A new year’s eve emergency brought home to Nick Samuels the huge gap between NHS staff’s compassion and the resources available to them
I have worked in and around the NHS most of my life, so even when I am a patient I see it through familiar and understanding eyes.
I get the processes going on behind the scenes and can see which policy or target is playing out. I have stood in the middle of different accident and emergencies most of my career and watched how they have changed, for the better, measurably and immeasurably.
But it took a heart attack, in me, on the morning of new year’s eve, to fully appreciate the marvel and wonder of the service, and its precarious, slipping grip under the sheer scale of the pressure it is under. I offer the following as personal observations that stretch only as far as my eyes and ears could see and hear.
NHS111, wow, what a response. I was sceptical that I needed any help; my symptoms were a bit odd, I thought, but surely not an emergency, especially on new year’s eve. Loved ones were insistent I call – they were right. The first paramedic was there within five minutes, with the ambulance in hot pursuit.
Teamwork, caring, exasperation
Assessment, treatment, then straight to A&E. No chaos or panic in A&E, it was just totally full… in a hospital without any beds free to admit patients to… on a Saturday morning, at the beginning of a bank holiday weekend.
But I had company; the paramedics waited with me for an hour to hand me over. And they had company; three other crews, queuing up, too. And more patients walking in, and no cubicles to go to, no beds to move patients waiting for admission to. And four ambulances missing from the streets of London on one of the busiest weekends of the year.
I sat on a chair with five other patients and in front of a couple more on trolleys by the side of the staff base. Saw a locum senior house officer late in the afternoon, in the plaster room, then back to the chair in the majors. Throughout the afternoon, I had a ringside seat of an A&E working furiously hard.
Teamwork was evident, caring was evident, exasperation was evident. The consultant made clearly audible phone calls regularly to report the department’s status. The status never improved; more patients, more ambulance crews waiting, all cubicles and corridors full and no beds.
At all times I felt I was receiving the best care any of the professionals around me could offer, but also that at times it was nowhere near what they were trained to provide or thought was best
Four or five hours after I arrived the heart attack diagnosis was confirmed, cardiologists would need to see me and I had been transferred to them, but would wait and be seen by them in A&E because there were no beds to transfer me to. No idea how this played out in the waiting statistics, which clocks started and stopped when, but am pretty certain my experience won’t match what the system records.
Cardiology turned up in the evening and said I would need to go to the regional heart attack centre for an angiogram and maybe stenting. But they had no beds, and I would therefore be kept on the cardiology ward probably until after the bank holiday weekend… once a bed freed up (QED?).
In the end, about 12 hours after my heart attack I made it in to a bed, not even an outlier in another specialty ward, but in cardiology. At various times I was assured it was OK to wait, for hours or days, but at other times it was clear I was being closely monitored in case another attack happened (hmm, a bit late then, no?). At all times I felt I was receiving the best care any of the professionals around me could offer, but also that at times it was nowhere near what they were trained to provide or thought was best.
Some other perhaps obvious observations, which don’t always click until you have hours on a seat, a trolley or in a bed to notice nothing else but. Hospitals are stressful, noisy places to be when you are being urged to rest and relax.
Sleep, strongly encouraged, is barely possible in an alien place, hooked up and with a few things on your mind.
Randomness feels common, like waiting three hours for the ambulance transfer between hospitals, to then blues and twos between them (easily the most stress and excitement enduing time of the whole period) and then wait again at the other end.
Until it happens to you, you also don’t get how unpleasant it is to experience what are considered routine procedures like endoscopy and angio. Both sophisticated and also pretty brutal, when all you have in your mind is a simple procedure. Tenderness and care was in abundance in every encounter I had with staff. And I got to watch a lot of it around me too. But the frustration of staff at many times only having tender compassion to offer was very evident.
I have seen the NHS under greater strain, when I first started in the 1990s and Stephen Dorrell was health secretary. I thought then that the service we offered was awful. I started my career in NHS communications, when I had to explain three day trolley waits in A&E and genuinely celebrate when waiting lists dropped below 18 months for the first time (that would be an outrage today, wouldn’t it?).
I think at times we do forget how far we have come and how much has changed since. But I dread the direction of what I and countless others are seeing every day now. A feeling of staff and services being overwhelmed, by demands they simply don’t have the resources to meet. I have seen it before and people suffered and died. Political platitudes of “funding what the service wants” are a nonsense when compared to many patient experiences and manifesto promises.
Our claims to be a compassionate, sharing society are surely most evidently tested in how we care for each other when we are vulnerable
None of the above is a complaint about any part of my care by any person or organisation. I am grateful and thankful to everyone and every organisation involved and am well and back on my feet. I also have some personal obligations to face up to, to do what I can for my own health through lifestyle choices, so I don’t become dependent on others to fix me.
In the 1990s, as now, we got what we paid for. Our claims to be a compassionate, sharing society are surely most evidently tested in how we care for each other when we are vulnerable. I saw no lack of caring, but huge lack of the means to care. And that is a choice it seems to me that politicians, ultimately, are happy to make, by omission and commission, but not be judged on.
I have learnt a bit about heart attacks in the last few days. They happen when a passage is blocked. Very bad ones are blocked in many places and can be fatal. The NHS is having a heart attack and constant defibrillation won’t save it.
Thankfully I don’t need social care!
Nick Samuels is director of strategy, policy and communications at the Royal College of Physicians