Professor of Psychiatry for Older Adults John Wattis is from the University of Huddersfield. In light of the delay of his mother’s treatment when she had to go in to hospital recently, he talks about how under-resourced the NHS is and how this lack of funding across the board is causing a capacity problem.
“Earlier this week I had a very frustrating experience of an NHS that simply doesn’t have the capacity to do what we expect of it. My 95-year-old mother who has multiple medical problems had finally lost the ability to walk independently a week earlier. The GP was involved and the Practice provided a good service. Further symptoms developed which suggested she might be suffering from cauda equina syndrome, a medical condition that can sometimes be alleviated by urgent surgical intervention. The GP, after a telephone discussion with a specialist, said that mum needed a special investigation (Magnetic Resonance Imaging, MRI scan). The only way to arrange this was to send mum to the local overworked Accident and Emergency (A&E) department, 12 or so miles away. My heart sank. Previous experience had taught that the A&E department was seriously under-resourced and did not have the capacity for the work that it had to perform. It was the one surviving fully competent A&E department in the three hospitals run by the local NHS Trust; the others had been downgraded for reasons of ‘safe practice’. In my view this was a management ‘fudge’ – the real reason was inadequate funding compounded by an undersupply of appropriately trained staff.
The ambulance service was excellent, arriving within an hour of being requested. Three very competent and humane staff (one a student paramedic) moved mum swiftly and with good humour. When we arrived at the casualty department, not long after 2pm, the problems started. Despite the fact that it was a weekday afternoon, there was a queue of ambulance-delivered patients waiting to be booked in. A capacity problem. The ambulance staff had to waste time waiting to hand over their patient, compounding the ambulance service’s problems in providing an efficient service. Eventually they got mum onto a hospital trolley and left.
After about a further half hour we were put into a bay to await one of the very busy doctors. A member of support staff did observations. After a while a nurse came and took some details and the very helpful letter the GP had written. Another wait; then an excellent casualty doctor came and examined mum carefully. He agreed with the GP’s conclusion and went away to try and arrange things. More waiting. The MRI scanner didn’t have an available slot till the next day. There was a problem of capacity.
The doctor suggested, in view of the 10-hour wait for a bed, that it might be best for her to come home overnight. We readily agreed to this but then there were problems with the ambulance service. Because of problems with capacity they would be unable to accept a booking to bring her back for the scan without 48 hours’ notice.
The ever-resourceful staff said “never mind, Age-UK might be able to provide wheelchair transport”. But first a blood test needed to be done to confirm mum’s fitness for the scan before it could be booked. Blood was duly taken by the doctor. Another long wait. The staff apologised: the laboratory was very busy…another question of capacity. Eventually mum had to be admitted overnight and, 24 hours after she first arrived in casualty, was still waiting for a scan. This is the outline of what happened. There were a lot of other minor niggles but throughout the staff were competent and caring, though clearly overworked and with little time to spend with each individual patient.
The solution to this particular problem might seem obvious. Once the need for an MRI scan had been agreed, the GP could have done the necessary blood test and booked the scan, by-passing A&E altogether. Perhaps this is what the Sustainability and Transformation Plans (STPs) will achieve. However, if the MRI scanner and the laboratory still lack capacity it wouldn’t help much!
That seems to be the problem. With a system that is overall so under-resourced, dealing with one bottle-neck only produces another. That is one of the points junior doctors were trying to make in their industrial action. It is one of the points made by seasoned NHS commentators like Chris Ham and Roy Lilley. Yes, we can become more efficient but no we cannot meet ever-increasing demand on a budget that does not allow the NHS to provide the capacity it needs to deal with the problems we expect it to cope with.”
“This is an account of personal experience, illuminated by my professional understanding as a former Medical Director of an NHS Trust. I do declare an interest. It is my mother. It is our NHS. My mother has given full consent to publication.”