The impressive NHS

I consider morale to be a rather important in the smooth workings of the NHS. True, some things in the NHS are done badly, and some things definitely need to improve. But we hear a lot more within the media about NHS failings rather than successes. This doesn’t just affect morale within the NHS. It can also give a skewed view to people who are trying to decide whether or not to accept NHS care.

I am handing over to Emeritus Professor Joe Lamb who has emailed and who is keen for his experience of the NHS to be heard.

A total knee replacement in a Scottish NHS hospital On Monday 23/06/08 at lunch time I entered the Golden Jubilee National Hospital in Clydebank and, like all other patients, was allocated a single room with en-suite facilities, TV, phone etc and then was seen by the surgeon and registrar, the anaesthetist and various other staff. Next day at 8am I was given a spinal anaesthetic & sedative (my choice) into my arm. I woke at 11am, had a normal lunch at 12-30pm and was up on a zimmer by 4pm. By recovery day 1 I progressed to sticks and was ready for home by day 3 (Friday). I stayed another day because of another medical problem. During the few days of my recovery three main themes were evident. Firstly pain relief was given initially by an anaesthetic into the knee via a catheter, and later by a variety of pills of various pain-killing strengths. Secondly the danger of deep vein thrombosis was addressed by getting the patients mobile as soon as possible, by special stockings (TED) kept on for 6 weeks and by a pulsatile pump on one’s feet during the night and then by ‘blood thinning’ drugs. Finally recovery of knee function was started on day 1 by physiotherapists with a variety of exercises which I found painful, tho’ necessary. I was so well drilled in these that I continued them at home for many weeks as I wanted as full knee movement as possible. I had last worked as a proper medic 50 years before and was astonished at the changes since then. The main change was that treatment was organised on a ‘production line’ basis by a range of nurses and by physiotherapists, all with specialist skills; each working to a timetable for each patient. Finally all meals were prepared on the premises and were of good quality; the next day’s menu was chosen each day after breakfast by the patient. Frequent hand washing was obligatory for staff, and patients and visitors were encouraged to do so. As all patients have a single room it was possible to empty the room and disinfect everything between patients. The presence of MRSA was reduced as all patients were screened for it before admission and if necessary treated. I talked extensively to all the staff and was impressed by their high morale and love of their jobs. The administrators deserve great credit for the excellent and unobtrusive way they have arranged this. This system even extended to after care in that they organise a nurse to attend at home for the first 2 weeks and have a telephone survey of wound condition at 15 and 30 days. If a physiotherapist is needed during recovery they organise it. The clear picture which emerged was that the whole treatment was integrated with all staff employed by the NHS, so avoiding legal problems of the ‘who does what variety’. The Golden Jubilee National Hospital started life as a private US venture for Arabs but was underused and so was taken over by the NHS to help with waiting lists. It provides services for planned procedures such as hip and knee replacements, cataracts, general surgery and endoscopies as well as diagnostic imaging and now is the home of the heart and lung centre; it does not have an Accident and Emergency Department. Because patients like me lived two hours away from the hospital, relatives are offered free accommodation (without food) at the adjoining Beardmore Hotel and Conference Centre.

This experience shows clearly that the NHS can run an efficient, integrated, excellent service for elective surgery with no parts hived off to the private sector. It confirms the views I have held for many years that the NHS is an excellent organisation, especially if left alone to get on with its job.

Margaret McCartney’s Blog

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A forum on healthcare policy and professional issues, by Glasgow-based GP and FT Weekend columnist Margaret McCartney.

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