Healthcare: asleep at the wheel

By Richard North - July 29, 2023

A medically illiterate piece, written for The Times by Eleanor Hayward, the paper’s supposed health correspondent, heralds what is described as a “new era” of healthcare that will see hundreds of thousands of patients avoid lengthy hospital stays and instead be treated in their own homes.

As well as medically illiterate, the piece is tone deaf to the history of medical service provision in this country and most of the rest of the world. This is the world where local GP practices used to be the main providers of primary healthcare, visiting the sick who were too ill to attend daily surgeries and treating them in their homes, referring them to hospital only in the last resort.

This is the world that I knew as a boy, born on the same month as was the NHS in 1948, but one that has long ceased to exist. Now, with most GP surgeries providing limited access, while arranging a same-day appointment for many is an unattainable ambition, the shrinking band of over-worked accident and emergency departments is often their first port of call, often via an equally over-worked and dysfunctional ambulance service.

The failures of this system have become the daily fare of the British media, from the broadcasters, the tabloids and the supposedly “quality” dailies. And, as the system fails and continues to fail, the NHS in general and the provision of healthcare has become a political battlefield which has featured prominently in general election campaigns and will, undoubtedly do so in the next.

But, if we’re to accept the glad tidings of Eleanor Hayward, things are about to change. From September onwards, 10,000 acutely ill patients will be cared for on “virtual wards”, using remote monitoring technology which automatically transmits data on their condition to teams of doctors and nurses several miles away.

Health chiefs, we are told, believe the massive expansion of the scheme, which is already the largest in the world, is essential to free up hospital capacity – preventing another winter A&E crisis and helping to bring down record waiting lists.

Every NHS region, it appears, has set up virtual wards for frail over-65s, including dementia patients, as well as for respiratory conditions such as asthma or lung disease. And, from this month the scheme will be rolled out to cover under-18s, allowing terminally ill children to remain at home surrounded by family.

Cue Amanda Pritchard, the NHS chief executive, for a nice juicy quote for the benefit of The Times. She tells the paper that virtual wards will be expanded further “in the near future” to more groups of patients – such as those with heart failure, a condition which affects one million people in the UK.

New figures, from an undisclosed source, show the number of NHS virtual ward beds in England has nearly doubled in the past year, with more than 160,000 patients treated on virtual wards since last April. Patients receive face-to-face visits if needed, while technology used in the scheme flags any worrying deterioration in “vital signs” that may require an escalation to in-hospital treatment.

Then, we come to the gem which tells us that “NHS research” shows that frail elderly patients treated under the scheme are 80 percent less likely to pick up infections such as pneumonia or MRSA, compared with those staying in hospital. They are also, we are told, significantly more likely to make a full recovery and avoid the need to move into a care home.

That something must give is evidenced by the comment from Dr Malte Gerhold, director of improvement at the Health Foundation. He says: “The only way for the NHS to be able to cope with rising demand is to find ways to support and treat people outside hospitals”.

He avers that technology enables a radical transformation, allowing monitoring of a larger group of people, using remote technology. Virtual wards, he says, are an essential part of changing the way we think of and provide health care in the future.”

He then adds in a “No shit Sherlock!” comment which is almost staggering in its palpable arrogance: “There is a growing understanding among the public”, he says, “that home is where you are most likely to get better”.

Speaking personally, this particular member of the public has long understood this core principle – one reaffirmed by recent experience.

In another “nightmarish episode”, I was admitted as an in-patient to Bradford Royal Infirmary on Tuesday week last (much against my better judgement), to permit the administration of intravenous antibiotics which were urgently needed to deal with a massive cellulitis infection.

As this stage, feeling really ill and in intense pain, I would probably have agreed to anything, but – as I recounted before – NHS hospital wards do not provide a healing environment.

This is briefly acknowledged by The Times story which cites the experience of former patient Anne Collins, a 74-year-old who was admitted to hospital last January with complications of chronic obstructive pulmonary disease. After an overnight stay, she had been issued a monitoring kit, which included a smartphone, blood pressure monitor and pulse oximeter, whence she moved back to her home in Bristol.

Collins measured her “vital signs” including blood pressure every day at 9am and 5pm and was visited by nurses once a week for blood tests. Living by herself, she says of the experience: “It was marvellous. I was much more relaxed and could walk around, do the garden and make myself a cup of tea. My family could come and visit me”.

She adds: “I’ve had long stays in hospital before, and it can be very noisy at night, you get woken up at 2am by other patients or by someone needing to get your blood pressure. Being at home meant I could get a good night’s sleep and definitely helped my recovery”. She thus concludes: “You’re so much better off being at home, and it means you can leave the hospital beds for the really sick people. It frees up doctors”.

For myself, this commentary is only too raw. In a noisy ward, with much coming and going, the last of my four daily intravenous infusions was scheduled for midnight, enforcing an hour of vigilance to ensure the flow was not interrupted – a common event rarely detected by harassed and largely absent nursing staff.

From 1am, in theory, I could then sleep, except that at least one machine alarm would sound, with others joining in in a parody of a dawn chorus, bringing me to 2am when I would be broken out of a fitful sleep for a blood pressure reading.

And despite the money spent on the NHS, it appeared that most of the equipment carts were ex-supermarket trolleys salvaged from Rochdale canal. With square wheels and squeaky axels having never seen lubrication in a lifetime, their progress around the ward would be followed with ease – like it or not – until 6am when the new day officially started.

When a sleepless Tuesday night ran into Wednesday, with a promise of early discharge turning into another night of bedlam, Wednesday night proved more of the same, with the medics then insisting that I should remain for yet another night.

With already inadequate pain relief – prescribed by someone who had completely ignored my input – and a wound-dressing so amateurishly applied that a five-year-old would have looked like an expert – I’d had enough. I announced that I was discharging myself, then to be told by an uppity administrator that such a course of action would be “sub-optimal”.

What still puzzles me to this day is which fucking genius ever thought that exposing a critically-ill patient to an noisy environment, equivalent in sound pressure levels to an airport departure lounge, keeping him without adequate pain relief, neglecting basic medical needs and then depriving him of sleep for 72 hours, comprised an “optimal” treatment pathway which necessitated in-patient “care”.

To cut a long story short, I was discharged within the hour and transferred to a day-care ward which I have attended daily for antibiotic infusions, blood tests, wound dressings and medical review.

I didn’t need, and don’t need, the fancy monitoring gismos – I don’t even have a smartphone. It would be nice, though, to have someone come to the house instead of bearing the expense of a taxi to and from the hospital each day. Nevertheless, good, old-fashioned care has so far worked admirably. And being able to sleep in my own bed, I am slowly on the mend.

Thinking back to the past, this is exactly the service which used to be offered by the cottage hospitals before they were closed down, augmented by the district nurse system which still exists in theory, although no-one has actually seen a nurse for years.

But now, we can all look to technology coming to our aid, no-doubt at the expenditure of many billions of pounds given in juicy contracts to private “care” providers, all brought about by the recognition that keeping patients permanently sleep-deprived is not always the best option for securing rapid recovery. Without such progress, where would we be?