So you think you could run a hospital…
After the NHS’S toughest winter, Rosa Silverman reports from the front line at a trauma centre featured in a BBC documentary
In the middle of what they call the “blue area” at Queen’s Medical Centre emergency department (ED), four patients are waiting on beds. One is lying on her side, head buried beneath a jacket that provides her only privacy; the others, who all arrived by ambulance, simply stare into space, waiting to be assessed.
Such is the relatively calm scene at the major Nottingham trauma centre when I visit this week; a very different one from that which viewers of the BBC documentary series Hospital saw on their screens on Monday night.
Filmed at the height of the winter crisis, the programme offered a shocking glimpse of the overcrowding that hospitals up and down the country have struggled with – and which Addenbrooke’s in Cambridge currently threatens to be overwhelmed by. The Cambridge University Trust confirmed yesterday that it had been forced to take the “extraordinary action” of cancelling every planned operation, even cancer and urgent cases.
In Nottingham, the perfect storm of a bad flu season and a prolonged run of cold weather, combined with a range of longer-term issues, saw patients crowded in rows of beds, sometimes for hours on end.
Caroline Shaw has been chief operating officer of Nottingham University Hospitals NHS Trust for three years, and has worked in the NHS for close to three decades. Even she, however, had never seen things reach this point before.
The omens had been bad since December 26. “Over Christmas, we usually see a dip in our admissions because people keep away from hospitals,” she tells me. Not this Christmas. “There was a big warning sign on Boxing Day. I was standing in ED and it was busy and I thought: ‘This doesn’t bode well.’”
Having worked over the festive period – her average shift is 12 hours long – she took a four-day family holiday as planned, but kept in touch to monitor the growing emergency.
“Every day it was getting more and more challenging,” she says. “They’d used absolutely every bed and we knew then it was going to be very different.”
But despite knowing just how serious it had become, nothing prepared her for her return to work. “They were literally stacked up in rows. I’ve never seen anything like that.” The ED was built to accommodate 350 patients, yet at least 550 came through the doors every day – “totally unacceptable for patient dignity”.
“I’m just horrified,” she adds. “If that was me on a trolley in the middle of the blue team area, next to a man or a woman I didn’t know, I’d hate it. It’s not acceptable care.”
So acute was the situation at the turn of the year, that the Government issued a national mandate to cancel all elective surgery apart from cancer, urgent and children’s operations.
“That freed up some capacity and we thought after a couple of weeks it would get better, but actually the same volume just kept coming in,” says Shaw.
The 51-year-old mother-of-two from Cumbria trained as a nurse in the mideighties and then became a midwife, before she moved into a leadership role. “I realised if I was in leadership I could make a difference to lots of families, lots of staff and not just one patient, like when you’re a midwife,” she says. At a special staff screening of the first episode of the third series of Hospital, everyone cheered when Shaw appeared on screen, and it’s easy to see why this down-to-earth and genuinely passionate manager has such support.
But how easy was it to keep their morale up when the hospital was on “black alert”, a status based on the number of people waiting for a bed? It was no temporary blip, after all – the crisis endured throughout January and February, and only halfway through March did it start to ease up. “I think the NHS quite likes a crisis,” jokes Shaw. “But this year people are truly exhausted and we’ve got to look after them. But [the staff ] are brilliant; it’s what the NHS is about. People go on and do it, [they go] above and beyond.
“People really are motivated and want to make a difference to patients but it’s been such a tough winter, probably the toughest winter on record. When I was on the wards, 25 years ago, we’d have a group of patients ready to go home who would help you serve out the teas and sort out the flower vases; you’d have a group in the middle who were self-caring; and you’d have a bay at the end of really poorly patients,” says Shaw. “We don’t have that luxury now. You go on to our wards and everyone is either really acutely ill and needing some form of rehab or [requires] support for complex health needs.”
Behind this state of affairs lie demographic and social changes and, paradoxically, the success of the NHS itself. When Shaw took a look around a ward recently, she encountered five patients over the age of 95. “People are surviving with huge complex needs, and you could say that’s been a huge success of the NHS, but with that comes a cost. Also families are different now. My mum lives 200 miles away. You haven’t got the same infrastructure because people are working away from home, they have different social responsibilities.”
Cuts to social care have left elderly patients with nowhere to go when they’re discharged, leaving them stuck in hospital beds, says Shaw. In the documentary, 86-year-old dementia patient Mavis was one such patient, marooned for weeks in a bed at Queen’s Medical Centre while a suitable care home place was found.
If the problems have been welldocumented, however, the solutions are yet to be agreed. This week Jeremy Hunt, the Health Secretary, called for a 10-year NHS spending deal and backed moves for a ringfenced tax, a proposal Shaw suggests would be “warmly received by lots of people”. She adds: “Doing nothing isn’t an option.”
Nottingham NHS Trust has a £24million deficit; unremarkable for a trust of its size. The NHS celebrates its 70th anniversary this year. But if the winter beds crisis so vividly documented this week shows anything, it’s that something must change in a health system creaking under myriad strains.
Shaw believes strongly that the public can be part of the solution – from primary schoolchildren upwards. “We’ve got a responsibility as a population to keep ourselves well,” she argues. “Because the next generation are our older generation of the future.”