Helen Martin: Hospital is on the critical list
Even the capacity of the hospital to cope with the needs of the local population has been questioned.
Whenever these issues are raised, and occasionally at points in between, this newspaper receives letters from grateful patients or relatives saying how well they or theirs were treated and heaping praise upon the over-worked nurses for doing a marvellous and caring job.
As with all public services, there will be good experiences and bad, sometimes depending on the expectations of the users.
And today, our expectations are very different from those we held in the halcyon days of the NHS when matron ruled, wards were run with military precision, patients and relatives were expected to do as they were told and nurses in starched aprons and impressive headgear were treated with awesome respect.
By comparison, the hospital experience today is informal and less daunting. The nurses stroll about in scrubs, patients are accommodated in rooms of four, and it’s almost impossible for a layman to identify who is actually in charge.
Many people know more than they used to, at least superficially, about patient care and their relative’s illness. And, like it or not, in the case of the ERI and the NHS as a whole, faith in and respect for the medical professions is lower than it used to be.
Relatives feel more responsibility to make sure they know all the options and to act as advocate for their patient because they no longer trust that nurses and doctors will automatically deliver the best care. Our view of hospitals has changed.
Many of the complaints, such as the recent attack on the ERI by TV doctor and research scientist James Logan, don’t concern high-end medical treatment but the commonsense end of the hospital business.
He complained of the poor bedside manner, the attitude, the way family were spoken to, the lack of communication between staff and the “level of service”.
I’ve had experiences myself of nurses on a ward at the ERI not knowing, or even being willing to find out, where one of their patients had been moved to that afternoon; of an old lady being left shivering and blue with cold on an orthopaedic ward while a nurse shrugged and said there were no spare blankets, and more. And we’ve all heard the shocking stories relating to neglect or ignorance of how to deal with elderly patients with dementia or other cognitive impairment . . . lack of feeding assistance or changing, for example.
There have been too many complaints about the ERI, leaving us all feeling there is a problem at our major hospital, something systemic that NHS Lothian has failed to grasp perhaps because it simply cannot see how poor its performance appears to patients and relatives, not to mention inspectors.
It’s all very well to concentrate on surgical and medical standards and outcomes, to have nurses clutching degrees and keeping abreast of the latest advances and procedures. But the basics we expect are that patients will be cared for, warm, fed, changed, reassured and tenderly treated and that relatives and the support they bring will be welcomed. Hospitals are about people, not just procedures. They are not “production lines”.
There is no room for arrogance or complacency about medical expertise because it is perfectly reasonable for a layman to assume that a hospital which cannot guarantee patient cleanliness, nutrition, dignity and reasonable comfort, all delivered with empathy and understanding, can hardly be trusted with anything more complicated.
It’s good that some people have positive experiences of care and are “grateful”. But it’s a hospital, not a bank. That should be taken as read with gratitude from all but the most truculent or troublesome patients and relatives (for they also exist).
Being short-staffed or over-worked as is often alleged, is no excuse, even over Christmas as Dr Logan pointed out. What appears to be missing from the ERI on the basis of the complaints and evidence so far, is not academic qualification, medical and surgical skills, scientific knowledge, or even manpower but humanity, elementary hands-on care, courtesy and common sense.
Or did hospitals throw them out along with the starched frilly bonnets and metal bed pans?
The ERI has a job to do rebuilding the faith and trust of the local population because whether it wants to hear this or not, it is not generally held in very high esteem. Each reported bad experience of attitude or basic patient care delivers another knock to public confidence.
No doubt it shares its problems with other hospitals around the country. And in the Lothians, we all need the ERI. But we need it to be better.