30 April 2009

NHS "Trust"

My father-in-law, 90 this year, is in hospital. He had a fall at the end of last week and was admitted without physical injury but certainly in an element of confusion, which remains to this day. He doesn't appear to have had a specific brain malfunction, thank goodness (he can still tell us about being in Basra in 1943 without any problems, but also managed to recognise me when I turned up to visit him, which was a relief) but there is something plainly wrong.

The problem is, we still don't really know what it is. This isn't because his case is so baffling that he has defied all the finest medical brains that the NHS Trust in Hull has to offer; it's because it took five days - five days - before he was seen by a consultant. That means that from last Friday morning until yesterday afternoon he was in a hospital bed, confused, not knowing why he was there or what got him there.

I read NHS horror stories as they obviously make good copy. Like many political innovations of standing, it has an issue which relies on the principle rather than the practical. The political phrase "the principle of it is widely accepted, but the way it works isn't" could apply as much to the NHS as it did to the poll tax, the desperately damaging local government taxation scheme brought in at the end of the 1980s and about which Douglas Hurd uttered those very words.

From looking at the way my father-in-law has been treated, it seems to be more apposite than ever. Upon his admission, he was shifted from a medical ward to the geriatric ward. That's fine, except nobody told us - his family - and therefore we turned up for visiting hours at the wrong side of a large hospital and then wandered freely but aimlessly around a ward, staring intrusively at all the patients because he was no longer in the bed where we'd earlier left him. Eventually we found out from an apologetic and - needless to say - hideously overworked nurse that he had been moved and she gallantly directed us to where we needed to be going, removing 15 precious minutes off the 60 allowed during visiting hours - 60 minutes for which, I should add, we had paid more than three quid for in the car park. Oh, and this car park was now at the opposite end of the hospital too, so we would have to leave my father-in-law ten minutes earlier than planned so we didn't risk a ticket. For all the inefficiencies in the medical side of the NHS, their parking staff certainly make up for it.

We got to the geriatric ward and found that it was locked up because the visiting hours were earlier there. We pressed the buzzer and waited, and eventually a knackered-looking nurse, just off duty, let us in and told us where we could find him. I'm guessing that this nurse probably broke some crazy rule about allowing visitors outside of hours by showing us where he was, bless her, but anyway ... Eventually we found the old chap, sitting in a chair next to his bed, his hands shaking from the Parkinsons Disease that has riddled him for a year or more.

The on-duty nurses were great with us, but we've discovered in the days hence that the adage about geriatric patients being less well regarded by the NHS because of their age is, sadly, true. There seems to be less inclination to find out what's wrong with any urgency, it's harder to get information about medication or allergies into the heads of the staff, and in my father-in-law's case, communication between different shifts of nurses has been poor. One immediate suspicion of his GP when he first fell at home was that his new anti-Parkinsons pills had a side-effect. Immediately he came off the pills, which brought back his shaking but stopped the imbalance. As soon as the nurses changed shifts at the hospital, they were giving him the pills again and - you've guessed it - he had another fall.

The NB got to hospital one day to find him wearing a T-shirt and trousers. He never wears T-shirts, and the trousers weren't his. A nurse explained that they were hospital clothes and he had been incontinent, which did him a great disservice; what had actually happened was that he had not been asked once over the previous 12 hours if he needed the lavatory. Upon this revelation, the nurse mentioned he had a bottle he could use - but any man with shaking hands cannot relieve himself that way.

At the moment, we have a confused man of 89 in a ward where nobody knows not only what is wrong with him but what basic standards of care he should be entitled to have. I hate to trot out the old line, but if a man who worked very hard from the age of 15 to 66, as he did, wasn't paying stamps for his own care in his old age, then what exactly what was he paying for? All we've had so far is lack of communication over his whereabouts, his medication and his need for basic hygiene care.

He's a proud bloke, my father-in-law. He's tall, distinguished and decent, a bit of a granny magnet when dolled up (and he knows it), and he doesn't deserve this, and his family who look after him tirelessly for the rest of the time don't deserve it either. Indeed, all we've had for definite from the system so far is a threat that we'd be sued if we didn't get him to hospital after his initial fall in the first place. Look what has happened - or not happened - since we acted upon that threat and got him to hospital. He'd have been better off at home where his family could care for him; instead, his family have been questioned and probed but told absolutely nothing.


Roman Empress said...

I'm sorry to read that. Being low priority on a hospital ward as an old person is an issue that worries me too. Not least because it will be most of us one day. A humbling thought but hopefully remedyable if enough people are made aware in the meantime.

----------------------------- said...

I have it on authority, from someone who works for the NHS in Harrogate but who has also worked in Hull (and for obvious reasons, who shall remain nameless), that the priorities at Harrogate hospital are somewhat different - elderly people get more funding than some other departments in the hospital. Now this could be because Harrogate has more than its fair share of OAP's, and apparently Harrogate (a highly rated hospital - 3 stars) has a high proportion of falls, possibly for the same reason. It's all down to the postcode lottery again, I'm afraid.

A Write Blog said...

You must feel desparately frustrated.

I think part of the problem is that the NHS has got so complex. A combination of increased number of services because of medical advances couple with a more demending public has put it into a position where problems will show more readily and be more difficult to overcome.

More can go wrong so it will.

That knowledge, of course, does not make it any easier for those lik you who are caught in such a mire of poor communication.

I hope it gets resolved.