Ozva AdminJust before Christmas my brother Tom slipped on some ice while loading the trunk of his car and fell and broke his arm badly. It was terrible luck, but that’s life. Accidents happen: he is 47 years old and otherwise in good health. He will live.
I must say at this point that he is not looking for sympathy. You have allowed me to reveal this because what happened over the next three weeks goes to the heart of an issue that I believe is partly responsible for the mess the NHS is currently in. And perhaps it will also give us insight into a much-needed solution.
After limping back inside, Tom quickly realized that the accident was serious: he managed to get his shirt off, and his left elbow was visibly deformed. He too was excruciatingly painful and made ominous grinding noises when he tried to move him.
After letting us know she was about to leave for a family reunion, she took an Uber to the nearest A&E.
What happened over the next three weeks goes to the heart of a problem that I believe is partly responsible for the mess the NHS is currently in. And perhaps it will also give us insight into a much-needed solution.
We’ve all heard the stories by now: emergency departments are beyond crisis point, battling an outbreak of flu and other nasty bugs on top of the normal winter pressures, nurses and paramedics on strike, and staff absenteeism.
Flooded hospitals warn patients to stay away unless they are dying. Last week some MPs suggested that the army needed to be recruited, with one dramatically likening the situation in a York hospital to “war zone-like carnage”. My brother’s experience at his local A&E was no exception: elderly patients were lining up out the door at 10:30 on a frigid Sunday morning.
As my mother, a retired oncologist who came to sit with him, said: ‘All of humanity was there. There was a woman screaming and passing out on the floor from the pain, and probably four times as many people as she should be in the waiting room.
And yet, despite all this, the system worked.
Tom was seen by an A&E doctor after about two hours and had an X-ray taken. It turned out that he had dislocated his left elbow and the lateral condyle of the humerus (the outer part of the lower part of the upper arm bone) had been completely fractured.
The doctor, assisted by two nurses, reduced the dislocation: Tom was given gas and air to distract him from the agony while they pushed the joint back into place.
It was all over quickly, and his arm was put in a cast.
After a night on a cart in a side room, she had a CT scan that confirmed she would need surgery to reattach the floating fragment of her arm bone with screws and plates.
He was later discharged.
Tom’s summary, having spent 24 hours on the NHS frontline: “It was really quite chaotic.” However, everything somehow continued to work.
After that, however, the wheels came off. Upon leaving A & E, my brother was told that the trauma nurse would call him the next day to schedule his operation for the following week. But the call never came.
In addition to being extremely uncomfortable and disabling, fractures like this don’t have to be fixed right away. However, if you wait more than a few weeks, it starts to heal, but out of position, making it difficult to operate on later.
In these cases, even after surgery, patients may be left with limited movement, even deformity.
With this in mind, after five days of silence, Tom phoned the hospital.
We’ve all heard the stories by now: emergency departments are beyond crisis point, battling an outbreak of flu and other nasty bugs on top of the normal winter pressures, nurses and paramedics on strike and staff absenteeism.
The switchboard tried to put him through various departments, but the phone rang every time. Finally, he spoke to someone who couldn’t answer any questions and then turned it over to someone else who said “a coordinator” would call him back shortly.
That didn’t happen. So she tried to call again, and the phone still didn’t work. This maddening dance went on for days.
As Tom said: ‘I just wanted someone to confirm that I was on a list. When he did get to talk to someone, he was always very nice, but he didn’t seem to have a clue what he was supposed to do.’
As I mentioned, my mother is a retired doctor, so she knows a little about navigating hospital phone systems.
The following week, he tried to help, but had the same problem: phones would ring and ring or go to answering machines that wouldn’t take messages. She spoke to someone at the fracture clinic who said ‘a manager on duty’ would call back in ten minutes and…she guessed it. Nothing.
On December 29, 11 days after his accident, after spending endless hours chasing with no solution in sight, my brother gave up trying with the NHS.
Instead, he called the private service at King’s College Hospital and was told to come in for an assessment that afternoon.
A postscript to the story: the day after he booked into the private hospital, he called the NHS hospital to let them know they no longer had to worry about him. The trauma nurse called him 30 minutes later. He apologized. He had been sick, he explained to her, and there was no one else in the entire hospital to cover for him.
He said they “might” schedule the operation for the following week, but could not guarantee it.
So Tom decided to go ahead with the much more expensive option and had the private operation two days ago. He will be in a cast for another month or so, but with much less pain. He too will be £6,000 worse off, but luckily he had savings to plunder.
But many people don’t. What are they doing in situations like that? I’m afraid to think
Much has been said recently about why this sort of thing happens in the £150 billion a year NHS.
Unprecedented demand, insufficient staff, insufficient funding, delays due to the pandemic, sick elderly occupying beds due to lack of social care, patients who go to the ER unnecessarily…
But what I saw in Tom’s case was a lack of basic administration and management.
As The Mail on Sunday’s health editor, I speak regularly with doctors and other health care personnel. I know how hard they work. I have the utmost respect for what they do in impossible situations.
But what hope do they have if the administrative system around them fails to get things organized? When a lone trauma nurse is the only person in a major hospital with such an important role, so that when he is out there is no one to call injured patients and organize vital operations, it is simply mismanagement.
Managers make up two percent of the NHS workforce, up from just under four percent a decade ago. There was a narrative a while ago that the NHS was over-managed. ‘Bean counters,’ some called them.
In the private sector, however, managers make up one in ten of the workforce. And I would argue that, when properly trained in problem solving, they are absolutely essential to any health service: studies show that even increasing hospital managers from two to three percent of the workforce led to improved satisfaction of the patient and 15 percent. percentage reduction in infection rates.
Of course, the challenges facing the NHS are myriad and complex. There’s no quick fix, but I’d say just throwing more money at the problem isn’t the answer. It’s how it’s spent, that’s the problem.
Doctors I know are incredulous at NHS Trusts’ advertising for a £115,000 a year ‘lived experience director’, or a £40,000 a year ‘mindfulness leader’ and other ‘equality, diversity and inclusion’ roles (EDI) – 187 of them last year, costing the NHS more than £8m.
This is just playing while Rome burns.
There are some signs that chief health officers have come to their senses: it was reported last week that EDI targets are being cut.
Perhaps this will allow the NHS to focus its attention on more pressing matters, such as making sure broken arms are fixed.
Ozva Admin
