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What 24 hours in A&E revealed about the NHS

by
03 January 2020

When Hugh Dickinson was rushed to hospital, he found a system struggling to manage, propped up by remarkable staff

THE rapid-response team arrived 40 minutes after being alerted by our doctor — pretty quick, considering that their base is 25 miles away. Two youngish female paramedics came in with backpacks and piles of kit (to a 90-year-old, anyone under 50 is “young”), and proceeded very efficiently to put me through tests which are normally done at A&E. Doing triage at home with some tests and medication is a simple way of easing the pressure on the hospital. It should be adopted everywhere.

In the course of their investigations, which were being recorded and forwarded on a laptop, they came across a problem that needed specialist advice. After a brief radio consultation, they decided that I would have to be admitted.

Forty minutes later, I was lifted into an ambulance in windy, wet darkness, and driven at high speed through the night, while I tried to work out where we were by the twists and turns and bumps in a road I know well. There was a pause while the team discussed my admission with the A&E controllers, and, finally, I was pushed through the automatic doors and parked in a corridor at the end of a long queue of people in wheelchairs or on trolleys. My daughter turned up to hold my hand and never left me for 24 hours.

 

MY FIRST impression at the hospital was of massive noise. Some of it was made by the crowds of people waiting in the corridor. I learned later that there were 62 patients waiting to be admitted that night; some were still lying in the ambulances that brought them. Sometimes it is more. The noise was relentless.

As I lay there in the chilly draught from the automatic door, I thought that it was like a single-decker bus built in 1960, which had an upper deck fixed to it in 1980, and was now struggling up a steep hill and stopping every hundred yards at a crowded bus stop to let off a few passengers and let on twice as many.

Soon, all the seats are taken, and then children are shifted on to parents’ knees and the aisle is choked with standing passengers who shuffle forward under pressure from behind. The top deck fills up, and then people are sitting on the stairs. Of course, we’ve been promised new buses in five years, but that is little consolation to the load of suffering humanity on this particular wet November night. Lack of realistic forward planning and financing has cruel effects.

How long it took us to reach the triage station, I have no idea. It felt like hours. Once we got attention, the process was remarkably brisk. All my medical notes had been sent on ahead with the report of the rapid-response team. From the triage post, there were several different routes to sort out the different medical specialities. The noise was persistent, but with a more incisive tone here — purposeful. People giving directions, making decisions, taking notes.

The system of record-keeping seemed to be highly organised. My blood pressure and temperature were taken at least ten times. I got regular mugs of water because I was dehydrated; wherever I went, my accumulating notes floated along with me.

So did one demented old woman in a wheelchair behind us, with her angry daughter trying to calm her down. It was obvious that many of the people in the queue could have been sifted out by a rapid-response team. But where would they have gone? The number of patients with mental problems was a shock. One clearly psychotic man disturbed the whole system for quarter of an hour. “What do we do with him — push him out into the rain?” It wouldn’t look good in the paper.

 

TRAFFIC management in A&E is a nightmare. Negotiating a trolley in that environment is like driving a “bendy bus” around Piccadilly Circus. We inched on into the internal workings of this huge machine. The scale of the operation reminded me of an aircraft-carrier in a storm.

Eventually, we found ourselves parked in another corridor — I have no idea for how long. A chance encounter with a nurse whom I had met on a previous visit got us surreptitiously sidelined into a curtained cubicle, which was a bit quieter, and my daughter had a chair. I was then pushed out through the hubbub to be given a scan inside a shiny white doughnut, which muttered and burped as it swallowed and regurgitated me. The scan is automatically sent to the United States to a specialist diagnostic unit and returned 30 minutes later to the A&E consultant with analytical comments.

Some time later, Tom appeared, a large man with hands obviously adapted to holding a rugby ball. He was immensely placid, but I was a bit nervous when I saw him fumbling with a cannula. He inserted it with a dexterity and gentleness which amazed me. After several chatty visits, he discovered that I was a priest, and immediately embarked on a voluble theological disquisition of the “Rapture”.

istockParamedics and a nurse wheel a patient through a corridor in the Accident & Emergency Department of a hospital

I must have met or seen 20 or 30 mostly exhausted nurses and doctors during the time I was in hospital — with only one did I see any obvious signs of exasperation. Sophie wore a pedometer which showed she had done 12,000 steps on this shift with four hours to go.

We stayed at the side of the women’s ward for an hour or so, being frequently promised a bed when one became vacant on another ward, which was at present blocked by patients waiting to be discharged as soon as social services could find carers at home for them.

Hours later, the highly professional senior consultant walked past. He stopped and looked at the nurse beside him. “Is he still here? That needle can come out; he can be discharged.” He nodded, scribbled a note on my pages, smiled, and burned off. A rather impersonal dismissal — obviously, institutionally logical in the global context of such stress, but I might as well have been an overripe apple in a supermarket stall. I can’t blame him for feeling that there was no time for friendly chat, but it does reveal how small gestures of simple humanity get squeezed out under constant pressures of the machinery.

After half an hour, at 2 p.m., we ended up in the discharge lounge with the promise of an ambulance at 4.30 p.m. to take me home. At 4 p.m., the ambulance was delayed until 5.30 p.m., at 5 p.m. till 6.30 p.m., at 6 p.m. until 7.30 p.m. Finally, with immense relief, I was wheeled out into the damp darkness and driven home at high speed by two delightful paramedics.

It was then that the most astonishing instance of the humanity of the NHS occurred. As I was lifted out of the ambulance, my daughter noticed that I had lost my spectacles and hearing aids. She immediately proposed driving back to the hospital to rescue them. At this, the paramedics said that she was in no condition to drive and offered to go back to the hospital and post them on if they found them. I was faced with the prospect of being three days deaf and unable to read.

An hour later, they turned up again with the lost items in their own car. They had driven back to the hospital, returned the ambulance to its base, found the precious possessions, driven back to my home in his own car, back to the hospital to pick up her car, with then the prospect of a 90-minute drive back home to Wales.

 

THE whole experience was both traumatic, mind-blowing, and revelatory. I have since tried to understand why it had such a profound and lasting impact on both my daughter and myself.

She works in a tough primary school in the East End of London, among a population of 20-per-cent immigrants, mostly towards the bottom end of social deprivation. But as she sat sleeplessly beside me, observing the passing scene with a teacher’s keen eye, she realised she was seeing a stratum of deprivation in British society below even the bottom level of the East End.

The second revelation is of the dedication and richly humane ethos of the medical staff. I was treated with far more than respect, with a kindness and good humour and sympathy which could transform Britain if you could distil it and bottle it. It is at this point that we touch on the beating heart of the NHS, and the golden elixir in the institution which we are in a danger of losing or wantonly destroying by monetising care. Surely this is part of what makes Britain really great.

 

WHAT is the cause of this wretched — should we say wicked? — situation? Yes, there is a huge shortfall in funding: £6.5 billion on capital projects and pay for the 100,000 staff who have been axed to pay for Trident. But those are symptoms of something much deeper.

At base level, it is a gross absence of real empathy and imagination among Britain’s comfortable classes, to which I myself belong. While the Holocaust was being perpetrated on their doorstep, the comfortable classes in Germany allowed the Shoah to go on its grisly course for eight years. Many of them alleged afterwards that they did not know what was happening. A German professor once admitted to me that most people knew that something wicked was going on, but were too scared to protest. Few people in China will risk making a fuss about the concentration camps in north-west China where President Xi is conducting genocide of the Uighur people. Think the wrong thoughts and you will be disappeared.

The struggle between heart and head, between imagination and technology, has been going on for nearly three centuries. Technology has miraculously built the machinery of the NHS. Christianity nurtured its ethos. Keats wrote movingly about unweaving the rainbow. That’s not just aesthetics, it’s our core humanity. It might seem ridiculously over the top to talk about the Shoah and genocide in this context, but it is true that the seeds of revolution are sown when the wealthy have no imaginative empathy, no real feeling for the misery of the poor. Spending a weekend in A&E as a patient would soften their hearts, if not break them! The same is no doubt true of child poverty and the cruelty of our prisons, which are a symptom of our moral depravity.

Free-market capitalism might be a beautiful algorithm for the wealth of nations. It is a cruel and inhumane ideology dear to hearts of only the wealthy to abate any residual twinges of conscience they may feel about the suffering they are causing or colluding with.

The sheer scale and intensity of human misery being revealed in our welfare state is almost unbearable when one has to endure it or see it first hand, as I have recently. As a card-carrying member of the comfortable classes, I could never vote for a party which has so little human empathy for the consequences of its inhumane heartlessness, or truly heartfelt admiration for the remarkable men and women who are dedicating their lives to a task which was at the top of the ministry of Jesus Christ.
 

The Very Revd Hugh Dickinson is a former Dean of Salisbury.

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