A couple of years after we qualified, my colleague Phil went to teach in an English school in Barcelona. On La Rambla one Saturday afternoon in his second term he experienced difficulty getting his breath followed by a sharp pain in his chest, he collapsed in agony on the crowded street.

‘Patients in the beds either side of him didn’t eat the food, instead their families came in twice a day’

He was taken by ambulance to hospital. He spoke only a few words of Spanish − all his teaching was in English and while the pupils came from all over the world they all spoke English as a second language. Fortunately the doctor in the accident and emergency department spoke excellent English. Phil had a collapsed lung, needed an urgent operation and would be in hospital for several weeks.

The Spanish hospital had some unexpected differences to the NHS. Phil was an adventurous eater and was enjoying the traditional Spanish dishes the school offered but the hospital food was disgusting. The patients in the beds either side of him didn’t eat it. Instead their families came in twice a day and they all ate together round the bed. No problems here about patients being malnourished or dehydrated. Phil didn’t have family or friends to bring in food and it was not something he could expect of his new colleagues.

Culture shock

He had another difficulty − the operation meant at first he could not feed himself. A ward orderly was allocated to look after the foreigner. This man in his mid-to-late 50s did not speak any English and his whole attitude was one that he did not want to be feeding, washing or taking anyone to the toilet. Phil noted family members did this for other patients.

‘The orderly wanted and expected to be tipped for any help he provided’

Despite the lack of knowledge of the language, Phil could tell this guy was making fun of him the way he spoon feed him his food the tone and manner were that of feeding a baby. Phil was forced to mime needing the toilet as the man pretended he could not understand what he was trying to say.

The man was impatient with Phil for eating too slowly, for making a mess of the bed sheets or for the inconvenience of wanting to go to the toilet when he had other things to do. He also wanted and expected to be tipped for any help he provided. Phil did not know whether this was standard practice or whether he was being taken advantage of, but the man made it clear by rubbing his thumb against his fingers that he expected a payment. It was the same with changing his sheets and his insistence on laundering the night clothes. Again these were tasks other patients relatives undertook.

I was reminded of what happened to Phil when I read about suggestions that the NHS could save significant amounts of money if it didn’t provide hotel services to patients and that the issues of poor care would be resolved if families took more responsibility for their relatives during hospital stays. And I shuddered.