E is for Everyday Heroes: In Praise of the NHS

Be not afeard; the isle is full of noises,
Sounds and sweet airs, that give delight and hurt not.
Sometimes a thousand twangling instruments
Will hum about mine ears, and sometime voices
That, if I then had waked after long sleep,
Will make me sleep again.

– William Shakespeare, The Tempest

Friday 27th July, 2012

The sun is setting, there is a hint of rain in the air, and the reclaimed marshes of the East End are filled with the rousing strains of Elgar’s Nimrod. It’s the Olympic Opening Ceremony and I – like the rest of the nation – am watching spellbound and teary eyed as a piece of history unfolds: Branagh’s Brunel; five molten gold Olympic rings; Bond, the Queen and her corgis; Mr Bean in Chariots of Fire; David Beckham speeding up the glorious Thames; Dizzee Rascal going Bonkers; and of course, Danny Boyle’s brave and beautiful tribute to our National Health Service. It may have left international viewers baffled, but for anyone on home turf here was a night to feel heart-bustingly proud to be British, and here was one of the best reasons why. The NHS – a remarkable ideal, a unique institution, and an enduring symbol of the better part of our national identity – the part that stands proudly and defiantly for compassion, solidarity, and everything that is good about who we Brits are, and how we look after each other. That we have maintained a universal healthcare system, free at the point of delivery for almost 70 years must surely be our greatest collective achievement. That we all know someone who is still here and thriving because of it is thanks to the millions of women and men who have devoted their careers to it, and they deserved their salute that night.

NHS

We ♥ the NHS!, by Scorpions and Centaurs, is licensed under CC BY 2.0

The collective principle asserts that…no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means

– Aneurin Bevan, In Place of Fear

I don’t profess to understand the complexities of the political landscape surrounding today’s NHS (and the fact that it isn’t abundantly clear to ordinary people is perhaps part of the problem), but I have spent a lot of time with the ladies and gentleman of the NHS. By my reckoning I’ve spent well over 300 hours in clinics, wards and waiting rooms since my diagnosis, so what I say here is based on my very personal experience as a patient and ‘customer’ of its services.

When I’m not being a breast cancer patient my real job is to help organisations do stuff better, so it has been impossible to spend all this time experiencing the sharp end of the NHS without drawing some tentative conclusions about the state of its health. I’ve worked with some of the largest organisations in the world and they have got nothing – NOTHING – on the complexity of this business model. The scope, the scale and the stakes of what the NHS does are staggering:

  • It serves each and every healthcare need of 64 million people, from babies to centenarians
  • It runs over 9,000 GP practices and over 2,000 hospitals
  • It is the largest employer in the UK, and the 5th largest employer in the world – larger than all household names except Walmart and McDonalds

And yet, the NHS I see is not being run in a way befitting one of the largest, greatest institutions in the world, responsible for the health of a nation. The NHS I see is an organisation so mired in bureaucracy and antiquated process that it cannot possibly keep pace with the evolving healthcare demands of the society it serves. The NHS I see is an organisation where the technology being used to run it is nowhere near as sophisticated as the everyday technology I’m using to publish this post. But mainly the NHS I see is an organisation full of dedicated, skilled, committed individuals working their asses off, frequently going over and above the call of duty in the face of inescapable pressures and punishing constraints in order to keep you and me healthy.

Saturday 27th July, 2013 – One Year Later

The sun is setting. It is swelteringly hot, and there is not a hint of rain in the air. My visitors have just left the building, and I’m staring down the barrel of a long weekend in Homerton General after my initial breast cancer surgery. If there is anywhere to witness the full warts-and-all workings of the NHS, it has to be a gynaecological ward in inner city London. The journey from the operating theatre to ward bed may be just a short trolley ride, but adjusting to life in this alien environment is a slow process that requires the Orientation Drill:

1) Who am I?
When you are wheeled onto a hospital ward, barely conscious and physically helpless, your world immediately shrinks, not to the ward itself, or even to your section of the ward, but to your body, your bed and the area around your bed within immediate arm’s reach. Somewhere far beyond your realm of consciousness there is a nurse’s station, and the double doors that grant entry to visitors twice a day, but at this moment you are primarily concerned with re-entering the land of the living, remembering who you are, and confirming that you still have all your basic faculties, if not body parts.

2) Where am I?
As you gradually overcome grogginess your awareness expands to the cubicles surrounding you. This is your Section and these will be your bedfellows for the foreseeable future. You speculate on who they are, what might be wrong with them, and how you are ever going to achieve the epic journey from your bed to the nearest bathroom. This is your Everest. Fortunately a nurse is going to patiently hold your hand and take your weight every excruciating tiny shuffling step of the way, even if it is going to take 10 long minutes that she really needs to be spending on something else.

3) Can I get an upgrade?
Morphine mania finally kicks in and it’s time to get organised. You need to make this cubicle as much like a business class flight experience as possible. That means all mod cons – phone, iPad, Bose noise cancelling headphones – out on the wheelie table within easy reach, and your coffee and newspaper order submitted for delivery at first visiting time in the morning. It’s going to be a long night. Except you have absolutely no idea what a long night is until you experience a night on an NHS ward. Go into hospital for surgery you can’t perform on yourself, go into hospital for opiate painkillers they won’t give you over the counter, but don’t under any circumstances go into hospital to sleep. Never in my life have I known so much noise in the dead of night, and I live above a wannabe drum and bass DJ. If it’s not the patients, it’s the staff, and if it’s not the staff it’s the phone ringing. You can learn an awful lot of stuff about an awful lot of people by listening to everything happening on the ward – and since the only question the nurses ever seem to ask relates to bowel habits you can learn stuff to make your eyes water and your ears bleed. If ever there was a cure for curiosity, this is it. And even if you do manage to zone out and close your eyes for a few minutes you will be promptly and rudely awoken to have your blood pressure taken, or to be given more medication – which will likely be laxatives, on account of the obsession with your bowel habits. There is nothing like being rudely awoken at 4am to be given a dose of laxatives.

Within a few hours on the ward you become strangely institutionalised, and you accept that you are totally reliant on the staff – and your visitors – for absolutely everything you need. And so, over and above all the noise and the drama, it is the small acts of kindness that you remember. It is the orderly who brought me an extra jug of ice with my water every day because it was a stifling 27 degrees and I asked him nicely, and then miraculously conjured up a fully functioning fan. It is the overworked surgical registrar who took the time to pop by last thing on Friday night before he went off on holiday just to check that I was ok and had what I needed for the weekend. And it is the nurses on the night shift who cared for me that first, unsettling night, when I didn’t come out of recovery until 9pm, disorientated, sick, and traumatised, who took the time to get to know me and my family, and made sure I was in shape to check out on time 5 days later.

 ward table 1

Economy Class Table, Business Class Accessories

Friday 6th February, 2015

The sun has set. There’s rain everywhere in the air. It’s cold, it’s dark, and it’s midnight on the mean streets of Hackney where the Friday night revels are in full swing. I’m reluctantly forcing myself out of bed and putting a coat on over my pyjamas to head to A&E with a surgical complication that can’t wait until morning, and I am in a world of despair. I’ve seen ‘Casualty’. I know all about taking a ticket like you’re at the supermarket cheese counter, then having an interminable wait on plastic chairs while a pompous arse shouts at the reception staff, only to be contrite when they later save him from a heart attack, all while some kind of urban gang warfare drama unfolds in the background. And that’s before you account for the romantic intrigue inevitably simmering away amongst the staff. I packed a really long book and reckoned I’d be home by the time the sun came up – if I was lucky. How wrong could I be? I’ve rarely experienced anything more seamless and reassuring, from the friendly reception staff, to being whisked straight in for fast, focused triage, and then miraculously seeing a breast surgeon who was on call, who I knew, and who was completely familiar with my complication and could resolve it in a matter of minutes. I was back home and tucked up in bed with a hot chocolate by 2am as though it had never happened. I accept that isn’t always the norm, but in the 3 times I have been forced to use A&E in the last 2 years I have always been seen quickly, efficiently and received excellent care, and never once have I seen anyone lose it and throw a chair. They couldn’t make a tv drama out of the reality of my A&E experience – it’s too boring.

Any given Tuesday or Friday morning

Jeremy Kyle is blaring out on the waiting room television, it’s standing room only in the corridors, and a dissatisfied patient is kicking off about the disgrace it is that their taxpayer money is being wasted while the doctor is clearly sat on their bum doing the square root of sweet Fanny Adams behind their closed door. This is Breast Clinic. This is where the day to day bread and butter of consultations and check-ups happen. This is where doctors have a maximum of 10 minutes per patient to do absolutely everything, including working out whether you have cancer or not, telling you whether you have cancer or not, or obtaining your informed consent on what to do about it. I like to consider myself one of the more no-nonsense cut-to-the-chase patients, but I definitely need more than 10 minutes to absorb the fact I have cancer, or to decide whether to permanently mutilate my shoulder or my stomach to rebuild my breast – and I have the advantage of being up on the lingo from a lifetime watching tv medical drama and having English as a first language. Hell, 10 minutes is barely enough time to strip your clothes off and get them all back on again, let alone fit in a thorough examination, discussion, conclusion and coherent letter to your GP. Clinic is where Consultants, Junior Doctors (who are, by the way, the least ‘junior’ professionals I’ve ever encountered) and Nurse Specialists treat every patient with the same focus, attention and respect, working straight through their lunch and into the next clinic to stick to a timetable that was shot before it even started. And Clinic is where you watch broken people emerge from behind the closed door, completely shattered by the news they just received, and you know that this long-suffering team of medical professionals have got their backs, and are going to do everything in their power to put them back together again.

You see I dreamed that we would have a night like this, but not in my wildest dreams did I think it would actually unfold in the way that it did – Lord Coe

Saturday 4th August, 2012

  • 11.36am Gold, GB, Men’s four
  • 11.57am Gold, GB, Women’s lightweight double sculls
  • 6.09pm Gold, GB, Women’s team pursuit
  • 9.02pm Gold, GB, Women’s heptathlon
  • 9.24pm Gold, GB, Men’s long jump
  • 9.46pm Gold, GB, Men’s 10,000m

Mo Farah crosses the line in the perfect climax to the perfect day, when it all came together in that glorious summer of 2012. But none of it happened overnight, or in a financial year, or within the neat confines of a political term. That electrifying moment in Stratford at 9.46pm on 5th August 2012 had its origins in an idea that was conceived fifteen years earlier, in 1997. London 2012 was a vision, then a bid, and then a plan, and it was delivered through years of blood, sweat and tears by the very best that Britain had to throw at it – from one of our greatest Olympians as Chairman of the Organising Committee, to one of our greatest film directors as Artistic Director of the Opening Ceremony, and everyone and everything that was needed in between.

Olympian endeavours require an Olympian commitment and an Olympian attitude to achieve them. And so it follows that an NHS which is not simply a ‘healthcare provider’, but a cornerstone of our civilised society and enduring emblem of our national identity requires our greatest minds, our most Herculean efforts, and our most passionate and patriotic support, so that one day – some day – it isn’t limping along, struggling to keep up, but is way out in front, crossing the line on its very own Super Saturday. And as for the amazing women and men who work within it – they may not be Olympians, and they definitely won’t win any medals for their day to day endeavours, but they are all my heroes, and I am forever in their debt.

 

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