Our city’s hospital is one of the most important institutions we have so you can count on me to fight for our NHS. The way to ensure it’s survival is to help it adapt to 21st Century challenges and give the investment needed to achieve this.
I owe it to you not just to fight for its survival and improvement, but to understand it from the inside. That’s why in recent weeks I have met with Matthew Kershaw, Royal Sussex’s CEO, and spent time work-shadowing doctors and clinical staff.
I thought I knew quite a bit about the health issues we face as a society and the challenges our NHS has adapting to meet them. But after spending quality time with the person charged with leading our hospital, then observing and talking to doctors, nurses and staff as they care for patients within such a complex organisation, I realise I had a great deal more to learn (and still do).
I spent time with Denise, a nurse leading the critical Care Outreach team which is based in Intensive Care but attends any critical events, such as a heart attack, that occurs within the hospital grounds. Spending a shift with Denise meant that I got to see the whole hospital and many wards.
Two things struck me. First, how cramped almost every ward is. In intensive care, for example, only two beds have the recommended amount of space around them. Every ward in the oldest building doesn’t just feel Victorian, it is Victorian! In several wards entire beds have to be removed in order for a gurney or wheelchair to pass. Doorways are too small for gurneys to pass through and extended wheelchairs designed to carry obese people cannot pass. On the top floor, in the ward for people who have suffered strokes, water seeps through the roof when it rains heavily. Things like this are uncomfortable for patients but also place great strain on clinical staff.
Secondly, I couldn’t help but notice that the overwhelming number of patients in hospital, including A&E, were over the age of seventy. This is important because the hospital is only one link in a complex chain and the best way to keep our hospital free from strain is to help people stay healthy in their homes and communities. Nowhere is the need for us to achieve this more important than for those living into old age. At the moment we simply aren’t getting this right. Living longer is a blessing for us as individuals and if we get it right it can be a blessing for us as a society too, but we’re not there yet.
Denise’ bleeper rang out and I tried to keep up as she hurtled towards A&E where the trauma team was needed. The head nurse, Adam, kindly allowed me to observe. An ambulance was en route and had radioed ahead alerting them to the complex needs of their patient. I saw the best of our NHS when a team of no less than 16 specialist clinicians gathered to be ready for the patient. The head nurse, an A&E consultant, two trauma nurses, a surgeon, an obstetrician, and a nurse wearing lead protective gear with mobile x-ray equipment were just some of the team. The patient arrived into the resuscitation room carried by two paramedics who calmly briefed the awaiting team. On television these situations are full of noise and chaos, but in reality it was calm, purposeful, and perfectly coordinated – much better for the patient when you think about it.
As clothes were carefully cut away revealing obvious fractures and several open wounds and terrible bruising, the paramedic explained that the patient was in her 90’s and had fallen down a flight of stairs. A nurse whispered to me, ‘I always say to myself at times like these, ‘this is someone’s mum and she deserves the care I would want for my mum’. A tearful moment for me, but who wouldn’t be moved by witnessing our staggeringly caring and professional NHS staff?
But they do so within a system that is struggling to cope with the challenges of modern life. I spent several hours with the Site Management Team. These are the people who manage a patients’ journey through the hospital and back into the community and grapple with difficult decisions – when I was with them the hospital was above 100% occupancy yet there were still twelve people in need of beds. They are also under pressure to solve problems such as departments with patients suffering long waits and targets being breached. I went with them as they met doctors and matrons to understand specific problems and try to ease strains.
We all know there is a capacity problem in hospitals, but it came as a surprise to me that despite the over occupancy there were 38 patients who had been cleared for discharge for more than a week who were still there. Why? Because community facilities weren’t ready, or in some cases, willing, to take them. So they stay in hospital where they risk further infection even though people recover faster when at home or in community facilities.
It is amazing that we are getting a new £420m hospital. Staff are so excited. Wards such as A&E don’t even have windows at the moment and the buildings are cramped. But alongside the new hospital – which sadly will have to be built with extra-wide doors and corridors to cope with our increasingly obese population – we must also radically improve the care we offer people in their homes and communities. We should support family carers better and we must allow more charities with specialisms to integrate within the NHS to provide the same world-class care in people’s homes as they can in hospitals.
And where a system does something that is plain stupid we should support those trying to change it. Let me give you an example. I was with a site manager who was trying to find a place in a nursing home for a patient who had been cleared for discharge for over a week. One home said, ‘yes, we have space but we cannot admit her until next week’. Why?! ‘Because our procedure says we must have a GP present to admit a new resident and he’s only here on Wednesday afternoons’. It was politely explained that ‘I’m calling from the hospital, we have hundreds of doctors, can we arrange for one to escort Mrs xxx to your home?’. Something tells me you can guess the rest (clue, it starts with a ‘no’).
Good people in a damaged system is not what our city deserves. We deserve good people in a system that adapts to what we know helps us stay healthy and recover from sickness.
Finally, I want to thank Mathew Kershaw and the doctors and nursing staff who have spent so many hours with me recently. I’m privileged to have gained a detailed insight into the amazing achievements of staff and the challenges they face. It’s an insight that will help me fight more effectively for the health of our city should I become your MP. All the best, Peter– at Royal Sussex County Hospital