"Great care but system failures"

This week I went into A&E to visit my uncle who had suffered a head injury. I am a medical student, and so feel the tension somewhat between being an anxious niece but also understanding something of the pressures the health service is under. 

Following a stroke a few years ago my uncle is quite dysarthric and also hemiplegic and so has regular falls. His struggles with communication mean he can often lash out physically or shout loudly in frustration when he can't do something or get his point across. This makes him a bit of a handful of a patient, and naturally healthcare professionals are often quite impatient with him. Therefore, when he goes into hospital I am quite used to having to fight his corner to make sure he is cared for and assessed properly before he is discharged. In past experience I have found that if there is no obvious sign that someone is loved their care is much poorer - the more I visit my uncle the better he is cared for. 

Going into A&E, I was therefore already on the back foot and ready to pester the doctors/nurses/HCAs to make sure he got good care. I almost certainly came across as an annoying and anxious family member, as I kept asking when I could speak to someone about his fall until I was able to see a doctor. 

Wonderfully, I was so pleasantly surprised by the quality of his care. The medical registrar who assessed him, Guilleromo, was incredibly patient - this is very important with my uncle. You see, when he is asked a question, because of his stroke it often takes around 20 seconds for him to start speaking in response. Most doctors seem unwilling to wait for him to answer their questions and so reformulate them in frustration assuming he hasn't understood, thus disrupting his efforts to speak. This doctor however, patiently waited for my uncle to answer each question and never made him feel rushed, ultimately allowing him to get a better idea of what his condition was like. He assessed him thoroughly, allowed me to tell him my uncle's medical background (in past experiences they have wanted me to be as quiet as possible as a family member and as a result gather very little information - after all, he struggles to communicate!) and also made sure his personal care needs were met such as a shower. 

The charge nurse, Tracy, was also golden. She had an unbeatable smile and patiently helped my uncle back into bed each time he tried to get out of bed (he should have been staying put!) approximately every 10 minutes. She was friendly, very ready to help, treated my uncle with real respect despite his dishevelled appearance and made my experience as a family member so much easier. 

My uncle was transferred to a ward later that day. When he was picked up in the ambulance however, he was unable to bring his phone, wallet or keys with him and so he could not contact us to let us know which ward he was in. My mum (his sister and next of kin) spent over an hour on the phone before she was able to find out which ward he was on. She was then unable to find out any information about the results of his scan or when he would be discharged. We appreciate their diligence in protecting my uncle's privacy, but we know he would have given her permission to speak to my mum. The person on the end of the phone told my mum she should call my uncle herself to find out what was going on, but as he didn't have his mobile she couldn't do this. Even more important is good communication about his discharge - let me explain why: my uncle needs a wheelchair to move about and so cannot travel home on his own. Therefore, when he is discharged he will kindly be driven home by the hospital transport system. He has no keys, no wallet and no phone. How is he to get into his flat when he arrives at home? He needs his carers to be there with their key to let him in. If we do not know when he will come home we cannot organise for his carer to be there. On the previous occasion that he was discharged from UCLH he was left sitting in the cold on his doorstep for over an hour before someone was able to come and let him in. Now, awaiting his discharge, we are worried this will happen again. 

To summarise - the care of the individuals looking after my uncle has on this occasion been exemplary. The process of discharge however, and the communication with family members who are outside London, must be improved - I believe the current situation puts my uncle in potential danger.