Pervasive NHS inadequacies

When Florence King's husband was admitted to hospital for a major brain operation, she discovered how, while the National Health Service is superb at matters of life and death, it often fails badly at the smaller touches that mean so much to patients . . . She explains: 'Over the past few months, my husband has had a major operation on the NHS and half-a-dozen follow-up stays in hospital. 'The medical treatment has been beyond reproach. He is making a good recovery and we can only express our gratitude. 'But so close and extended an experience of hospitals - not just of the one where he had his operation, but other hospitals where he underwent tests - highlighted a whole range of areas where a little thought would have improved the experience for patient and visitor alike.

'Many of the faults would cost little or nothing to remedy: it is more a matter of attitude than money. The overwhelming impression was of a system - as years of almost permanent revolution come to an end - that is expensively over-managed at the top and grievously undermanaged at the patient level. 'Most of those involved, including nurses and ancillary staff, are so wrapped up in the system that they fail to appreciate how it looks and feels to the people in their care - the people who are, after all, the whole reason the hospital is there.

'Before his operation, my husband could barely walk. He needed door-to-door transport, which meant the car. And when the hospital is out of town, a car makes visiting more flexible, which is how I encountered that most vilified of "hidden" NHS costs: parking charges. 'Now, I completely understand why hospitals in urban areas or on small sites levy charges: they don't want parking spaces that their staff need clogged up with visitors' cars and they don't want commuters squatting there for free. 'And if you have a disabled sticker, as my husband does, you do not have to pay to park. No complaints there.

'As an able-bodied visitor, though, I stuck to the rules, which meant shelling out more than 30 pounds for each of the first two weeks, until I discovered that, as a regular, you could buy a weekly season ticket for 12. 'I would not say, though, that they were exactly advertising that fact. The aggressively worded instruction boards at the car parks warned - among other things - that it was an offence not to display a valid ticket; that the machine dispensed no change; that the charge had recently gone up to 2 pounds for three hours; that charging operated 24 hours a day, seven days a week; and that there were regular checks. 'Oh yes, and they warned that thieves were about - so the patrols were about money, not security. Thanks.

'I discovered the good news about season tickets by chance, from the small print of a leaflet in the hospital coffee shop. But not before learning how more experienced visitors coped. Dozens park on surrounding roads, which creates traffic jams at visiting times. 'There was also what seemed a well established practice of passing your ticket (with its unused time) to a new arrival as you left, or leaving it on the machine for the next person to pick up. That seems fair enough. 'The 2 pounds-for-three-hours charge particularly grated because official visiting hours are two separate sessions of two hours. This means you have to pay at least 4 pounds if you visit both times.

RECEPTION

'As an arriving in-patient, my husband would have an official letter and a window of time allocated for his arrival. Invariably, there was no one manning the central reception desk or the entrance to the ward. 'Despite all the stories you hear about poor hospital security (from petty crime to stolen babies), I have entered and got lost wandering around every hospital my husband has been in. Invariably, no one has challenged me. 'Signposting is absolutely hopeless: non-existent, inconsistent; or in such impenetrable jargon that no outsider has a clue.

'Some reception desks, it turns out, are staffed only at certain times or particular days of the week, and the staffed hours bear no relation to when new patients actually arrive. For whose benefit, you ask, are they manned at all? 'Sometimes I had to winkle semi-willing staff out of adjacent side rooms where they were on a break.

'One newer hospital of my acquaintance, a positive paean to the Private Finance Initiative, has an atrium that rivals any major airport with ranks of reception desks to match, except that only the central desk is staffed - so there are muddled queues. 'It is too expensive to staff the other desk said a grumpy porter. All this public space - which has to be cleaned, heated and lit, if not actually staffed - is an extravagance. 'It is also intimidating for semi-mobile patients, who find themselves having to hobble enormous distances, even if lifts and automatic doors make it a great deal easier than in older hospitals. 'Why was the money spent on a lavish atrium rather than separate wards rather than separate bathroom facilities for men and women?

DOCTORS

'The doctors I dealt with were, without exception, informative and calming. It was almost as though they had graduated from a course in "dealing with patients and their relatives as intelligent people and how not to alarm them". Perhaps they had. 'I didn't feel at any time that the top specialists were patronising me or my husband, and they seemed to make conscious efforts to avoid using impenetrable technicalities.

'I do not doubt, though, that having doctors in the family and long familiarity with the medical minutiae of my husband's illness probably helped communication. In general, the junior doctors seemed more off-hand.

'If I have a complaint, it is the general invisibility of doctors outside the ward round. Of course, they have other places to be: in the operating theatre, seeing acute patients, lecturing. 'But they seem to inhabit a planet from which they occasionally descend, with a certain delay for effect, at the behest of ever-changing teams of nurses. The continuing, and glaring, doctor-nurse divide left me feeling that some doctors found it easier to talk to me than to the nursing staff.

VISITORS

'As visitor, you would go into the ward - sometimes you had to ring to be admitted, sometimes not - and want to announce yourself to someone. 'I felt that someone should know I was there; that it would be better not to wander around the beds looking for my husband (sometimes he was in a side ward, sometimes not); and it would be useful to know before I saw him how he was. 'No one, even at official visiting times, routinely met the visitors. Official visiting times existed, and there were rules discouraging young children and more than two visitors per patient. But hospitals seem to make a virtue of permissiveness. 'When my husband was very ill, I was grateful for the flexibility. But permissive visiting makes for a lot of coming and going. 'Not enforcing the rule about young children and multiple visitors made for more noise and bustle than my husband easily tolerated. It was, frankly, an imposition.

NURSES

'WHEN my husband was admitted to the hospital ward, I saw a notice on the wall behind the nurses' desk team saying: We operate a team nursing system." I soon discovered that this meant that no one individual was in charge - everyone was equal. 'The combination of having no one visibly in cahrge and incomprehensible shift patterns meant neither patients nor visitors had any obvious continuity.

'My husband seemed to receive his medication with punctilious regularity, and was duly recorded, along with any problems, in the handover log. 'But there were slips and times when the log was completed with a delay: "Whoops, I forgot, but I know I gave him his dose . . ." 'Every individual seemed to have a high sense of personal responsibility. Yet the fact no one demonstrably in charge left doubts. It all seemed a bit haphazard.

'I was not made to feel unwelcome. On the contrary, at mealtimes I was cheerfully called up for feeding duty. I just felt that a single, obvious contact point every day would have been desirable. The counter-argument, of course, is that everyone is too busy and hierarchies belong in the ark.

NOISE

'Thank goodness: with the introduction of individual screens, the age of the blaring TV at the end of the ward is over in many hospitals. 'But it was not only the visiting times, as my husband told me, that could be noisy. Nights were also noisy, and only partly because some patients became agitated. 'My husband's biggest complaint, though, was about the nurses and their chatter and laughter. He was on a ward for patients who'd had brain operations or suffered brain injuries. They really needed quiet. Again, who is a hospital for?

HYGIENE

Ward hygiene was good. The hand-washing and disinfectant messages have got through to the staff. I have to say, though, that I didn't like seeing nurses arrive and leave in uniform.

'I was surprised that most patients, except the very ill, were encouraged to wear their own clothes, which meant I had a pile of dirty laundry to take home a couple of times a week. I have a car and washing machine, but some relatives might not.

'What I found shocking was how often nurses seemed to prefer the patient to soil himself rather than help him to the commode. 'At one point, my husband was well enough to be detached from a catheter, but still too ill or slow to get up or reach for the urinal in time. A more considerate attitude by the nurses, not necessarily more of them, could have reduced the number of 'accidents'.

'In two hospitals, I complained several times about the lack of loo paper and general filth of the lavatory facilities for visitors. Nurses and ward staff say it is nothing to do with them and I could never find anyone who'd admit to having responsibility.

FOOD

'Meal service was separated from nursing everywhere and seemed to have a life of its own. 'The times were generally not too uncivilised, and the quality and choice were better than both of us had feared. 'My husband could also ask for toast or an ice-cream at almost any time if he had missed a meal or felt peckish. He lost a lot of weight while recovering from his operation and enjoyed these little extras.

'But, oh, the service! OK, so you don't expect restaurant standard or even charm. But I think you could expect to have the plates set down somewhere where you might be able to reach them in the order you might want to eat what is on them. 'And the amount of time allotted for eating was minimal, so the hungry patient feels pressured to gobble, and anyone who has difficulty eating simply gives up. Those who made a fuss generally got fed, but often had to wait so long that the food was cold.

'Expectations about patients' ability to eat when in bed were unrealistic. While nurses and meal staff equipped themselves with disposable plastic aprons off a big roll, patients had to make do with a tiny paper napkin. 'A disposable plastic bib or a cloak like the ones you have at the hairdresser's would be a vast improvement.

'It would also be a good idea for someone to review all the menus for ' eatability'. Roast chicken came in joints and was clearly popular, but my husband could not have begun to tackle his if I hadn't been there to cut it up; he could not even lift it! 'Anything that cannot be picked up easily by hand, fork or spoon is a nightmare. Even boneless meat, if it is in one piece or drowned in gravy, is a challenge. I especially dreaded 'pea' days - they ended up all over the bed.'

TELEPHONES

'A lot of people complain about the tariff for hospital phones. All the hospitals my husband has been in, though, allowed patients to use their mobiles, which most did with discretion. That's good.

TELEVISION

'I know that if I were in hospital and reasonably conscious, I would love to have my own TV and radio. The arrival of bedside TV and games consoles - a bit like those in passenger planes - is a great advance.

'Aha, but the NHS has news for you. It is not as simple as it seems. First of all, you need to pay, and while I would be happy to do so, the system seemed expressly designed to extract the maximum amount of money in a rather deceptive way. 'You could pay for a day, three days or a week. But the time was consecutive. So, if you had an operation on day two and were incapable of watching TV that day, you lost that day. To pay for just one day, though, was much more expensive.

'The method of payment left much to be desired. All right, you can't expect nurses to collect TV fees. But you have to buy a card at a slot machine that says it gives change and accepts notes, but doesn't, or pay by credit card on-screen. 'For me, able-bodied and equipped with a mobile phone and credit card, this was complicated, didn't work initially and necessitated two frustrated calls to the inquiry desk.

'For my husband, with fingers that didn't work well, problems with his voice and difficulties sitting up (before the operation), setting up the TV payments would have been impossible. In the week after the operation, it was even worse. 'Plus, his bed was moved first to a different ward and then to various positions in the ward. Each move meant having to re-start the TV, using a long ID number. Mostly, he gave up. 'And a head operation meant wearing a headset was not just uncomfortable but impossible, yet no earpiece was on offer.

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