When I was young, my family celebrated Christmas on Boxing Day. My dad ran the hospital of a maximum security prison and wasn’t always able to take Christmas Day off but that mattered little to us as children, we just grew up thinking that the 26th was a really special day and the day we opened our presents.
Over the years, my sympathy for all those people who continue to work hard over the festive period grew. If I’m honest, I was also a little concerned that the media always made reference to doctors and nurses who were working, and sometimes the police, but rarely mentioned the many thousands of other people who work so hard to keep us safe and to support us while we are having fun – staff in and around the hospitals, not just the medical teams, but also the cleaners, caterers and maintenance teams, then there are the support staff in police stations, prison officers, firefighters and so many, many more. In fact, I worked in television for most of my career and remember the security officers, engineers and the programme makers who worked through the festive season to ensure that we all have Christmas shows to watch (and to complain about).
This year, I was reminded about them all as I spent Christmas Eve in A&E with my husband who was unwell. That experience has made me even more grateful for all the work that is done by others….. but it has also made me question many other things that were taking place. So, here is my story… the good, the bad and the ugly. I am sure you will agree with some of it and you may be disappointed with some of the comments I make but I wanted to be truthful and to explain my experience in all its gory detail.
On Thursday 21 December my husband had a Laparoscopic Cholecystectomy which, for those of us with limited medical knowledge, is the removal of his gall bladder by keyhole surgery. The operation went well and he was discharged with pain killers that same evening… everything was good for the first two days then, on Christmas Eve he started to have severe breathing problems. This was really scary but, never wanting to knowingly waste the time of staff in A&E, particularly at Christmas, we spoke to a GP and then called the NHS 111 service to get medical advice. The advice was consistent and straightforward and that was to get him to hospital as soon as possible.
It was when we were on the way to the hospital that I suddenly realised that I’d left my handbag at home… so here I was on a mercy mission with no cash, no bank or credit cards and no phone charger. We arrived at the hospital to find that there is no car parking near to the A&E entrance and no free parking elsewhere for emergency use. I couldn’t leave my husband alone at the entrance so we had to head for the public carpark which was up a hill but thankfully had mobile parking facilities – thank goodness for modern technology. As I parked I saw two men putting a patient into another car and they had been using a hospital wheelchair. They were quite clearly Muslim guys (I mention this deliberately) and I asked them if I could take the wheelchair from them. One of them immediately brought it along, he helped my husband into the chair, held his shoulder for a moment, wished him the best of luck and as we walked away said Merry Christmas …. His words on that cold, dark night were lovely and made a real difference to us.
Sadly things then took a different turn. When we arrived at A&E we were met by a reception team who had quite clearly signed up to the same (lack of) charm school. Now, bearing in mind that the majority of people arriving in A&E are worried, feeling ill and sometimes stressed, and appreciating all the good things that the NHS stands for, I think that the least a receptionist can do is to attempt to be pleasant to those who arrive. However, in my hurry to wheel my husband in from the cold and to what I thought was our refuge, I failed to notice the scrawled and obviously temporary sign which said “wait here to be called to reception”. As there was no queue in the area, I had pushed my husband up to the desk and was waiting for one of the three receptionists to look up but I had obviously overstepped the mark. None of the receptionists looked up and it was quite clear that they were not occupied with anything else. Instead, one of them snapped for us to go back to the line and to wait to be called….. I took my husband in the wheelchair back to the “line” whereupon the same receptionist immediately said “Next”, waved for us to approach and said “How can I help you?”. It was so very officious and upsetting. Sadly, we saw this behaviour repeated several times as people arrived in A&E. Now, I have managed a number of reception teams over the years and in some very busy circumstances and I can honestly say they have been some of the best people I’ve ever worked with. The more welcoming they are, the more people feel appreciated and the more co-operative everyone is. I feel dismayed that this positive behaviour does not appear to always be promoted and encouraged in facilities in the health sector. I hear so many people complaining about receptionists in doctors’ surgeries and hospitals. Receptionists who show little patience and scowl at people who are asking for help. I really do understand that visitors can be difficult but a welcoming receptionist is so very important and particularly when you are scared and worried about your health or the health of your friends and family.
We explained to the receptionist that my husband had been discharged from that very hospital only a couple of days earlier – she gave no reaction. I said that we had spoken to a GP who told us to come straight in – she gave no reaction. We said we had called 111 and had been told to come straight in – ah, that garnered a response but all she did was tell us succinctly that 111 was nothing to do with them. She told us to take a seat and wait for what was likely to be 30 minutes to be seen by a nurse and up to four hours to see a doctor. Now again, I appreciate that a lot happens in hospitals but when the waiting area is plastered with signs asking you to go to your GP before going to A&E and advising you to call 111 before turning up, it felt like double standards. Did the people putting up the posters talk to the reception team? Did the reception team understand the messages the posters were transmitting? And as I said earlier… smile and empathy would certainly go a long way….
Now let’s move on to the people waiting to be seen. Firstly, some people appeared to have brought their family and friends along for the ride… leaving no seats for patients and often not standing to allow patients to sit. Then there was the man with the sore foot… who was dancing to the music on his iPhone, using his sore foot quite happily. And, then the man who told the receptionists he wanted some painkillers rather than going to the local pharmacy and, as for the woman who had taken the time to make sandwiches for her family before coming and who was having a picnic in the waiting room. Maybe some of these people had nowhere to go on Christmas Eve?
So, an hour and a half after we arrived, with my husband still struggling to breathe and unable to walk anywhere, a nurse called out his name and I got up to move the wheelchair… low and behold the man who had earlier asked for painkillers shot up and ran in ahead of us…. To say we were shocked is an understatement. One thing I did realise while sitting there was that the advice given out in crisis situations by the emergency services to treat the silent victims and patients first certainly rings true. Those who make a fuss and shout loudly are quite clearly not the ones who need urgent attention. This was quite evident on Christmas Eve. There were several men in reception, predominantly the older ones, who were clearly in tremendous pain but were sitting silently waiting for the doctors to see them. Others were complaining loudly and sadly, those that cried loudest were invariably seen first. If only people could be more aware of what is going on around them and to think about others who may be worse off than them.
Looking around the waiting area in A&E and in the main hospital, things weren’t really geared to supporting visitors. I appreciate that it was Christmas Eve but the café closed really early, as did the shop. The cash machine was out of order, the public telephone was out of order and the screens displaying waiting times in A&E were not working. Again, I appreciate that a hospital is a huge beast and everyone needs to be careful how funds are spent, but, sometimes I can’t help but think that if there was more of a “one team” approach that things could work better. At one point there were three nurses looking in a key cabinet for a key to an office…. Not the best use of resources. I remember learning very early as I began my career in Facilities Management that it’s essential to keep keys secure, to label them and sometimes even to log them out. Just a thought…..
When we finally got through to see the nurse she could not have been more helpful. She immediately stressed that my husband needed to be taken to the “majors” department as he was quite clearly in need of immediate help…. So, maybe a genuine filtering system when people arrive in reception is what is needed and I know that this is something that the NHS have talked about for many years. In fact, it is something I countenanced a few years ago when my husband developed sepsis. It had been diagnosed over the phone by the hospital’s senior consultant, who told us to get him to the hospital immediately. He told us to ask Reception to call him when we arrived. They refused to do this, saying they needed to “clerk” us. It took four hours to get him through A&E, in part because of the system and in part because of the behaviour of the reception team. By which time my husband was desperately ill. Thank goodness there is now much greater awareness of sepsis and its consequences, although I would question whether or not the three receptionists on duty on Christmas Eve would actually have taken any of the symptoms into account.
After seeing the nurse we were taken to the “majors” area and asked to sit and wait, the beds were all taken, along with an elderly gentleman in heart failure and a young girl with kidney problems. Now I have always been somebody who feels the heat. I remember when I was running the FM team at Channel 4 and I was so sensitive to temperature I was able to call the team when I felt that it had shifted one degree from the set point. Well, the waiting room temperature in majors was so very high it was extremely uncomfortable for everyone there, even with the windows open and a fan. What is the maintenance regime I wondered? There were signs around, particularly on the local distribution boards advertising the helpdesk of a certain FM provider. Not sure if they were responsible for all of the M&E but I did begin to wonder what the regime was and why it was so very hot and uncomfortable. Let’s go back to the “one team approach”. Anyone working or passing through the area would immediately have realised it was unacceptable and, if there was a real problem that couldn’t be solved, how hard is it to put a sign up apologising for the awful temperature? That said, we were sat in an area where one door had a large sign saying it must not be obstructed at any time. Well, apart from the chairs which had been carefully set out for patients in front of said door…
Now I hear some of you saying that I am being unreasonable, it was Christmas Eve after all and the people working in the hospital weren’t able to celebrate with their families. But I do genuinely think that the busy times of the year are the times when more staff are needed, not less and I go back to what I said at the very beginning of this story… Many, many people are scheduled to work over Christmas, most are selfless people but they also know that it is a consequence of the job when they apply and the career that they have chosen. Most importantly, and I may not be popular when I say this but the staff on duty were clearly not all that busy, many of them had time to stand and chat, to talk about their holiday plans and to ignore people who were waiting for help…. Many of my family have spent their working lives in the public sector, some in hospitals and some in prisons, another in the police force and they and I have witnessed many inconsistencies across the professions. All I can say is that I have on many occasions entered a hospital or gone onto a ward and seen staff standing around chatting, carefully avoiding eye contact with you as you approach. I know that this is a snapshot in time and not always a true reflection of what is happening. I also know that there are many really hard working and dedicated people, particularly in specialist teams but what I really think is that we need to stop saying that ALL people in ALL hospitals are undervalued, underpaid and overworked. Some are, some aren’t, the same in many other professions. I have worked with really hard working teams over the years who have been busy every day of the year. What I witnessed on Christmas Eve was the lack of management expertise to help organise these establishments and to focus resources appropriately so that specialist staff are doing what they are paid to do…
By this time, the elderly gentleman who was in heart failure was now looking desperately ill and the next bed available was given to him. However, he was left in the cubicle for about twenty minutes before anyone even spoke to him and before I am challenged again about how busy everyone in A&E is, I am sorry but this was simply not the case. We could clearly see everyone and I genuinely think we were back to the lack of a one team approach. Staff were standing around talking and a few wandering up and down, others were very busy. All I know is that the daughter of the elderly man was the one who struggled to get him onto the bed, the one who went looking for help and the one who kept him reassured. In a perverse way he was lucky because he had a caring relative with him. The ECG machine was portable and was “parked” next to the fan. It took twenty minutes for somebody to plug him into the machine. A reading was taken and when they saw the results he was immediately whisked away for treatment.
As I mentioned earlier, my father managed a prison hospital, he was also a medic in the Royal Army Medical Corps. My mother in law was the matron of a major hospital. They have spoken to me many times over the years and have been in and out of hospital as they have got older. Both of them say the same thing and that is that the staff in hospitals have become more and more siloed over the years and this is becoming more and more detrimental to patient care and to the efficient running of the hospitals. What I witnessed on Christmas Eve certainly gives the perception that they are right in what they are saying.
Now I will flip to a point on Christmas Eve when I felt that the core medical team in A&E were amazing…
After yet another hour sat waiting for a bed for my husband to be examined (five hours since we had arrived), a paramedic came into the area and asked the sister if the side room was unoccupied (the room next to where we were waiting). She told him it was empty and within minutes we heard an unearthly commotion coming towards us through the emergency ward. Three muscular policemen in full gear were struggling through the ward with a screaming guy who was handcuffed and in a wheelchair. He was bellowing obscenities, lashing out at anyone who came close and threatening the lives of the staff and policemen. He was taken into the private room whereupon he started screaming abuse, using words that I would not be able to repeat. He threatened to kill the officers, their wives and their children, to maim them and to hunt them down when he was released. It was really distressing for everyone involved and for those of us witnessing what was happening. Three police cars, four police officers and five of the hospital staff were involved in trying to control this guy and they were all treated appallingly and their safety was so clearly at risk. The banging, clattering and thudding against the walls was horrendous and at one point the police were having to use hazard tape and leg restraints to protect both him and everyone around.
It is important that I stress that at all times in this very difficult situation the police officers were extremely professional. They struggled with the heat as they couldn’t close the door to the private room as it was impossible to deal with the situation as the temperature rose. They were clear with their instructions, they were consistently polite but firm and did nothing to antagonise this man, other than to try and get him the medical support he so clearly needed. They were protective of the nursing team and one officer even took the time to come to our waiting area to apologise to us all for the disturbance and the language. This was really special given everything they were having to deal with.
One thing that was clear for me to see was that there was no security of any description to support the staff and patients in A&E. The nursing staff were calling for assistance but none came. Each and every nurse went to help without a thought for themselves but they were all being called away from providing care to patients by the behaviour of one individual who quite clearly had no thoughts for anybody but himself and the substances he had clearly taken. Thank goodness the A&E team had trained police officers dealing with the incident. It was all so very distressing for everyone, particularly those people who were so very ill and in need of peace and quiet and a stress free chance of recovery. Why we have got to the point where trained medical staff are having to act as security teams I really do not understand. Is it budgets again? Is it management?
Half an hour later my husband and I were ushered to an empty ward. A completely empty ward. We were under the care of an efficient and helpful doctor who treated my husband without any support from others in the care team. He went to get all he needed and carried out the ultrasound on a portable machine in the empty ward then took us to x-ray and personally took bloods. It was odd being in a completely empty ward. We assumed this was overflow space should A&E get busier but are not really sure whether the doctor was simply finding space to treat patients who were in need of care. The results of the x-rays confirmed that my husband needed a bed and to be examined by a surgeon who would be able to take a view on appropriate treatment. At this point we were ushered to another bed in another ward.
We have heard so much in the press over recent months about the impact of Brexit on the UK and the impact on people working here. Well, the majority of medical staff in the hospital, including this helpful doctor, were from overseas, and not just Europe and it is clear that we need to think about the impact on our NHS of any changes to immigration policies. One really special moment when we were on the emergency ward was when a male nurse put on a Christmas hat, put his iPhone on Christmas Carols and wheeled a trolley of hot drinks and chocolate around to patients wishing them a Merry Christmas. How very sad when an obviously well to do male patient started making disparaging comments about how Christmas was celebrated in the nurse’s home country. Thankfully the nurse was bigger than him and rose above the comments but what a very sad reflection on things.
Now, let me mention paperwork for a moment. When we arrived in reception we were logged onto a computer. We already had the discharge notes and reference numbers so my husband’s details were called up very easily. When we were seen by the nurse who asked about my husband’s history and filled in a booklet of information. When we were checked by the doctor in majors he completed another booklet, asking many of the same questions: patient history, symptoms, allergies etc. When we arrived on the ward where we were waiting for the surgeon, the nurse completed another booklet and asked the same questions. When the surgeon arrived he had another booklet – red this time and asked the same questions yet again. So, four booklets, all completed by different people, in different colours…. Are these highly qualified people being used for admin when they would be better treating patients? Maybe a system where the patient carries the booklet (or it is hung round their neck) would cut down on all of this paperwork… just another thought.
When my husband got the medication he needed and we got the all clear to leave by the surgeon we got quite excited. The nurse, however, told us we might need to wait for up to another hour while he waited for the surgeon to complete the discharge notes. Well, we waited, and waited – occupying a much needed bed. I asked if we could leave as it was now nearly midnight and we had been there for over eight hours. We were advised to stay as the discharge notes gave us useful information. Well, when the surgeon finally came back he told us to that the printers weren’t working, so they couldn’t print off the discharge note but that it wasn’t anything to worry about because it didn’t really say anything!
I wheeled my husband back to the car, with the medication he was so much more comfortable. He slept all the way home and when I got him to bed he slept for twelve hours…… If there had been a better filtering system in A&E I wonder how long it would have taken to get us treated and out of the hospital? That said, I was privileged to witness so many things that opened my eyes to how we humans behave, how we respect each other (or not) and how working together to support each other really does make a difference.
Our NHS is special, I am grateful that I was able to get my husband the treatment he needed. The principle is something we should all be proud of but I also think that we shouldn’t glorify a system which needs to evolve as society changes. It needs the support of the public, politicians, administrators and visitors alike if it is going to survive.
To everyone who has worked over the Christmas period, to everyone who has been ill, and to everyone supporting others, and to those of you reading this missive… and to the young guy working in M&S on Christmas Day who served me a makeshift Christmas dinner (I hadn’t had time to defrost the turkey). I wish you all the very best and, let’s remember the words of Helen Keller “Alone we can do so little, together we can do so much.”