As controversy continues to dog the NHS, here prominent Southampton professor Colin Pritchard gives a considered view on the state of the service after witnessing the care his wife received in her final days at Southampton General Hospital.
THREE weeks ago my wife entered accident and emergency (A&E) at Southampton General Hospital on a Saturday at 7.15pm and was finally admitted to intensive care on Sunday at 3.15am.
After 17 days in intensive care and four days on ward C she died peacefully and calmly. This was the NHS at the sharp end.
My work concerns research on health care, while as a patient I’ve had major operations and chemotherapy for cancer nine years ago, so I understand something of the pressures on carers, patients and frontline staff.
The A&E experience was “organised chaos”, as a steady stream of varied ill and injured people arrived continuing throughout the night.
As my wife was in resuscitation, during treatment time I returned to the corridor to see spinal injuries, fractures, sprains, three or four cardiac arrests, suicidal behaviour, a scald, a distressed victim of domestic violence, respiratory failure and more while all the time new patients with different levels of needs kept arriving and almost inevitably the macho male who having lost a fight wanted to reassert his pathetic masculinity – but the slightly built nurse calmed him down.
Yet one could feel the ever-underlying tension, with a sense that anything could happen or explode and, of course, another car accident arrived.
Later it became a little quieter but as a nurse said: “Tonight? No nothing unusual, a typical Saturday night.”
Yet staff kept their heads amid the complex and confusing situations and continued to offer their best professional skills – they generally were magnificent.
By midnight there were now very ill people lying on trolleys awaiting a bed. I will explain the reasons for the lack of beds later.
Arriving on the general intensive care unit their 12 beds contained desperately ill people with a range of life-threatening conditions. During my wife’s 17-day stay, I saw crises emerge and resolve but throughout that time they never had an empty bed for more than half a day – in effect always full.
After every effort, periods of dialysis, it was clear we were nearing the end and my wife and the family were fully involved in the evolving discussion about whether to stop treatment.
As nothing further effective could be done for her, in the last analysis, the bed was needed for someone who perhaps could be helped.
My wife Beryl, a former theatre sister, would have fully agreed as there was a person with a greater need than she but the change of ward was disturbing as the staff had got to know Beryl and we had begun to feel secure amid the hurly-burly of an intensive care unit, where almost without exception the staff, while always hugely busy, were magnificent, professional and very caring.
The transfer to C5 ward however proved successful as again Beryl received the high quality of care given earlier.
The last four days, after the rollercoaster of hopes to be dashed, were the worst, despite excellent care, The patient’s wishes were clearly known but the rules and regulations’ seemed more fitted for a debating society than for those involved in reality – but this end of life issue merits a later discussion.
Of course the treatment and care was not always 100 per cent perfect but 99 per cent, as the little minor things were too trivial to note. The NHS is run by people so you get variation but overall Beryl’s care could not be bettered, for skill, dedication and consideration and we are indebted to the numerous doctors and nurses who gave her the highest quality of care.
Our older daughter professionally visits a famous London intensive care unit, where she explained: “The treatment they give is intensive – unlike Southampton, where the treatment is also intensive but is always given with care.”
But why are people laying on trolleys in A&E and why did they need to move a dying person from the intensive care unit? Simples!
The bed shortage is because compared with most other Western countries, we spend less on health than they do and readers can see the evidence themselves.
In 2011 I published two research papers (British Journal of Cancer, Journal of Royal Society of Medicine) that found that from 1980 up to 2006, every Western country’s mortality rates for people under 74 fell considerably.
However, in terms of money spent and lives saved, up to 1980-2006 the NHS was one of the most effective and efficient in the world.
In her first week Beryl encouraged me to continue work on newly available data that takes us up to 2010. To try to keep sane through the days of vigil I completed the analysis.
In brief currently we are the third lowest spender of the 21 countries.
Out of every £100 of national wealth (GDP) we spend £8.70, compared to the US £16 and are well below the Western average. Greece and Portugal spend proportionately more on health than the UK. The public need to understand that this is a major reason for some of the NHS problems.
I can show that in terms of GDP spent on health and lives saved, the NHS is now the second most effective and efficient in reducing all causes of death, and top of the league for reducing cancer deaths.
This is not the picture we get from the media?
After all what about the Francis Report and the Mid Staffordshire Hospital scandal and the recent 14 acute hospital trusts in the Keogh Report?
After being at the sharp end of the NHS I am angry at the total misrepresentation.
Yes there are errors, yes there are some falling below acceptable standards but neither the Francis nor the Keogh Report mentioned what we spend, or rather, don’t spend on health compared to other countries. Margaret Thatcher rightly said “we can only spend on health what we can afford”, but we don’t “afford” as much as other countries.
We need to acknowledge that comparatively we are getting our wonderful NHS on the cheap and that in reducing adult mortality rates, the NHS achieves more with proportionally less. The only way to really judge the NHS is to compare it with other countries.
In her first week, Beryl urged me to “let people know what’s happening”.
As readers can imagine after 50 years of marriage this is easily the worst week of my life but I owe it to Beryl, to the other families and to frontline staff and to Southampton who should take pride in our hospital, but need to know about the handicap under which they working.
PROFESSOR COLIN PRITCHARD, School of Health & Social Care, Bournemouth University and Visiting Professor, Deparment of Psychiatry, University of Southampton.
This article first appeared in The Southern Echo
