries and no money. There was no problem in getting NHS soap, toothpaste comb etc. from the ward and one of the nurses asked around the ward to borrow a charger from another patient. And even if it is true that there are no chiropodists available in the hospital, is it beyond the skill of a nurse to cut an old man’s toe nails? Isn’t this sort of thing known as nursing?

  • Baron

    Not unakin then to what it was when the whole of the East was ruled by the Red Menace when even Yugoslavia with a less lethal mutation of the communist bug was a frightening place.