"Day surgery at the Norfolk and Norwich Hospital"

About: Norfolk & Norwich University Hospital / Ear, Nose and Throat

(as the patient),

My problem

I started wearing a hearing-aid on the right 8-10 years ago. Gradually I became bothered by a sort of tinny buzzing in response to certain musical sounds. This became so loud that I had to stop using a hearing-aid on that side and had one fitted on the left instead. I could still hear the buzzing on the right without the hearing-aid, but only faintly.

Monaural hearing can be inconvenient, so when the consultant at the Norfolk and Norwich Hospital suggested that an operation would remove the buzzing and allow me to hear normally again - with the help of a hearing-aid - I agreed to go ahead. I told him I would be happy as long as I was no worse off than before; the consultant assured me that there would be an improvement.

Sadly there hasn’t been. The buzzing is perhaps less marked, but when I’m listening to music I still have to choose between binaural with buzz and monaural without. In addition I now get a sort of low crackling in response to fairly soft undifferentiated external noise, an odd sort of reverberation in response to my own voice (noticeable when singing - and I’m in a choir), and a sort of bumping noise or sensation when I’m running or cycling over bumps.

I’ve seen the consultant twice since the operation - a week later and a month later, something like that. When I went to the first appointment I was nearly in tears - my hearing was so very much worse than before the operation. Oh, that’s quite normal, said the consultant, it’s bruising and will pass. So why on earth did no-one see fit to warn me? By the time of the second appointment things had settled somewhat but it was nevertheless clear that I was still worse off than before the operation. I’m due to see him again in mid November. As always with the NHS things move at a glacial pace.

On the day

I turned up at the hospital as requested at 07: 15. I was given no information as to what I might expect. The windowless waiting-area (there’s no shortage of windowless areas at the Norfolk and Norwich) was quite full. There was a lot of coming and going among medical staff; occasionally patients would be called out and then reappear. At no stage was any information provided. In the course of the morning I was seen very briefly first by a nurse and then by the consultant’s assistant, really only to confirm information they already had. Each time we had to look for an empty room - adding to the general impression of disorganisation.

Then suddenly - I think it was towards midday - I was rushed into the operating theatre.

When I came to in the recovery room (at around 13: 00, I think) there was no-one with me - despite the specific assurance I had been given beforehand that there would be. It didn’t take me long to realise where I was and what had happened, so I wasn’t frightened - but I quite easily might have been.

The recovery ward, like so many other spaces at the N&N, has no windows - as if no-one had ever heard of the therapeutic value of the sight of trees and clouds. The staff were all dressed in what appeared to be dingy and ill-fitting plumber’s overalls - this does not inspire confidence. (Snow-white overalls that fitted properly would have been fine. ) The staff didn’t pay me a great deal of attention - not even nodding and smiling as they walked past the bed. And this matters - it’s all part of the reestablishment of consciousness. For a while a nurse did sit beside my bed - she made no attempt to engage me in conversation, though, but rather continued reading a textbook on the nursing of children.

One of the nurses did stop to chat for a few minutes - about this and that, nothing special, but that sort of conversation has real therapeutic value when you’re still feeling a bit woozy.

I asked for and was given water - fine. I was eventually pressed to have some tea, but instead of half-way decent tea in a good old NHS cup and saucer what I got was a foul-tasting lukewarm liquid in a plastic cup. That sort of thing really doesn’t help you to feel better.

And so the time passed. I was able to stand unaided and could easily have walked with only minimal assistance. So why was I still in the recovery ward after 16: 00? Why couldn’t I just be discharged? Because you can’t be discharged straight from the recovery ward but must first be transferred elsewhere. By that time I didn’t need a bed - but “they” insisted I had to wait until a bed was available.

Eventually one was. By that time - 17: 00? - I could have walked unaided, but I had to be wheeled there in a bed and transferred to another bed. I promptly got up and sat in a chair. It was a small ward, used only for patients awaiting discharge. Then what? Nothing. I was offered a cup of tea in a cup. Fine. By this time I was fit to be tied and decided to do a runner - I’d have managed it too, if I hadn’t been so clumsy pulling out the - what is it called? - needle that’s taped to the back of your hand to inject anæsthetic. Should it have been there still? Anyway, I started bleeding profusely and that put a end to my escape attempt.

Eventually a nurse turned up with a leaflet giving information for patients on discharge. Apparently the last part of the delay resulted from some problem in obtaining the leaflet.

When I looked at the leaflet I read that I should avoid blowing my nose for a few weeks. I already had done so, of course, on the recovery ward. Why on earth wasn’t I told on coming to that I mustn’t blow my nose? Communications failures seem to be pervasive at the N&N.

My friend that had come to drive me home had been waiting for some time - by now it was after 18: 00. What a relief to see a familiar face and to be returned to familiar surroundings.

The Hospital

In my experience it is impossible to find anyone with a good word to say about the Norfolk and Norwich Hospital buildings, which I think are 13-14 years old. The layout is confusing: you can come out of a treatment room and literally not know which way to turn. The worst problem is the large number of windowless spaces. Many waiting areas, and even some treatment/diagnosis rooms, have no view of the outside world.

How can any architect with any sense of what hospitals are for have designed such a building? How can any health bureaucrats with an ounce of sense or imagination have approved the plans? And how can any Chancellor with even an iota of prudence ever have made such reckless use of PFI?

Information and communication

The hospital website is in my opinion useless. At the very least it might include layouts of each floor that patients could print and bring with them.

When you enter the hospital there is nothing to tell you that you are on Level 2. There are no maps showing the layout of each floor. There isn’t even an alphabetical list of departments, wards etc. with an indication of where to find them. There is a reception desk manned by volunteers - but you really shouldn’t have to ask.

There is plenty of signposting but it isn’t always helpful. Sometimes you have to walk up and down corridors to find a signpost to the department you want. In particular you can’t always see an “exit” sign - and that can be quite unnerving.

The various duplicated leaflets and letters issued by the hospital were written by people who haven’t the slightest idea how to select and present information in ways helpful to the reader: there is no attempt to see things from the patient’s viewpoint. Language and layout should be geared to the needs of people who aren’t highly educated and perhaps don’t read very well - while at the same time not appearing condescending or dumbed-down to the more educated reader. It can be done.

I have a hospital appointment on an unrelated matter. The location of the clinic as given in the letter of confirmation is: OP ENT/Audio Level 2, Out-Patients West Norfolk & Norwich University Hospital. Gibberish.

The N&N’s “mission statement” reads: “Our vision: To provide every patient with the care we want for those we love the most. ” Presumably what this slightly odd phrasing means is that the hospital will provide the best possible care. D’uh. What else would it be there for?

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Response from Janice Bradfield, Senior Communications and Membership Manager, Norfolk and Norwich University Hospitals NHS Foundation Trust We are preparing to make a change

We are very sorry to hear about your experience and lack of information provided.

In terms of the building, we are making efforts to improve the signs and colour coding the walls to help patients find their way about. Our staff will always help patients with directions and we understand that the building is very large and can be confusing.

Thank you for taking the time to feedback and we will pass your comment to the ear, nose and throat team.

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