Hi °C | Lo °C A few months ago I went to my GP with a sore tummy and 12 hours later was in surgery having an emergency appendectomy. Five days later I was out of hospital and on the road to recovery.
So what's the story? I was one of the many thousands of successful operations in NHS hospitals last year. No big deal for a service in which we take success for granted and whose failures we highlight to extra-ordinary lengths. My company - PA Consulting Group - recently submitted a major report to the Irish Health Service on the use of acute hospital beds.
But what did my own recent experience have to say about the state of the current health service in Northern Ireland? And could looking at the service as a 'customer' give any additional insights into the way in which the service is run?
Appendicitis is one of those funny diseases. It is relatively widespread, regarded as a young person's problem and nearly everyone has a story about someone who has had it removed. It is according to the expert's one of the most common causes of abdominal infection and an appendectomy is the most common emergency surgical procedure. It can also be fatal. The problem lies in the failure to diagnose. A report into deaths after surgery found examples of fit your people dying from appendicitis because doctors sometimes fail to recognise the symptoms (Harry Houdini and Rudolph Valentino died from complications arising from appendicitis).
My own admission through A&E was chaotic. You were left with the feeling that long waiting times were the norm, particularly during busy periods. Even midday during the week the Triage Nurse was very busy and there appeared to be some duplication between A&E staff and those responsible for admission. All this can cause major bottlenecks during busy periods. There were lots of patients just sitting around - waiting.
In my case the system worked, but it was the diagnosis that was the tricky bit. During the day I saw five clinicians all of whom expressed doubt as to what the problem was and they all, thankfully, aired on the side of caution. The final decision to operate was taken by a Senior Register who saw me for about five minutes - he looked under pressure in what was clearly a busy day. He was still unsure but wanted to "have a look". As it turned out it was the right call. All of this came as a bit of a shock as I had been expected to leave with a pill and some lifestyle advice.
The first thing you notice about a hospital ward is the sheer number of people involved. There are the cleaners who clean the floors and dust and the ancillary staff that provide the meals. Then there are the junior nurses, nurses and sisters. The doctors have their own pecking order from the very junior doctors (four attempts to take a blood sample was a bit steep), house officers, registrars and the consultants. Outside the ward there were the laboratory people who analysed the blood tests, radiographers who did the X-ray, and administrators who managed the paperwork. They all have to be managed by managers. Above them we have the health board officials and the 1,000 people in the Department of Health and Social Services. Does everyone who works in the health service have the patient at the centre of what they do?
My experience was mixed. There was, for example, limited communication to me as a patient. I constantly had to ask questions as to what was happening and try and elicit information. On more than one occasion my case was spoken about as if I wasn't there - hardly good practice in this modern age.
Which raises the question as to whether the beds were being used efficiently and effectively. On my experience the answer again would have to be a mixed one. The ward I was on was only two-thirds full in the week I was in hospital (is there still a bed shortage?). My neighbour was admitted on the Friday evening for a non-emergency operation the following Monday. He subsequently told me that his operation was to be carried out the following Thursday.
My biggest problem was in relation to discharge. Good practice states that discharge planning should begin on admission. I could easily have stayed an extra two nights in hospital (Saturday and Sunday) had I not threatened to discharge myself on the Saturday morning. Also I was also given no discharge information concerning the operation I had just had (when could I drive, what care did I need to take of the wound etc ¿ ). This can be common. In the PA study for the Republic, 60% of patients did not have a discharge plan.
Hospitals are full of elderly sick people. When you are sick you don't notice it. When you are getting better it's all you can see. In our study of hospital admissions, 62% of the 3,000 patients surveyed were 65 years or over. The majority of nursing care seemed to be taken up with the care and attention of elderly patients. Make no mistake this is a difficult job.
In a small private ward the family of one patient had placed a picture of him in his early 30s. His smiling face contrasted with the very frail, very sick gentleman. The only time I heard a nurse complain was when she couldn't find an additional blanket for an elderly patient.
Our population in Northern Ireland is getting older. As it gets older it will need more hospital beds to look after it. Hospital beds are very expensive places to be. There needs to be a much greater focus on other forms of care than acute hospital beds. The Department of Health and Social Services here launched a primary and community care strategy a number of years ago. Implementation, it seems, has been slow.
The Review of Public Administration in Health has led to a smaller number of hospital trusts. Whether this will mean a reallocation of resources away from acute hospitals and into the community and the development of more effective ways of treating patients remains to be seen.
I'm grateful for the speed of access which I had to the service and the decision to operate. Technically the health service is good at what it does. It is in aftercare where the problems arise and better management of this would improve the way patients are treated.
The last word went to one of my daughters. She was devastated to know I didn't have my appendix in a jar for her 'show-and-tell' in class.
