Posted by: talkjack | October 11, 2008

Talkjack’s NHS hospital experience

Perhaps I should have called this article ‘Dear NHS, while you are talking about patient dignity, please leave my penis alone!’ Read on to see why!

Day Surgery Day finally arrived! After months of waiting and a raft of tests, I woke up on the morning nervously realising that the big day had finally arrived and I was due for day surgery at my nearest NHS hospital in Coventry. This is the only hospital which was available to me for the treatment I needed. The Choose and Book system had been a facade.

Here are some of the highlights of my day:

I was determined to remain in high spirits throughout the day, and am pleased to say I achieved this. I was friendly and polite to everyone I encountered.

I did not suffer too much from hunger during the day. I was booked for surgery in the afternoon so was able to have a small breakfast and some water later on. I recall only 24 hours earlier, frantically trying to research the fasting requirements at work because I had not received my letter.
Environmental unfriendliness

Being unable to afford the parking fees I chose to walk to the hospital carrying all the stuff I was told to take with me. To take public transport would require two bus journeys; the first in the opposite direction all the way into Coventry City centre and the second back out to the hospital. This triples the distance travelled and is environmentally or financially efficient. I have always felt that the bus service in Coventry is geared up to maximise journey distance and profit, and has scope to be much more eco-friendly.

Upon arriving on foot at the hospital grounds there is another 10 minute walk from the road to the main entrance. There was no public transport to save walking this last half mile or so. I walked past big signs banning smoking in the open air, and plenty of red lined roads and obstacles to car parking anywhere except on the expensive car parks. Ten years ago there were many cars parked out of the way of roads and footpaths upon grass verges on the hospital. These facilities have gone now that the NHS has imposed their huge car parking charges. The ‘free’ car park near the entrance now has a barrier and appears to be reserved for paying staff only. I imagine all these manipulations help the NHS managers to make more money from ill people.

Approaching the main entrance on foot, one is forced to cross the road twice. As usual I found buses waiting there with their engines idling. This forces sick people and their visitors to inhale exhaust fumes as they are steered across the road to the central bus stops. This is dumb. In the interests of health and safety, bus drivers could switch off their engines when waiting for several minutes, but they do not. See what I meant about there being scope for the buses to be more eco-friendly?
Next I traipsed past all the smokers. The NHS has a voice recording playing constantly, proclaiming that the hospital is a smoke-free area. (But not a diesel fume / pollution free area I thought!). The anti-smoking noise pollution seems to have no affect on the array of smokers I was forced to walk past, other than some of them hide around the corner. Really, the NHS haven’t thought this one through, have they?

Get Lost!

Lungs full of diesel fumes and second hand cigarette smoke, I entered the hospital. I found and tried to use the toilet, but there was a queue at the gents again, and my appointment time was imminent. I decided to hold it, and look for the correct reception area to report to.

Not having a medical background myself, it took me a while to work out that the NHS use the terms ‘Day Surgery’ and ‘Short Stay Surgical Unit’ interchangeably. At least it appears so, comparing the written instructions in my letter to the signage at the hospital. After some confusion and wandering around to check all signs in the main entrance area, I fast walked across the hospital and arrived at the correct reception area with seconds to spare.

After a short wait I was taken through with a group of people into the Day Surgery Ward. (I’ll stick with that name). I was taken to the far corner of the room and plonked inside a small area delimited by a curtain. The area was just big enough to squeeze in a trolley (half sized bed on wheels – the NHS may have another name for it) and a chair.

Upon the bed were my patient notes, lying where any other patient could have picked them up and read them. This, of course, puts patients at the risk of being identity theft victims. Not very clever of the NHS to do that, I thought. I was left unattended for 15 minutes, so I glanced through my own notes to pass the time.

Patient indignity

A nurse walked up to me and exclaimed ‘You haven’t got changed’ I smiled and replied ‘Sure, I can do. No one asked me to change’. The nurse glanced down at the bed and said ‘Oh, they haven’t given you a gown. She then went and fetched me a gown to change into.

I closed the curtains and changed. Just as I removed my trousers another nurse stuck her head through the curtains without warning, paused for a couple of seconds then went away again.

I changed into the gown, and the original nurse tried to help me do it up. This proved impossible because I had been given a damaged gown with some of the fastenings ripped off the side. So I spent the rest of day with my backside sticking out of the gown. Strike one point for patient dignity.

I offered the nurse the urine sample the NHS letter told me to take. No one wanted it. Not having a suitable bottle at home for this, I had purchased one specially. I ended up carrying a bottle of my own pee to the hospital and taking it home again. Strike another point for patient dignity.

A nurse weighted me and took my blood pressure and pulse rate. I was told that my pulse was a bit high but not too much. I explained how far I had walked in carrying my gear.

I waited around for a while, until the surgeon came. He drew on my chest with a marker pen, then told me he was doing three operations that afternoon and had not yet decided in what order to perform them. It later turned out I was second of the three.

I needed to use the toilet. A nurse gave me directions and I wandered off, keeping the rear of my gown closed with one hand. I only found a single disabled toilet where the nurse directed me. I spent another two minutes looking for the gents, then. In danger of wandering too far I gave up and returned to the disabled toilet. I later found out that the disabled toilet was the only one available for that ward.
I returned to my trolley. More waiting around, which I had anticipated. Feeling hungry now.
 
Whilst waiting I was interviewed several times by NHS staff about when I had last eaten or drank anything. I was asked if I had painted my toenails. I would have liked to have responded in an Al Murray Pub Landlord voice ‘No, I’m normal!’, but I remained calm and slightly amused.

I was asked if I had any metal on my person. No I replied, except for a crowned tooth. This proved insufficient. The nurse went on to ask question me twice more on this until I had firmly established that I do not have any genital piercings. I can guess why the NHS has to be certain about this sort of thing before an operation, but I was embarrassed by the question. I thought I had covered the subject with my initial answer. Strike a point for patient dignity.

When my turn came to be taken to surgery there was a problem. It was a bit vague, but for three quarters of an hour I was asked in the anaesthetist had seen me yet. They had not. No one turned up for that. Apparently the anaesthetist should have discussed things with me before the operation.
In the end they gave up waiting and wheeled me off to be operated on. I was told to leave my slippers behind, which I did.

Two nurses wheeled me along on the trolley. After a few paces, one of them put down a clipboard of notes. To be specific, she put it down resting right on top of my penis. As they wheeled me along the trolley, the notes slid left and right, and the two ladies occasionally pushed them back to the middle. To be frank, I did not enjoy having my penis pushed from side to side repeatedly. Being an old school English sort of guy I was too polite to say anything. I lay there quietly feeling embarrassed.

When we reached the lifts the nurses apologised to me because one of the lifts was out of action. We spent five minutes or so waiting for a vacant lift to arrive. Ironically the nurses started having a discussion about patient dignity whilst they each in turn picked up the notes off my penis, glanced through them and then put them right back on top of the old chap!

The nurses expressed their concerns about patient dignity because patients had to share a single lift with orderlies. I did see some young guys wheeling equipment along, they too were waiting for the lift. They politely waited around the corner to avoid me seeing them, glancing periodically through the glass panel to see if I had gone up yet. Given the uncomfortable penis situation, I was entirely unconcerned about orderlies waiting for a lift, although the nurses seemed to think it mattered.
Strike more points for patient dignity!

Whist waiting on the trolley I tried to distract myself by reading the graffiti on the broken lift door. It appeared that hospital staff had affixed a piece of A4 paper to the lift door; a handwritten note about the lift being out of action. I presume that the graffiti was written by staff, criticising the Estates department. My favourite was ‘How inept are these people?’ to which someone had replied ‘Very!’.

I arrived upstairs had had a chat with an anaesthetist. He was an Indian chap who spoke perfect English in a clear, comprehensible accent, and he was very friendly and helpful. This is important to me because I have a hearing impairment so I often struggle to understand people with strong accents, or those who speak poor English. Please do not interpret this as racism on my part. Ignorant politically correct people sometimes do so, which I find that hurtful and rude.

Pillowgate!

Moments away from going into theatre, there was a major crisis. At least the only member of staff in a blue uniform made it seem so. It appears that, like several other people, I had been sent to theatre without a pillow. The lady was very vocal and seemed rather annoyed about this. She said that patients were not allowed into her theatre without a pillow. I could see clean pillows on the shelf near the clean linen, but they must have been reserved for more important people because I was not allowed to use one during my operation.

One of the nurses from the Day Surgery ward was waiting next to my bed until I was taken into the operating theatre. She was ordered downstairs to go fetch me a pillow from her ward, and dutifully obeyed.

In the mean time, another friendly, helpful lady came and needed to wheel me off to surgery. The operating team were ready to begin. Rather than delay for a pillow from downstairs, and being unable to use one of the pillows from upstairs because the ranting lady would not let anyone take them, the lady from the theatre team improvised a pillow from a blanket and pillow case. I liked this lady; I would have done the same thing if the situation had been reversed.

The big moment

The final journey to the operating theatre was interrupted because the staff had blocked the corridor with equipment. There was a short scuffle with empty beds and other kit I could not identify before enough room was made to squeeze my trolley down the corridor.
Outside a set of double doors I was asked to step down off the trolley and walk out of the corridor into another room, then climb onto another trolley. I managed to do this OK, but was trying to hold the gaping rear of the hospital gown closed with one hand keep my backside covered. At the same time I wondered exactly how clean and MRSA free the floor was here, because I hated being barefoot in this busy corridor outside the operating theatre. Maybe I am paranoid, but there are a lot of newspaper reports of large numbers of deaths under NHS care in recent years due to superbugs such as I did not witness a single member of NHS staff clean their hands the whole time I was at the hospital as they went from patient to patient, nor did I see anyone clean the floor. I wished I had been allowed to keep my slippers on.

I climbed onto the trolley for my operation, had a friendly chat with the staff while they knocked me out. The last thing I remember was the anaesthetist making small talk about my work, and the pain in my right arm as they drip-fed the anaesthetic into me.

I regained consciousness 20 minutes later, waking up from a dream about being at work. I was very sore and had a dressing on my chest. I have to say that the anaesthetist seems to have done a perfect job as I had no ill effects from the anaesthetic at all. This was a very different experience to the general I had when I was a teenager, which left me sick and unable to walk without falling over during the subsequent two days.

Recovery

When the people wheeling the trolley back to my ward took a wrong turn and paused to work out which way to go, I was able to give them directions. I spent the next few hours in the Day Surgery ward, and was given extra painkillers. These did the trick, as even the weight of a single bedsheet was extremely painful at the time.

There was an argument amongst the staff because I had been returned back to my ward on a bed rather than a trolley, and the tiny alcove I had been allocated was a bit too small to accommodate a bed. I was suffering a lot of pain, and was very glad they did not decide to make me climb onto a trolley at that point.

There was also a deal of conversation about a missing pillow from the Day Care ward, because a nurse had taken a pillow up to theatre, but I had returned without it. I wondered if the shouting lady upstairs was collecting them.

As the anaesthetic wore off I started feeling very hungry. Eventually, one of the nurses came over and offered me some food. I gratefully accepted the tea and toast which filled the gap. It was very painful to eat, but I got by without help.

Two minutes after I finished by fifth piece of toast, I felt pleasantly full. I was grateful to lay back down after the pain of sitting up. At that precise moment, another member of staff appeared and offered me dinner. I would have loved to have eaten the lamb stew she offered, which sounded much nicer than plain toast. Talkjack’s timing usually works out like this.

A nurse came over and gave me some pain killers to take away. She also sat down and with a piece of paper to explain my after-care requirements specific to myself and the hospital treatment I had received. Well, actually they were the instructions and private notes of the chap in the next bed, but I spotted this after 30 seconds or so, and the piece of paper was whipped out of my hand and replaced with the correct notes. I am normally quicker thinking than these, but it is understandable that I was feeling distracted and stressed.

Telephone racket?

To be honest, the rest of the waiting passed quickly. Eventually I was allowed to go home provided that I had someone to pick me up. My father had offered to do so, and was waiting for my phone call.
I had a problem phoning my father because my mobile phone had no signal. This sounds suspiciously like the NHS car parking racket. The hospital provides telephone facilities at a premium cost. The NHS used to ban people using their mobile phones claiming that they interfered with hospital equipment. Now that this ban has finally been lifted, the hospital faced losing revenue from sick people because there would be less demand for their premium telephone service.

The solution? Easy really, just install a mobile phone jammer on the premises so that sick people are unable to use the emergency mobile phone they took in with them.

To get around this problem I made my way just outside the building, where the mobile phone signal resumed. I phoned my father and waited for him to arrive. Feeling tired, I waited on the pavement amidst the smokers for my lift to arrive, filling my lungs with second hand smoke. Had the NHS allowed me to use my mobile phone indoors then I could have found an indoor seat and phoned from there.

Parking nuisance

My father arrived, he pulled the car into the drop-off bay, and I carefully picked a seat behind him so that the car seat belt would not touch my chest wound. At that point he tried to drive off, only was unable to do so. His car was blocked in with a vehicle behind, and a selfish person in front who had parked their car with the hazard lights on, blocked the exit from the drop-off bay and wandered off.
We had a five minute wait and eventually managed to squeeze our car out backwards. As we drove off I saw the selfish driver return to their car. It was a lady wearing an NHS identity badge who had blocked the road, ignoring the no parking road markings!

When I got home I washed my hands and feet for hygiene’s sake. My clothes went straight in the wash. Can’t be too careful given the NHS reputation for spreading superbugs, especially after you have been walking barefoot outside operating theatres and touching hospital door handles. I then had the luxury of spending a few days at home doing as little as possible while I recovered, managing my own pain relief with the thirty odd tablets I had been given.

Aftercare

I was instructed that my practice nurse would have to remove or change my dressings after 72 hours. I guessed correctly this meant to contact my GP’s surgery and book an appointment with their nurse, however for all I knew a practice nurse may have been a kind of trainee at the hospital. I was given some additional dressings in case they were needed.

I made the appointment with the practice nurse at the start of the following week. I spent an hour in the waiting room because her previous patient significantly overran their appointment. When I was seen there was some confusion over why I was there. I told the nurse that I had been given a letter from the hospital to be given to my GP, which I had handed in to the receptionist when I arrived. I wonder why the NHS did not use a computerised system to transmit this information to my GP’s surgery, or why they do not trust their own postal system.

The nurse removed my dressings, and got a colleague to check me over. They reached a consensus that I was healing well enough and it would be better to let air get to the wound. I left without a dressing on my wound, grateful that I had planned ahead and worn appropriate light clothes which did not rub. I would have preferred to remove my own dressing; I am sure I it would have been less painful to pull in the opposite direction. Oh, and I would have given myself less of a chest wax too!

The follow-up hospital visit

When I had left the hospital following my operation, I was told that I needed to come back six days later. The nurse said that I would receive a letter with my appointment time and place. No such letter arrived.

It took phone calls to the hospital on the previous day to find out the time and place the NHS wanted to see me. Confusingly, they never did send me a letter for this appointment. When I arrived they only had my name hand-scribbled on a torn off sheet of A4 paper along with the time. The receptionist told me I was a walk-in patient, whatever that is.

I knew I was in the right place, because I sat in the waiting area next to the guy who had been in the adjacent bed the week before. While waiting I did not mention that I had been given his notes to read! He seemed the short tempered type.

There was some more confusion when I arrived, because I had no dressing on my wound. I explained that I had been told to see a practice nurse after 72 hours, which caused some frowns to appear, but when they examined me the NHS staff seemed satisfied that all is well.

Conclusion

I have now returned to work, and the bruises from my operation have nearly gone. The scar is still visible, but is surprisingly small and not obvious to the eye. I still have some occasional mild pain, but I have full mobility and look forward to being able to exercise soon.

So there you go – a summary of Talkjack’s trip to hospital. You will hopefully observe as I did that the actual health care was pretty good,. However I could not help notice that the administrative management leaves much to be desired.

From a patient’s perspective there seems to be an NHS management goal to meet time-based targets, but equally a goal to raise revenue from sick people, their visitors and NHS employees through cleverly designed car park schemes and telephone charges which feel like a racket. No wonder Coventry’s Councillor Dixon dressed up as a highwayman for a newspaper article about the extortionate NHS car park charges in Coventry.

From what I observed throughout this process, the NHS health care professionals are mostly good, considerate, skilled people. The administration however let the NHS down in my experiences, and on occasion little incidents like mismanaged appointments, lack of clear instructions and patient dignity felt absurd and farcical. I felt that the health care staff did care about patient dignity, but staff shouting about pillows made me feel that there is some sort of stock check target for staff, which was distracting staff from patient care.

I consider that a correctly installed computer CRM type system would automate business rules for the NHS to ensure that appointment letters are correctly sent out, and that GP’s are given the correct information, whilst at the same time safeguarding patient’s confidential data.
 
Speaking as a patient about my ‘NHS customer experience’ I would suggest that if you have a valid complaint about the NHS then please reflect whether it is appropriate to take it on the front line staff. In my opinion NHS managers are responsible for ensuring that you receive good health care and good customer service. If you are unhappy or angry, please do not take it out on the health care or admin staff. Contact an appropriate manager instead and tell them what you experienced instead; if the manager is competent then they should do something to stop it happening again.

Having said that, if you have experienced any amusing, absurd or farcical treatment at the hands of the NHS the please feel free to leave a comment on this blog and share your experiences.

(c) Copyright Talkjack 2009

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