I like the NHS. It’s free and it keeps me alive. Not all my treatment is available on the NHS for free, but the main bulk of it is. However, I would say that overall, the majority of my care is ‘average’. Sometimes it’s exceptional, sometimes it’s shocking, but on the whole, people treat me in the way I’d expect to be treated. I spend a lot of time hanging around in waiting rooms of various different treatment centres, so I overhear a lot. I find comments like this interesting:
– I couldn’t have asked for better care
– the staff were amazing
– they went the extra mile
Sometimes, the person saying it has received exceptional care and the comment is justified. But in a lot of cases, it’s become one of those phrases that you say about the NHS even if it isn’t strictly true because people have heard other people refer to the NHS in that way. So it’s kind of become an expected comment. Especially if people don’t have many interactions with the service. While eavesdropping recently, I’ve heard people say those phrases in relation to:
– being able to book a flu jab for the next day rather than having to wait 2 weeks
– because the doctor introduced himself
– after having had their wrist plastered
– because someone was polite
Those aren’t examples of extraordinary care. That’s what the standard of care should be. Even worse, I’ve heard people refer to being exceptionally cared for because:
– they were given a warm sponge bath rather than freezing cold water which is what they’d had the day before
– they were given their insulin at the same time as their meal rather than having to wait half an hour by which point their dinner was cold
– someone took the time to explain their procedure to them rather than just doing the bare minimum of the job and not interacting with the patient
– the nurses talked to them during obs times rather than just picking up their limbs and not interacting
– receptionists smile and make eye contact rather than just looking at their screen and vaguely talking in your direction
Again, that’s what people *should* be doing. It doesn’t deserve the phrase ‘I couldn’t have asked for better care’. Like I’d say to student teachers, you might have delivered an outstanding lesson but you can always think of a different approach for the next time because there’s always something you could have done better when you’re dealing with humans. So I started asking a couple of people what makes them say that, questions like:
– did your buzzer get answered and did you get pain relief in a reasonable time?
– did you get your obs done regularly? (I’ve had mine filled in on my chart and no one actually come and take them a couple of times)
– did you feel like you were able to make an informed decision about your care?
I was surprised that a lot of people answered no. Which means their care could have been better.
So why do we say ‘couldn’t have asked for better care’ when actually, we could have had better care? It boils down to the fact that the people who work for the NHS tend to be overworked, underpaid and overstretched. Meaning, instead of making complaints about having to wait an hour for pain relief, people are more likely to give them a free pass and say it’s because they’re overworked. Which is true, but it kind of becomes a self fulfilling prophecy; we, and the overworked staff, want things to change, but because we don’t complain about it, there aren’t as many ‘black marks’, which means the (foolish) government we have continue to make very stupid decisions about how the NHS should be run. I’m not saying that everyone complaining would fix the problem, but it would make it very difficult for the government to ignore, not to mention piss them off, if there were hundreds of complaints in the system about level of care which could be avoided with improved staffing or extra funding.
I spend a lot of time with HCPs, so here are some examples of extraordinary care where the staff did go ‘above and beyond’ for me. Because brilliant care does exist, and it’s important to recognise it:
– a senior fellow spent about an hour and a half tracking down and talking to my (also very senior) endocrinologist to get the best treatment plan for me after being admitted to the assessment unit. This meant I actually had a treatment plan appropriate for me and not some vague fabricated one or just being told to apply sick day rules (which is expected advice). They’re both very busy people and I wasn’t actually supposed to be on their patient load that day, so I really appreciated the time they took to help me, and it helped me recover far quicker than normal
– my gp has spent 2 hours of her admin time (i.e. She’s not supposed to see patients) on a couple of occasions, giving me an extra long appointment to give me the best advice
– a paramedic risked a lot by arguing to support me when his colleague disagreed that I needed hospital prior to diagnosis. There weren’t any obvious clinical reasons for me to have called an ambulance that they could assess, I’d rung because I had a really bad feeling, the paramedic had treated me before so knew I was genuine, and if he’d stuck to the rule book, I’d be dead right now.
– doctors who immediately say ‘I don’t know what this is, teach me’. I think it takes a lot of balls to be confident enough to say that in the current culture of medicine.
– a nurse who worked out I needed the toilet roughly every 20 minutes when I was in a&e but couldn’t walk, so just started appearing with the commode, despite being overworked, underpaid and overstretched
– the nurse in charge making a point of coming to see me to apologise that it was a noisy ward full of old people and I was the youngest there. She couldn’t do anything at all to make it quieter and less stressful for me, but she said she’d help me get as good quality of sleep as she possibly could.
Extraordinary care does exist but it’s very much dependent on the good will and integrity of individual staff members rather than the system as a whole. For example, School is free to attend, teachers are also overworked, but it wouldn’t be acceptable if the teacher ignored one child all day and didn’t get round to marking their book because they were busy dealing with more problematic pupils. So why do people put up with it when it comes to NHS care?
Sometimes, people genuinely couldn’t ask for better care. But I think it’s important to make the distinction between someone doing their job adequately in difficult circumstances and actually receiving amazing care. It also is a little bit rude to the people who always give very good care if they’re lumped with people who just do what’s expected of them!