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Friday, 11 October 2013

Taking healthcare for granted

When my mother died a couple of months ago, she did so in a hospital ward where the healthcare could not have been better. The entire team providing this care - doctors, nurses, administrators and cleaners - demonstrated sensitivity and professionalism of the highest order. They explained every aspect of her care, not just to her children but also to my mother herself. They did so even when she was unconscious, as she was for most of the last three weeks of her life. They knew when to approach and when to withdraw. Their interventions were timely and appropriate and carried out in a way that preserved my mother's dignity right to the end. Most important of all, each member of staff genuinely seemed to care about her. Every decision about my mother's care focused on what was best for her.

We knew that such unity of purpose and values has to be led from the top and constantly nurtured and reinforced. The quiet leadership of Dr Chadha,  my mother's consultant, exemplified these qualities. His team lived them in every aspect of their care. None of you, I am sure, would want to die of a stroke but if you do, Ward 16, the Acute Stroke Unit at Doncaster Royal Infirmary, may, in my opinion, be one of the best places in which to do so.

In many other countries, particularly in the United States and in developing countries across the world, access to high quality healthcare has not traditionally been a 'given'. It may be available, if you can pay enough, but people have rarely been able to take it for granted, as we in Britain have tended to do. For more than two years we lived in a country, Uganda, where that was definitely the case. We wrote at length about the shocking examples of lack of care in Ugandan hospitals and clinics in a number of posts on our previous blog, The Ritchies in Uganda (see below). Patients experienced inaccessible healthcare facilities, unnecessarily high rates of maternal and neonatal mortality, demands for bribes to access even the most basic of health provision and a horrifying lack of compassion. We used to read routinely about women in labour being transported to clinics in wheelbarrows, midwives berating prospective mothers if they made too much noise when crying during labour, health staff closing up clinics and going off home to sleep and even the askari (security guards) demanding bribes before they would let patients into the hospital grounds. The callousness which seemed to characterise whole sections of Uganda's public health system appeared to derive from the inferior status of health staff, low salaries often paid very late or not at all and levels of morale which were rock bottom. We reacted by being profoundly grateful for the healthcare provided by our native country, Britain, which for half a century has prided itself on the universality, effectiveness and humanity of its National Health Service (NHS).

Sadly, in Britain, healthcare such as that provided by Ward 16 can no longer be taken for granted. We were alerted to this on our return from abroad by news stories such as those about the failings of North Staffordshire Hospital, for example. For all the brave words of the politicians, it seems to us that parts of our NHS are being gradually dismantled as a result of cuts in funding and almost constant re-organisation. Demand on the system outstrips supply and managers and clinicians are having to make painful choices while nursing staff struggle under heavier workloads. The situation seems to be worse in England than in Scotland, but that may simply be our own bias.

However these stories about healthcare failings have not really meant anything to us personally until very recently, shortly after the birth of one of our young relatives. The local maternity unit having been downgraded to a service provided only by midwives, his parents decided he would be born in the next-nearest hospital, a well-known London teaching hospital. Their decision turned out to be the right one as he was eventually delivered by emergency caesarian section. However, mother and baby were fine and two days later, on a Friday, they were sent home from hospital. His parents were assured that a midwife would visit once they got home.

Saturday and Sunday passed uneventfully, with the usual lack of sleep and periodically bawling child. However, no midwife appeared: that means no one to check on the baby's health or on that of his mother. In the meantime, his parents were beginning to get worried. It took several phone calls to every health professional his parents could think of in three separate hospitals for a midwife to appear. Living in a post code area where health boards intersect gave plenty of opportunity for health workers to deny responsibility for the health of this four-day-old baby. Nevertheless, as I said, a midwife eventually appeared. She weighed the baby and insisted that he be immediately taken to hospital as he had lost too much weight. Not an uncommon scenario, particularly these days when mothers are shunted out of hospital before they've barely left the delivery room. How unlike my own experience thirty five years ago when the usual week in hospital included personal attention and advice from a midwife at feeding times and the opportunity to rest and recover. So, they all drove into central London, fortunate that they had a car and did not have to take their newborn by bus or underground.

However, things got worse rather than better. The post-natal ward refused to admit them because there was no paediatrician working that day. The special unit also refused to admit them. They were sent to Accident and Emergency and left to sit for hours in a 'disgusting' treatment room. And all this time, while health staff refused to take responsibility for the newborn, his state of health continued to deteriorate. Several hours later, they were eventually admitted to the post-natal ward where they had been refused entry in the first place and people started to do the job for which they were paid.

Now, this is not a shock/horror story about a desperately ill baby being denied treatment. It is a story about a baby who is fundamentally healthy. What it does exemplify, however, is what happens when nobody takes responsibility, when people are frightened of making decisions because of hospital hierarchies and when nobody listens to the patient or to the patient's carers. It is a story about a depressing lack of care and a reluctance to envisage the effect of this lack on patients' wellbeing.

In Britain, it seems, we are now increasingly being disappointed when our experience of the NHS is at odds with our expectations. Not always, of course. It is important that we hold on to our memory of Ward 16, and the committed staff team who make it what it is.  And we are not as badly disillusioned as we would be if we lived in many places elsewhere in the world. We are not yet, thank God, experiencing 'third world' levels of healthcare. However, we do seem to be experiencing increasing demoralisation among health workers and a consequent reduction in the qualities of care and compassion.

No longer, it seems, can we in Britain take the quality of our healthcare for granted.





You may also be interested in the following posts:

Caring for the sick in Uganda

What price compassion in Uganda?

HIV/AIDS and Uganda's children

How to survive until you are grown up

The health budget is passed but women and children will carry on dying








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