Reflections on the NHS

When I left school, our Head Master made a memorable speech based around three thoughts, one of which had to do with the benefit of experience. He made the point that as you go through life, you will find that everyone has a view on things – particularly institutions – but usually, every opinion they hold is based on hearsay. He told us what a privilege it always is, whether you have loved something or hated it, to be able to base your opinion on the solid foundation of having actually known what it was like.

I thought of his advice this week after I had spent a week in hospital, getting my first experience of the NHS since I had a minor operation as a 7-year-old. Very rare visits to the GP aside, I have had no personal interaction with any part of our health service since 1978 – other than the natal wards, which seem to me to be such a ring-fenced part of the service that I am not sure that they count.

The conclusion I have drawn is that the NHS does one thing unbelievably well, with the pity being that it is true in both senses of the word: crisis.

The efficiency of the operation that I witnessed when things were going pear-shaped was awesome to behold. From the much-maligned 111 service onwards, it was impressive. The paramedics called ahead after they had picked me up: this was a cardiac situation, they explained, not one for A&E. That meant they were going either to Hammersmith Hospital or to St. George’s – so which should it be? The answer came back that St. George’s was busier. To Hammersmith we went.

On arrival, everyone was ready. An entire team took me in, cleared me up, and sorted me out. From start to finish, it had been seamless. There is no doubt at all that between them, they saved my life.

But having immense admiration for everyone involved cannot mask the obvious inefficiencies in the system which became apparent as I progressed through the next few days. Of course, because I was recuperating, I was never in any rush, and was always happy to wait for things to happen, not least because I had a comfortable bed; I was being looked after; and I had plenty to ponder on, read, or watch. But it was striking how long was every delay between any decision being taken and any action being implemented – an extraordinary phenomenon best exemplified by my discharge last Thursday. Told I could go home the night before, I was then asked to stay overnight. Did that mean leaving mid-morning, I asked? No,  they said: it will be 2 by the time we’re ready… But at 11.45, that became 4; and at 3.45, six. It meant I got a cab home when I was finally discharged.

In a similar vein – more worrying still, perhaps – the most shocking thing about Hammersmith Hospital is its lifts. I couldn’t fault my ward: it was clean, well-equipped and more than adequately staffed with people who, if they are as stressed as anecdote relates, betrayed none of their concerns. But to get from one floor to another for anything – a scan, a check-up, or even a life-saving operation – took at least ten minutes.

There were two lifts in my wing. One was not working at all, and the other regularly went on the blink. Hospital porters would lean on the doors to ‘help’ them close, but at least one in three attempts to move floors would result in an automated voice saying that the lift was out of service. Once it recovered, a few seconds later, it would creak up and down, full to the max and opening at every level to expectant crowds. They would have to await its next pass, at a minimum, before they could get in.

What point is there in having world class cardiac facilities on the first floor of a building that you can’t get to because there isn’t a lift up? It seems the most basic and obvious thing in the world,  and – you would think – not terribly expensive (in the context of the overall budget) to put right. But it was clear that this was not some recent breakdown: everyone knew that they had been like that for years.

It’s odd that nothing has ever been done about it, and the fact that nothing has suggests that it isn’t an unusual phenomenon. Unlike the issues of bureaucracy, it has an obvious – and easy to implement – solution, which isn’t even that expensive. Like a lot of things in the last fortnight, I’m still trying to work it out…