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OPINION

'After being an in-patient, I am in no doubt the NHS is in a humanitarian crisis'

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I have been extremely perplexed by the responses of the media, NHS health managers and parliamentary ministers to the public statements made by the CEO of the Red Cross that there is a humanitarian crisis in the NHS.

To start, I have looked up the definition of a ‘humanitarian crisis’.

It is as follows: A humanitarian crisis (or humanitarian disaster) is defined as a singular event, or a series of events, that are threatening in terms of health, safety or well-being of a community or large group of people. It may be an internal or external conflict, and it usually occurs throughout a large land area.

Humanitarian crisis - Wikipedia


I appreciate that we associate these statements with war-torn areas — areas where natural disasters occur or large pockets globally of need due to famine or disease occur. In 21st century Britain — in peace time — most of us are able to disassociate ourselves directly from being affected by a humanitarian crisis.

However, if you strip back to the wording of the definition, and you look at it in relation to individual or groups of people, I feel that it is an accurate description to describe patient and staff experiences. And, I commend the CEO of the Red Cross for stripping fancy management terms, such as the NHS is ‘distressed/stretched/challenged/tested’ etc., and actually making a clear and accurate description of the condition in NHS primary, secondary and social care as well.

This is a hidden humanitarian crisis that isn’t talked about unless you are directly affected by the need for these services.

I was recently admitted to the hospital via ambulance and would have to agree with this statement. I am a usually healthy 47-year-old. Following the GP guidelines, my husband rang our GP, who triaged me and advised the need to go to A&E. My husband rang an ambulance as I was completely immobile from the waist down. The ambulance rang me back and decided they would heighten the priority and dispatch an ambulance.

“The paramedics spent the rest of their shift (approximately four hours) waiting with me in the back of the ambulance”

Six hours later, the ambulance arrived. I was assessed, transferred via stretcher to the ambulance and taken to our local A&E department where the paramedics spent the rest of their shift (approximately four hours) waiting with me in the back of the ambulance as A&E did not have a spare trolley, and I was unable to sit in a chair.

The shift change of paramedics occurred. Still, many ambulances and crews were stacked outside A&E, which meant a bigger drain on resources as changeovers took place. This resulted in taxis being used to ship morning staff to A&E and take night staff back to ambulance stations to sort kits out before an onward taxi journey home!

This appears a huge drain on resources, but as importantly a huge emotional drain on staff and patients, further affecting their well-being, safety and health.

By the time I was seen, I was in agony after not having been able to pass urine for over 25 hours. Finally, I was catheterised outside A&E in the ambulance, triaged and treated for the initial and immediate presenting symptoms and condition, transferred to a ward for observation and review, and then sent home to be discharged to care of my GP.

I had not asked to be discharged; this was as per a hospital care plan with the advice from ward staff that if the condition did not resolve, or if it reoccurred, I could ring the ward and return in the morning.

 “The following morning, unsurprisingly my condition had not improved”

The following morning, as no proper exploration or investigation had been carried out, unsurprisingly my condition had not improved and was as it had been when I was admitted the previous night. I was still immobile from the waist down, and I was urinary and fecal incontinent. I did not have the ability to pass urine at all!

With a distended abdomen and excruciating pain, my husband rang the ward as per discharge instructions. He was informed there was no bed available and I could not return to the ward, so I would have to see my GP. My husband rang the practice but I was immobile and would have been unable to leave the house for an appointment.

With the structure of GP services, I was amazed but extremely grateful when my doctor came out to do a home call. He examined me and rang the hospital ward I had been discharged from hours before. He liaised with registrars from two regional hospitals, and finally managed to get me readmitted to a different regional hospital via ambulance and organised me some analgesia.

“If you total up the hours of resources used, this seems completely unreasonable given the strain on all services”

This took the GP a number of back-and-forth phone calls to my home, in addition to hours of making and waiting for calls from specialists and registrars (and presumably bed managers) from both regional hospitals.

During this time, he should have been working through his existing patient list as a community-based GP. If you total up the hours of resources used, this seems completely unreasonable given the strain on all services. Robbing Peter to pay Paul. With all the different services that were required to treat me, wouldn’t it have been simpler to retain me in the hospital, assess my symptoms and treat my condition before discharging me after my initial admission the night before?

I had to wait for 4-5 hours for the arrival of an ambulance, and then I had to wait in an ambulance outside the hospital. Eventually, I was seen and admitted to a ward in Singleton Hospital.

“I saw people crying hours later with swollen legs, unable to move or elevate their legs without staff assistance”

The next two weeks as an inpatient were truly heartbreaking. I was on a gastro urinary ward, but most of the other in-patients, with the exception of two or three, were elderly. Many also had mental health conditions that presented additional care management needs. During my stay as an inpatient for two weeks, I saw a revolving change of ward companions who had various needs and were in various degrees of health.

I saw proud people, confused people, articulate people, vulnerable people, frail people, shy people, frightened people, subservient people and people grasping to retain their autonomy. I saw people lifted out of bed into chairs by staff at 5:30am so staff could start ward rounds due to demand of patient needs, doctor needs and staff needs. I saw the same people crying hours later with swollen legs due to restricted venous return and positional body pain because they were sitting in one position, unable to move or elevate their legs without staff assistance.

“Their patient on-call buzzers were not activated so they couldn’t call staff”

I saw patients crying because they were cold due to not having blankets, as well as nightwear, because they were in chairs and unable to reach for dressing gowns or blankets themselves. I saw people crying in bed who were distressed because they were unable to go to the toilet without aid, and there were no nurses or auxiliaries available to help; their patient on-call buzzers were not activated so they couldn’t call staff.

I saw people crying due to the humility of having had an ‘accident’ when they soiled their beds and clothing after waiting around three hours for staff to respond. I saw less demanding patients go completely ignored, and I watched their health, spirit and presentation deteriorate steadily over two or three days because their health, emotional or informational needs were not addressed. This is the classic inverse care scenario due to staff’s needs to meet demand with the resources available.

I saw patients crying when medication was requested but missed or given late in the business of the ward. I saw patients who tried to vocalise their needs, pain or requests but were intimidated by staff; some night staff attempted to enforce compliance and subservience to these patients. I saw immobile patients crying and hiding under blankets because they were fearful and helpless as mentally confused mobile patients wandered the wards; they entered other patients’ bays, and they threatened other in-patients.

They also rummaged through their belongings either until staff became aware that a confused patient was missing, or until the confused patient moved on to another patient’s bay. I heard patients shouting for help from toilet rooms, and no one in my bay opposite the toilet were able to summon help, as our call buzzers were silenced or not working.

“Their visitors were upset to see the patient distressed as their well-being deteriorated due to dehydration”

I saw patients who were too weak to suck and drink fluids; their visitors were upset to see the patient distressed as their well-being deteriorated due to dehydration. I repeatedly saw observation charts filled in with fictitious recordings of observations that had not been taken or monitored.

And the list goes on.

I must say that all the staff, with the exception of a very small minority, were doing their best during my stay as an in-patient. The staff were doing the best they could under the circumstances and with the resources they had. Many had worked shifts that exceeded European working time directives to meet the needs of the ward. I saw staff often end their working days late.

“The staff, with the exception of a very small minority, were doing their best”

So tell me, in consideration of the original definition of the statement ‘humanitarian crisis’, how does the experience I encountered — and the situations I witnessed — not meet the elements identified in the definition of a humanitarian crisis?

As a person who has previously worked as frontline staff in community and hospital environments for approximately 15 years, I know the scenarios I saw as an in-patient are transferable across NHS trusts and departments.

I think any NHS frontline staff or community health and social care staff would struggle not to agree with the statement of Red Cross’ CEO. And the sooner that managers and directors of mental, social, community and primary health, as well as secondary or tertiary health care providers, stop using words to keep the humanitarian crisis that is real in Britain hidden, the better.

“The honesty of the Red Cross CEO should be applauded and not seen as a criticism”

This is not a reflection of failure — it is surely a reflection of the reality of unrealistic targets, budgets, resources and services that cannot meet humanitarian needs of its service users and the British population.

The honesty of the Red Cross CEO should be applauded and not seen as a criticism. Without those who are brave enough to call this hidden dilemma a real, ongoing hidden crisis, nothing will change or improve. Why is identifying the need for help, change and acknowledgment failure seen as a weakness? Without this acknowledgment, nothing can change.

It would be nice to see other health managers, politicians and senior British government employees prioritising the need of the NHS.

How can acknowledging the need to meet a real crisis be a bad thing? It would improve addressing needs and eliminate the event, or series of events, that lead to the failure of the NHS to meet the health, safety or well-beings of communities.

Finally, I would like to ask anyone who has been directly touched by an NHS experience recently — be it staff, family or individual patient experiences — which part of that statement is not relevant?

Sally Rees

 

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