"2000 chracters is not enough"

What I liked

I have had occasion over the past two years to attend both the Whittington and UCL hospitals, not as a patient, but whilst accompanying my wife who has been very ill indeed.

London Ambulance Service

My wife has three times been taken to hospital by ambulance in a crisis, twice when she has had a fit, and once as the result of a fall probably caused by passing out. On each occasion the ambulance crew has radiated calm and has taken the panic out of the situation. On each occasion I think this has been the correct thing to do, given that the worst of the crisis had in fact passed by the time they arrived, as she was by then neither fitting nor unconscious. Under these circumstances the training, experience and adherence to protocol of the crew has proved an absolutely solid foundation for moving on to the next stage. The crews themselves have been friendly without being intrusive and have always given me confidence.

The protocol has felt at times frustrating. As far as I can recall the first step is a visual check of what has happened, followed by a series of questions about the incident, followed by a medical history, followed by some practical steps perhaps including medical observations, ECG, insertion of a cannula and eventually a journey to an emergency room. Whilst all this does take the panic out of the situation it does all seem to move at a glacial pace. If it takes 20 minutes for an ambulance to arrive, it having had to come from a remote hospital, the further 45 minutes going through the steps feels like an absolute age. Calm and panic free, yes, but apparently interminable.

There is also the paperwork. This entire protocol is documented at some length on a prepared form. Some of it is box ticking, but a great deal is a narrative relating the history of the patient and the incident.

Speed bumps are an abysmal invention. There seem to be a million between my house and the Whittington. Some alternative means needs to be found to control speeds

What could be improved

The worst of these was also at UCH in the middle of a busy morning. The formal triage process had almost completely broken down under the pressure of a queue of patients awaiting admission, a succession of harassed nurses dashed by, each promising to be “with you in 2 minutes”. Eventually one was after about half an hour. She checked blood pressure and temperature and went away apparently happy. After another half an hour she came again, more basic observations and turned to leave. I admit I raised my voice and explained about the brain tumour and that my wife was dying. A senior nurse overheard my raised voice, carried out a few further checks and immediately moved my wife to the resuscitation room. I feel that both the handover from LAS to ER and the triage process had failed completely. Another bad experience was at the Whittington. My wife had fallen and was spectacularly bruised. As it turned out the bruise was trivial, but the cause of it was serious, a further deterioration in her condition. My wife lay quietly on the trolley, barely conscious. LAS had done their usual sterling job and on arriving at the ER stood quietly by the door waiting for attention. Apparently this is the accepted procedure. There is no formal queue, no meaningful prioritisation and no system even for recording that they are there until acknowledgement from the nurse in charge. A moment later another LAS crew arrived with a lady on a trolley,she was immediately admitted to a cubicle entirely without formality. My wife, the LAS crew and I continued to wait. We waited for another 20 minutes.

Anything else?

No other admissions took place as we waited. Little knots of ER staff sat about chatting about their private lives. A senior looking person (apparently the hospital bed manager) strode by holding a clipboard and his nose in the air - The senior nurse in charge looked up from her computer terminal eventually and asked “are you waiting?” I’m not sure how I managed to remain polite.

The formal handover then took place. This handover takes a long time as LAS explain to the nurse what they have found out and done. It certainly seems that none of the succession of staff subsequently examining the patient have any idea what has been handed over. The questioning starts from scratch with each new examination, and is transcribed onto yet another sheet of paper. It is only some time later that a printed piece of paper arrives beside the patient with some amalgam of the different mis-transcriptions typed out. By the time we get to the discharge note some 48 hours later a simple fall has become “the patient collapsed”.

Given that all this is going on, and there are other patients to treat, it takes a long time before a doctor arrives. In my experience, when they do, they are very capable. Staff Obviously, the NHS is huge. It employs a very great many people. Some of these are extremely capable, highly trained, well motivated, articulate, considerate and caring.

Some are lacking one or more of these characteristics. Some seem to lack all. At different times these characteristics carry different significance. “Articulate” is always important.