This summer the UK has been privileged to witness some really special achievements. The Diamond Jubilee celebrations, followed by Olympics and Para-Olympics, proved to even the most hardened sceptics that Britain can pull off global events to be proud of. Danny Boyle’s tribute to the NHS provided a timely reminder that – whatever its shortcomings – our largest employer remains a key part of our Heritage.Hopefully the performances of our athletes will inspire us to become a fitter, and healthier Nation and end the much-feared obesity epidemic….there’s no harm in hoping.
But amidst all the Olympicand Para-Olympic euphoria, many acute physicians willhave found themselves battling against the familiar challenges of bed crises in our acute hospitals -even in August. When we can achieve so much, why is it that we seem to struggle to resolve this problem after so many years of trying? The Foundation Year doctors, arriving on 1st August, might be forgiven for assuming that this is a new problem – of course it isn’t. The last decade has been filled with attempts to find solutions – length of hospital stay has reduced dramatically for many conditions, ambulatory care pathways have been developed along with widespread schemes to avoid ‘inappropriate’ hospital admissions. According to Gordon Caldwell’s article in this edition, will still need to become ‘leaner’ – in his words to ‘Cut the Crap’ from our systems. He cites many examples of what could – and should – be cut out; I am sure many of his suggestions will ring true with readers of this journal. The inefficiency of ‘waiting’ is highlighted in his article; certainly this wastes many precious hours of our time – and the day never seems quite long enough as it is. But such delays are trivial in comparison to the waits which our patients endure on a daily basis; this is a fundamental problem which we have to resolve before we can move forward.
I met an American patient recently – visiting for the Olympics and admitted to hospital with diarrhoea and rectal bleeding.This was likely to be a new presentation of inflammatory bowel disease – she was not in imminent danger, but not really well enough for outpatient management.The plan to start some treatment and arrange flexible sigmoidoscopy ‘in the next day or two’ was greeted with the response ‘So what the Heck is wrong with today?’ Americans sometimes have a refreshingly direct approach – but of course she had a point: what the Heck was wrong with today? OK – I could rationalise it: even if the test were done we would probably have had to wait to see how she responded to treatment, and she had no-one to ‘keep an eye on her’ if she left hospital. However it made me realise how, in NHS hospitals we have become so used to waiting that UK patients – and their doctors – often perceive it as inevitable. Patients wait for assessment, wait for a test to be done and then wait for the result, they then wait for someone to review and act upon the result and then wait again for something, or someone else.
It is true that some patients get better while waiting – time can be a healer, and can reveal the ‘real’ diagnosis. However it is hard to make the case that delays ever improve outcome; if something is deemed to be necessary, and is only going to be done once, then why not do it as soon as the decision has been made? Is there ever a justification for a patient waiting in a hospital bed for additional nights for a test or assessment which is scheduled on a future date? I suspect that every reader of this journal will have patients under their care who fall into that group; across the UK, on a daily basis, this figure will amount to thousands.
My American patient suggested this must be a British thing: ‘Nobody back home would accept this’, she said. If queuing was an Olympic discipline, the GB team would be nailed-on for gold, and NHS patients would be first on the team sheet. But perhaps the time has come to challenge these assumptions; to ask ourselves, and our colleagues the same question: ‘What the Heck is wrong with today?’If we don’t ask it, sooner or later our patients will.