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Collection point

NHS Trust patients are being dumped into observation-lots to meet A&E waiting time targets

HealthWarehouseIt was one of those texts, out of the blue. It said: Lndn, 999 2 A&E, can u hlp?

I confess to not being good at the 'text-thing'. Nevertheless, I took it to mean I am visiting the metropolis and I have been taken unwell. As a result I have been conveyed to hospital by ambulance. This was unexpected, so I will need some assistance to regroup, advise my family without panicking them and to access the accoutrements I will require, should my stay here be for longer than a few hours.

My interpretation was not far off the mark. My friend, who lives 'up north', was in London for a meeting and had collapsed. She had a briefcase and not much else.

I popped into The Body Shop, Boots and M&S before heading to the hospital. I thought I would have to sweet-talk a dragon of a sister into letting me pop in with the supplies but, in actual fact, I was able to walk into the ward, up to the bed, and said hello to a very pale and wan patient - unchallenged.

I say 'ward' but to be accurate it was more of an observation-lot that Trusts use to decant patients into when they are approaching the four hours A&E deadline and they cannot decide what to do next. There are targets for A&E waiting times; overstay four hours and it is recorded as a breach. Too many breaches and the chief executive gets the sack. Hence, hospitals now have chief executive job-saving arrangements called warehouses for the undiagnosed.

Conjure up a picture of the Crimea, or of Armageddon and Piccadilly Circus and you'll get a better feel for it. A swirling mass of people. Admin staff with phones clamped to their ears. Noise, bedlam, piles of patient notes on counters, sample bottles, wheelchairs, trolleys and almost every spare inch of wall space cluttered in a forest of notices, warning posters and stickers. In the absence of clear, well defined processes, it is common for staff to resort to management by poster campaigns.

The beds were crammed side-by-side. Behind the adjoining curtain a patient let out a series of howls. In the corner a very elderly lady - her hair matted with blood - clambered repeatedly in and out of bed. Each time she did this her flimsy hospital robe parted and revealed her pinch-thin body. Dementia is a cruel prospect.

Opposite, a huge woman lay fully clothed on the bed - shoes and all - furiously texting. She looked immaculate. Hoop earrings, smart black suit, stunning floral blouse and a voluminous handbag that advertised Armani.

In the next bed a grey-faced woman sat staring out of the window, picking at the blankets. The remains of a half-eaten meal lay on the trolley at her side.

My friend had no idea what was wrong with her. She had defied the collective knowledge of A&E and had been parked, waiting for 'tests'. She was 'down for a visit' from the doctor. When? No one knew.

The patient behind the curtain howled again. A member of the domestic team, or perhaps a healthcare assistant, or even a nurse disappeared between the curtains with a mop and bucket. (The smell was the only clue to the purpose of this visit.)

It was difficult to tell staff roles. They wore different coloured uniforms but all came wrapped in the same plastic aprons. The only thing they had in common was that I never saw any of them wash their hands.

The chaos parted and a group appeared at the end of the bed. It was the doctor my friend was waiting for, along with his posse of apparatchiks.

The doctor was immaculate. Navy suit, blue shirt with cutaway collar and spotless cuffs. He combined this with a silk tie, broadly knotted. His team, mainly women, were groomed. One in particular caught my eye. She was wearing knee-length, high heel boots, skin tight jeans, a fluffy Angora sweater and dangling earrings. As she moved her hands, bangles and gold hoops dropped on to her wrist and then disappeared up her sleeve. On the other arm she wore an expensive wrist watch; a present from an admirer, perhaps? She was a stunner.

I thought they looked like a group of dealers from a city office on their way to a leaving party at an expensive restaurant. There was not a white coat in sight and I wondered what had happened to the Department of Health's (DoH) guidance that staff should be bare below the elbow, not wear a tie and no jewellery or wrist watches?

I was mesmerised. All the women in the group carried handbags; some the huge shoulder variety that made the one owned by the woman in the bed opposite look modest. The consultant was charm personified and shook hands with his patient. I was fascinated. I never saw him wash his hands or use the gel-dispenser at the end of the bed. Many of the infection control guidelines do not seem to apply in this hospital.

In the DoH survey, published in April this year, 82 per cent of staff said their Trust was doing enough to promote good hygiene and 61 per cent said hand-washing equipment was always available to them. A government poll of 77,000 patients in England showed that cleanliness and low infection rates were more important when choosing a hospital than anything else.

Unsettled by her experience of a front-line London NHS Trust and undiagnosed, my friend discharged herself. She works for the DoH so it came as something of a shock. If the hospital only knew who she was they would have had a fit.

I would say the pressures of throughput are pushing this hospital to the edge of dysfunctional. It must be impossible to work here. It is frantic, clamorous and down at heel. 

Should I name the hospital? In fairness to all the London Trusts who might consider themselves in the shadow of this experience, I would like to. However, for reasons of a legal nature, I can't.

The Author
Roy Lilley is a (sometimes controversial) healthcare author and broadcaster

16th May 2008

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