Observing the NHS…

Opening bleary eyes at 5:30am in a hospital ward bed to see the smiling face of a PPE-clad nurse wanting to thrust swabs into your nose and throat for a COVID test is an interesting start to the day! This test marked the start to each long, visitor-free, in-patient day that would eventually end around 10p.m. at night.

Patients were not allowed visitors until their stay surpassed five days. After that, one person could visit for one hour, but only once in every subsequent five-day period. No one grumbled. Instead, the Badger and fellow patients used video calls from personal smartphones or tablets to maintain contact with loved ones. The absence of visitors meant we experienced and observed ward operations performed without distractions, and we habitually shared our remarkably consistent primary observations during the quiet troughs that speckle an in-patient’s day.

Firstly, there was unanimous respect for doctors, nurses, and the ward staff who kept things shipshape (many of whom work 11 hour shifts with just a 30-minute unpaid break). Secondly, we observed that although the NHS is slowly transforming to the digital world, there’s still too much paper-based activity constraining efficiency. One nurse commented, ‘If someone borrows your drugs form before I get to you, it’ll take me half an hour to track it down’. Thirdly, we observed that nothing happens unless a busy doctor says so and signs a piece of paper, which they rarely do promptly. Telling a patient in the morning they’re being discharged, and then telling them in the evening that the doctor’s been busy and has gone home without signing the discharge paper is incredibly annoying and systemically inefficient!

There was also a consistent view that debates about NHS funding, a staple for media reporting, are red herrings because there’s much the NHS can improve itself that needs will rather than money. Its own Long Term Plan shows that it knows it must transform from a way of delivering health services that’s still locked into a model largely created when it was founded in 1948. It just needs to progress faster.

Finally, like most transformations, we observed that it’s the people and working practice issues of change rather than technology that is the biggest challenge. Transforming the NHS, the biggest employer in Europe and the world’s largest employer of highly skilled professionals with a headcount of 1.35 million, over half of which are professionally qualified clinical staff, is undoubtedly a massive task. It’s akin to reengineering a giant A380 plane full of passengers while it’s in flight, but it has to be done for the service to be sustainable. Even with its observable flaws, inefficiencies, and transformational strains, we all felt safe, in expert hands, and hugely proud that our country has the National Health Service as part of the bedrock of life across the population.