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Martin Vander Weyer: In my hospital bed, I saw the future of the NHS

What's needed is not top-down reform, but continuous improvement from the bottom up

4 January 2014

9:00 AM

4 January 2014

9:00 AM

I blamed the pheasant casserole, but I did it an injustice. Its only contribution to the drama behind my disappearance in mid-December was a residue of lead shot in the small intestine that briefly confused the radiologist. The real villain revealed by the scan was my appendix, which had taken on the raging, bull-necked, bug-eyed appearance of Ed Balls faced with a set of improving growth figures.

And so it was that I spent a week in the Friarage at Northallerton, a small ‘district general hospital’ that has survived every NHS restructuring to date and is cherished by the citizenry of rural North Yorkshire. For someone who hasn’t been hospitalised since 1957, this was the Full Monty: the ambulance in the night, the agonised wait in A&E, the sudden euphoria of morphine; and when the crisis had passed, the stultifying routine of life on the ward, waiting for the relief of the next visiting hour or doctors’ round or tea trolley or troublesome patient. But at least it gave me time to think — not just about the state of the health service, but about the ailments of the nation in 2014 and beyond.

Of course I shouldn’t leap to generalisations on the basis of a single skirmish with the NHS. But I’ll say this: given limitless demand as longevity rises, inevitable scarcities and bottlenecks of resources, bureaucratic risk-aversion driven by fear of the Daily Mail, and voters’ reluctance to pay more tax for anything, including their own healthcare, it’s a miracle this giant contraption is as robust as it is.

Could it be more efficient? Of course it could, in every corner. It took 60 hours after admission — and a clearly foolish threat to discharge myself — before they finally wheeled me past a scanner appeal poster and fed me into the space-age machine that settled the diagnosis. Staff levels sometimes looked lavish, at other times strained or skeletal. There was no means of knowing who was in charge at any given moment. As for keeping track of the patient, I kept thinking, ‘Why don’t they buy some software from Travelodge or DHL or Ocado, instead of all this scribbled paperwork and duplication?’

But I couldn’t accuse anyone, from consultant surgeon to catering assistant, of not trying their best within an imperfect system, or not caring. I eavesdropped through the curtain on a young nurse — near the end of a 12 hour 40 minute shift, in which the 40-minute lunch break is unpaid — gently comforting a patient whose spirits had crumpled after he woke from a bowel operation to find himself with a temporary stoma bag. It was done with real empathy, and it made me think that the ethos of the NHS is good even if the nuts and bolts are loose.

And in the end, the ‘patient experience’ is far more about ethos than about macro-management structures whose prime objective is cost elimination. What’s needed here is not yet another bout of Whitehall-driven top-down re-engineering, destabilising networks and pitting one entrenched interest group against another — but bottom-up kaizen, the Japanese factory-floor philosophy of continuous improvement.

Angel wings

And then there are the patients. All life is here, even in small-town Northallerton, and my first observation is that if you want a non-judgmental argument in favour of tax breaks for married couples, take a look at a busy NHS ward at visiting time. It seemed to me that every older patient had a spouse or a sensible grown-up daughter at the bedside, bringing news of grandchildren and fussing over arrangements to be made at home. But all the younger men had broken relationships, and some seemed troubled by the ‘next of kin’ question.

One likeable lad gave us the whole soap opera between mouthfuls of crisps and painkillers: ‘I’m not with mi’ girlfriend any more, I just went off on one and walked out. But I love mi’ daughter to bits, she’s two, I’m getting a new tattoo when I get out of here, whole back, angels wings and a poem, just for her. I rang and said can I have a council house, I’ve nowhere to go, and the bloke said no you can’t, we need them all for t’ Romanians that are coming in January. It’s like this Polish bloke at work, he got a council house for his brother who hasn’t even left Poland yet, no bother, it’s their human rights apparently. I’m telling you, I’m the biggest Ukip supporter there is, it’s the only hope for this country. So I’m staying at mi’ grandad’s…’

You don’t have to project far — many would argue we’re already there — to a time when the breakdown of traditional family structures and cultural norms translates into spiralling demand for state welfare that voters will be even more reluctant to pay for, and that acts as a brake on growth as well as a catalyst for inequality. The talkative lad was worrying about all that too: ‘I’m putting aside money for mi’ daughter now, when I can, I mean, otherwise how’s she ever going to get to university, this economy’s never getting any better…’

I tried to reassure him on that last point, having absorbed the gist of George Osborne’s autumn statement and subsequent statistics from my iPhone (never ask for the television to be switched on in a hospital ward, you end up staring at hours of silent snooker). ‘Growth’s up 0.8 per cent in the last three months,’ I recited eagerly, ‘factory output’s up 4 per cent, job vacancies are rising at their fastest for 15 years; of course we should worry that export demand from the eurozone looks weak…’

The pills seemed to have put him to sleep, which was lucky because I was about to add ‘…and I’m afraid your chances of buying a house, which is the best way you can secure your daughter’s future even if you don’t get back together with her mother, will get worse as property prices race ahead of earnings for the next couple of years.’

Even without his angel wings he looked beatific as he snoozed. Like the nurse behind the curtain, like most of us really, he’s just an ordinary human trying to do the right thing in an imperfect world. I guess that’s my first theme for 2014.

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  • ProperDave

    I’m guessing from the phonetic writing that the author doesn’t have a North Yorkshire accent. Patronising or what?

    • Terry Field

      WHAT what?