Lacking patient care …
The following is a personal example which highlights the lack of NHS staffing, inadequate implementing of procedures and blatant ignorance around how to best meet patients’ needs, in particular of those who are very seriously ill, frightened and in pain.
My sister died in xxxxxxxx Hospice in 2013, after suffering unnecessarily agonising pain and bouts of what I feel was negligence, upon being diagnosed with cancer in 2013 at Broomfield Hospital, Chelmsford my sister, I’ll refer to her as ‘Janet’, whilst undergoing a common-place surgical operation was unexpectedly and shockingly diagnosed with cancer. Janet was discharged from hospital – it was agreed that she would receive chemotherapy.
Several weeks passed with no sign of chemo starting. In constant pain and not being able to keep any food down and literally wasting away before our eyes, on attendance at an assessment appointment at Broomfield Hospital, Chelmsford, in May, Janet took her overnight bag and insisted she be admitted. She was placed on xxxxxxxxx Ward. Apparently her notes had either been mislaid or she had been overlooked, the reasons for which were not made clear to members of her family.
Sixty-four year old Janet was a positive person, intelligent, caring, humorous and a fighter – a business woman – socially engaging and until this illness was physically building an extension to her house. I do not know whether this is typical of NHS hospitals but on a daily basis the level of care and treatment of patients on xxxxxxx Ward, Broomfield Hospital, in my opinion, was deplorable. A few examples:
* Shortly after admission Janet was placed on a side-ward and we presumed that the intravenous drip, which had been set-up for her, included nutrients, owing to the fact that she could not eat due to pain and sickness. She was hoping that in this way she would regain her strength thus making her physically more fit for surgery. It was discovered by chance, that without any discussion with Janet, her partner ‘John’, or her family, the hospital had independently taken the decision to place Janet on a ‘nil by mouth’ regime. She and her family were very upset and angry and after they complained, staff began providing food for her – though it was not suitable so her partner and children took more appropriately prepared food into the ward for her.
* Janet had various ‘tests’ and was told that as her cancer was not hormone related she would not have intravenous chemotherapy but would be prescribed medication in the form of a pill; this was impracticable as Janet could not eat due to her pain. Her autopsy revealed that she did, in fact, have ovarian cancer – which is hormonal.
* Cancer patients on xxxxxxxxxx Ward were being left for over three hours with their medication drip-feeds empty, therefore without pain-killers.
* My sister, in great pain, ‘buzzed’ for a staff member several times but eventually had to struggle out of bed and look for a nurse in order to be given her med.
* This same nurse in the presence of other staff, on a doctor’s ward-round, accused Janet of ‘feeling a bit sorry for herself today’.
* A staff member attempted to take Janet’s blood pressure. This auxiliary/nurse did not even know how to put the BP sleeve on my sister’s arm – Janet had to tell her it was upside down. The ‘nurse’ then proceeded to take other patients’ BP but appeared to write nothing on their charts – finally walking away with the pulse monitor still attached to a patient’s finger – almost pulling her out of bed.
*In my presence, another patient, who had previously waited six hours for her pain-killers, asked a senior member of staff (do not know her title) if she would pass on that information to the relevant person so that something could be done about it. This staff member replied, with words to the effect that, ‘it was nothing to do with her’.
* I made several attempts to speak to the ward sister via telephone but with no success.
* Janet had severe diarrhoea and although, again, had ‘buzzed’ repeatedly for help, finally had to get herself out of bed and to the toilet – could not make it in time, then slipped and fell in her own faeces. A nurse, on finding her, scolded her for getting out of bed.
* John, very anxious and upset at the poor management of Janet’s pain, pointed out to a nurse that Janet needed her medication before meal times, to help her with the pain related to eating, and that she was not getting her med. until after her meal, so was unable to eat or even attempt to eat anything – plus Janet was becoming panicked by the inevitability of her pain. John also suggested to the nurse that it would make more sense if priority was given to those in most need, as it was clear that some patients were more comfortable, they were watching TV or eating, so able to wait a little longer for their pain-killers. The nurse ‘reported’ him to the ward sister, he was reprimanded and nothing changed. It seems that only one male nurse, I cannot recall his name, he worked nights, used his initiative and prioritised patients. Janet felt relieved each time she saw he was on duty.
* I telephoned PALS – they were helpful and gave some advice.
* On my visit in May 2013 it was clear that Janet was in excruciating pain, she asked that we did not visit again until her pain was managed. I phoned xxxxxxxxxx Ward several times after that day, to see how Janet was, also to arrange to see a doctor. The phone was never answered.
* John, told me that on one occasion Janet phoned him in tears after a doctor said to her, ‘Does your family know how ill you are?’ How irresponsible. Saying that to her without speaking to one of her family first so we could be there. It made Janet feel hopeless, plus it implied that her family did not care or visit, which was not the case. John decided to attend xxxxxxxxxxx Ward from 9am and sit and wait until a doctor was available to speak with him about Janet’s care. He sat and waited, until late afternoon, for two days and it was not until the third day that someone became available. xxxxxxxxx Ward was clearly understaffed, and some staff were unprofessional, obviously not adequately trained and clearly had little respect or concern for the patients.
*Staff Hand-Over conducted in public places such as corridors or reception desks. Visitors and patients were able to overhear the personal details of others.
*I witnessed two female staff members, sitting virtually at the foot of my sister’s bed, laughing/flirting with a male member of staff who was standing several yards away, in the corridor. They were discussing their planned evening out and the menu and how good the food was going to be – within easy earshot of patients. I find this unprofessional attitude and lack of respect, outrageous. For staff to be so lacking in empathy and so dismissive of patients’ needs usually means they are not being supported themselves, often due to poor management.
*In the few weeks Janet was in Broomfield she and her bed must have been moved at least five times. Shunted around like a piece of luggage. Janet’s family had repeatedly asked that something be done to help her and eventually she was operated on in the hope of relieving her inability to eat without vomiting or suffering pain and for a week or so she was able to take food and keep it down. On speaking to a more approachable senior staff member, I discovered that staff did not know that Janet and her family had only been aware of her illness for a few weeks and were in a state of shock – let alone trying to come to terms with the fact she was dying. Either this information is not included in patient’s notes or they are not fully read by staff.
One of my colleagues, who qualified in nursing over thirty years’ ago, is infuriated at the decline in basic nursing ability and upset at the reputation this gives competent, professional NHS hospital staff. She assures me that unqualified and auxiliary staff are being used in many hospitals as they are cheaper – also and quite controversially I imagine, she states that British born and trained staff do not want to work with foreign staff who have not received UK NHS training, many of whom cannot communicate clearly in English.
Whilst I was visiting Janet, a male member of staff – a doctor? Stood at the end of her bed, trousers frayed at the ankles – shoes with the sole hanging off, attempting to tell her something. His English pronunciation was so poor I could not understand him and Janet had to ask him several times to repeat it. We finally understood, he was telling her they ‘could do nothing for her’. What a way to tell someone they are dying. The family contacted a private consultant with a view to referring Janet on and requested that a copy of her notes be forwarded to the consultant. I did not hear this conversation but I am told that Janet’s family were informed by Broomfield staff that they would have to go through Broomfield Hospital lawyers.
One of Janet’s family mentioned contacting the media – that seemed to have resolved the problem. Janet was discharged, it was clear she was dying, in severe pain and in no fit state to be at home. Even her local GP was shocked when he saw her condition on discharge. However, this same NHS GP refused to process a prescription, which the hospital had given Janet, for Paracetamol suppositories, as at twenty-five pound they were ‘too expensive’. John had to drive all over Essex to find somewhere he could obtain them. I found Paracetamol suppositories being sold on a medical provisions website for five pounds.
On Janet’s discharge from Broomfield, as far as I am aware, no support was in place other than a MacMillan nurse. No practical help was offered – her family bought her a purpose-built bed and John was her lone-carer until she was re-admitted to Broomfield, then finally discharged to the hospice. I do not think the answer lies simply in private care. I have worked in hospitals as both medical secretary and mental health therapist. My experience leads me to the conclusion that whether private or NHS, all staff need a higher level of training, with regular, independent supervision (i.e not by their own line-manager).
All staff also must be able to communicate effectively in English. But, as I wrote in my letter to Secretary of State for Health, Jeremy Hunt, if the National Health Service continues to be less about patient care and more about saving money and box-ticking, then sadly, nothing will change.