Remember the days when
the NHS hospital scandal was empty beds?
Or when we moved on to
not enough beds – people who were dangerously ill, premature babies, being ferried round the country, day or night, by ambulance, in search of an empty bed, sometimes ending up more than 100 miles from home.
Now it is poorly people being ‘thrown out’ into the dark of the middle of the night.
We have been hearing plenty of stories which, on the face of it, sound pretty horrifying, but nothing from those who have benefited from this system.
Hospitals do not ‘throw’ patients out just so that doctors & nurses can have a rest, & patients do not choose when to get so ill as to need their care, not necessarily with the kind of urgency associated with sirens & flashing blue lights, but definitely ASAP, sooner rather than later, outside normal working hours, even when it is dark.
As someone who did once have good reason to feel grateful for this system I should speak up.
It enabled me to spend the few hours, while I waited for a hospital bed to become available, at home in the perfectly good bed in my bedroom rather than on a trolley in A&E, before being transferred, in the ambulance they sent for me, to a ward which was quietly busy after midnight. And it was not just the doctors & nurses – blood tests were analysed & I was wheeled down to X-ray at about 3 o’clock in the morning.
Next day I was wheeled up to one of the main wards.
One thing which impressed me about the organisation of this system was that I spent the whole of my stay in the first bed I was put into; when I was finally ‘thrown out’ the bed I had been occupying was wheeled away for a thorough cleaning & another patient was wheeled in, in a bed which occupied the space I had vacated.
I know because I was there to see it. The hospital operated a policy of organising transport for all discharged patients – I was told that this was more efficient than trying to manage & organise friends, family etc to turn up at the right time. Indeed some of the complaining stories that have appeared in the press seem to fall into the category of families who believe that it is the hospital’s job to look after their relative until a time it is convenient for them to come & remove them.
I could understand the sense in this hospital policy, though it rather amused me to remember that part of Ken Clarke’s case to justify the cuts in the ambulance service which led to the 1990 strike was that it was just an expensive taxi service. Not necessarily so expensive after all when taking everything into consideration.
I was also rather relieved to hear that they normally had one ambulance assigned at night purely for taking people home - there were lots of patients who really did not need to stay, indeed would prefer to go home;
my relief came from understanding that I had not been lying in my bed at home waiting for someone to die before I could move into their hospital bed
The problem in my case was that, although my discharge was planned, the hospital was indeed trying to move as many patients out as they possibly could because it was February, the weather had turned very cold & so there was real pressure from new patients needing urgent admission with chest problems, flu, etc. So I had a longer than expected wait before the arrival of my driver; I was not at all neglected however – they gave me my evening meal.
The ambulance/minibus which eventually took our group of five, all going in the same direction, had been borrowed from a neighbouring authority.
One of the patients had to be picked up from a different building on a far-flung corner of the hospital site; when, because of building works in progress, the driver had a bit of difficulty finding the way, he remarked that you could tell that there was plenty of money around for the NHS because there was just as much building going on at every hospital he had been to that day.
This chucking out policy has not just suddenly been developed in response to cuts, nor is it hard hearted & uncaring.
The problem of making sure that a bed is available at any time for anyone who needs it could be solved by making sure that the number of beds available at least matches the maximum demand – which will mean beds being empty for a good proportion of the time. And not, of course, just the beds but the staff needed to provide the care which is what is really needed. Paid for doing nothing. Or we could have the staff sitting around, unpaid, at home, just waiting for the call when a patient arrives.
This just-in-time, using scarce resources only when they are really needed, is what efficient modern management is supposed to be all about. Of course abuses should be stopped. But let us not forget that, grateful as we are for the care & treatment, we would all really (&, from the point of view of the nurses who have been looking after us, ungratefully) prefer to be at home, even in the middle of the night.
My great fear in all this is that the politicians may feel backed into making things even worse (as did Tony Blair with his 48-hour GP appointments), by announcing a total ban on nighttime discharges.
