6 February 2016

Life threatening

It was my unfortunate experience last night to spend some hours at the local A&E at The Manor Hospital in Walsall. It is the third time in as many months. A loved one experienced an accident three months ago that has left her with brain injuries. We were told last time she was discharged from hospital that there should be no hesitation in calling 999 should another incident occur. There was no hesitation.

I have to say that I find the Manor a curious place. I have seen examples of both the best and worst of care there. I will never forget the attitude and care my Mother received when she was an inpatient in HDU and ITU. You knew instinctively that she was receiving the best of NHS care. Nor will I forget the care she received again during her last day of life, from the staff in A&E to one particular ward for a few hours and finally, ITU. Exemplary. Experiences like this demonstrate what a wonderful thing we have in our NHS and how a small local hospital can give the very best.

Sometimes though staff are encountered who are stressed for whatever reason, have an attitude lacking in empathy and sympathy, communication is difficult between both staff and their colleagues and staff and patients. Perhaps it is the stresses and strains that are put on certain services. The over work, the lack of full staffing levels, a lack of fully trained staff, a lack of fully rested staff. Sometimes these problems are all down to local issues, mostly I blame the government and their deliberate policy of downgrading the NHS, outsourcing services to profit making companies, ensuring that people perceive the NHS as not to be working  thereby meaning that less of a fuss is made when one day in the not so distant future we wake up and the NHS as we know it, no longer exists. Don't be fooled.

Back in November we endured two nightmare experiences in that A&E, the first lasting over 7 hours and the second nearly 6. The department was full to bursting, not even standing room, ambulances backed up to the West Wing and a line of patients on trolleys down the corridor waiting to be admitted, paramedics stranded. The entrance waiting room was totally packed. Clearly there were too many people using a service for which there are not sufficient staff. Or maybe something else was happening? I ask because part of the problem with the back up in A&E was that there were no beds available in the hospital. Patients and potential patients could not be moved on and there was something else too, something that until last night I could not put my finger on.

The controller who took my 999 call was superb. She sensed the distress I was desperately trying to control. She spoke to me on a very personal level. Towards the end of the conversation she asked me if I thought my loved one's condition was life threatening. I am not medically trained. I really cannot answer that question with any expertise but in my gut? Loved one may have been having a brain hemorrhage. I didn't know and so I answered that in all honesty it could be life threatening.

The paramedics were brilliant, just like the previous two occasions, efficient, patient, caring and soon we arrived at A&E. This time there was no line of trolleys down the corridor, no backup of ambulances, the entrance area was not packed, booking in was efficient and the receptionist was pleasant adding a personal touch that is needed when you are stressed. The department itself was busy but not full. Different.

I cannot comment on the care at the moment apart from the fact that communication is still not right but I will comment about what was said and what it was the staff were prepared to do. A few hours after admittance we were told to go home as the condition was not life threatening. Apparently so we were told, A&E staff are there to deal with life threatening conditions. They are not there to refer a patient on for further treatment unless there is to be an immediate in patient admittance and despite the problem being exactly the same as the previous two occasions when in patient treatment was deemed appropriate, this time it wasn't life threatening enough for consideration for admittance. Go and see your GP on Monday for the continuing care that is both required and needed. We are life threatening care only There is, it seems no one NHS, there is no streamlining of care. There are separate entities and n'er the twain shall meet.

The fact that the phrase life threatening was used by different people from different parts of the NHS made me see what has changed and why there were no delays or queues and possibly no delays in getting a bed if thought necessary. Unless your condition is life threatening you will be despatched as quickly as possible to become a burden elsewhere within the NHS. Our underfunded and understaffed emergency services may just be able to tick along and meet targets if this is done. Perhaps you've fallen off your cycle and are lying in the road with a broken leg, unable to move, in enormous pain and also in shock. You do not have however, a life threatening condition so you may wait for your ambulance and when it does arrive and they deliver you to A&E, you may be treated quickly but observation will not be a consideration and you will be left to become a problem for someone else but not them.

Maybe I am seeing things in the wrong way here and no doubt there are massive holes in my thought process that will be pointed out but I strongly suspect that word has come from on high, from our political masters who have interests galore in private healthcare provision and therefore less of an interest in an expensive National Health Service, streamlined to meet the needs of the patients as opposed to the needs of the staff, department, hospital, government, that unless it's life threatening, you pass the buck on or not at all but leave it with the patient and let it become a problem for someone else, somewhere else, where perhaps the immediacy and the importance is not quite as sexy for reporting upon when there are problems. Let's face it, it's the beds and A&E that get the vast majority of the reportage. This was my sense last night. It was different. Something had changed and in a very short period of time. The language was very different and language is at the heart of what is to be conveyed for public consumption and perception.

Or perhaps it's all to do with being classified by the CQC as failing and being put in special measures. I do hope whatever it is, medical staff are being allowed to do their jobs properly with due care and attention, rather than with an eye on targets.

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