Well, yesterday I had reason to go to our brand spanking n ew A&E unit in Portsmouth. It's only been open a couple of months.
The A&E unit is designed to serve the city of Portsmouth and all the local towns North of Portsmouth like Havant, Waterlooville, Petersfield, etc. The Queen Alexandra Hospital covers a pretty wide catchment area.
So you'd think this brand new, state of the art A&E unit would be designed to accept a lot of people, given the wide catchment area.
Er, nope.
The 40-seat A&E unit (yes, just 40 seats, less than the old A&E) is the size of a postage stamp. Despite it opening only a couple of months ago, evidence of poor design abound.
Things are taped in place, there are temporary screens in front of the triage "area" (no longer a separate room) and there are lots of tannoy announcements requesting relatives of patients stand so that patients could be seated. Yeah.
I was originally attended to at work by an Ambulance. The crew said I needed to go to A&E, but could I make my own way there so as not to tie up the Ambulance? I agreed, obviously, given someone at work offered to give me a lift.
When I got there, Oh. My. God.
I got there between 12 and 1pm. The measure of efficiency of the so-called "system" they have in place was shown by the large number of people still in pyjamas. So obviously they had been brought in overnight.
They also seemed to be losing a lot of patients (more about this later), because nurses were calling for people and the people weren't coming forward. That could be the system, or it could have been the noise of the jackhammer being used underneath the waiting room drowning out their shouts.
It took an hour before I was triaged. I say triaged, but realy it was only just checking I was there in person and making my initial observations like heart rate and sats (more about that later as well).
Then an hour after that, I get to go into a room for initial assessment, which took less than 5 minutes to have a chat, fill in the form and direct me over to a GP in another building. Another half hour or 45 minute wait, I got seen by the GP.
Now I'm presenting with facial paralysis on one side of my face. I have a history of stroke and heart attack. But apart from the usual FAST test checking my limbs for loss of function, there wasn't much discussion as to what may have caused it.
So, 45 minutes later, I'm back in the heaving A&E department as the day's casualties start to build up.
Luckily it's only a 10 minute wait before I'm called and wheeled (no walking) to the CT scanner. 20 minutes in the scanner and I'm done, being wheeled back to A&E reception until I'm intercepted. The doctor is ready to see me in a consulting room.
Cue more fast tests.
Can I say at this point I had been asked about my previous issues at every turn. It seems my previous medical history is not available on the new system they are using in A&E, or it's so inaccessible, it's just easier to keep asking the same questions of the patient over and over.
So the Ambulance crew with their fancy online tablet can't see my history, the A&E team can't, the GP at the hospital can't, and the consultant about to make life-changing decisions about my treatment can't either. Not only that, the ambulance crew information they entered on their tablet isn't accessible by A&E either it seems.
Anyway, the doctor, with two trainees in tow (or it could be the other way round) start making umming noises whilst looking pretty cursorily at my CT scan. Not sure how you can flick through the scan of my brain in 5 seconds a couple of times and make a diagnosis, but that's where it stands. There's a risk of missing something subtle, but unfortunately I don't expect subtle or thorough from the NHS.
For me, I'd say all you can see at that speed is to identify the patient has a brain and not miss a massive and quite obvious tumour. Something small and subtle... not a chance.
So, the doctor explains his diagnosis is either another TIA (doesn't feel like one, but hey ho, or it may be Bells Palsy (more on that later). He's changing my meds (they like to do that to make it look like they've done something) and he's going to give me a big dose of asprin and blood thinners before I go home. Just in case. (yeah, I know you don't know what the fuck is going on in my head and you're just going through the motions). The doctor says he will arrange for further scan including and MRI next week.
And there's me believing the adverts that say you need to act FAST to save someone from the effects of a stroke. Next week is fine to confirm if you are fucked up permanently of if there was something we could or should have done yesterday in that golden hour they're always bashing on about.
The trainee (who I think is a better doctor than the specialist) pipes up about blood tests. So he agrees and asks for the usual cholesterol, etc. to be tested.
Not at any time was there any discussion or investigation as to what may have caused the facial paralysis, just that it was there. Discussion and fixation was on past history of TIAs, but as far as I'm aware, the mechanisms that cause Bell's Palsy are different. No questions on what I was doing leading up to it, anything else like infections that could be affecting the facial nerves. Nothing of any depth. Again, the process is king. About the only questions were have I had cold or flu like symptoms in the past few days.
Anyway, the trainees leave, the doctor faffs with the screen, grumbles, then tells me he's going to arrange all of this and will be back. He exits the room.
2 hours later, I go to reception asking what's going on. Note that during this two-hour period, the shifts have changed.
The people at reception ask me my name and date of birth for the umpteenth time. Except I'm now not on their system. I'm not supposed to be there, except as I said at the time, I most clearly am.
I few minutes of digging, and it appears that on the system, I've been given a script for my new meads (which I haven't), I'd been given my big dose of "just in case" meds (which I hadn't) and I had been discharged from the hospital (which, most obviously I hadn't).
Rebecca on A&E reception was a star. However, she had a battle. She had to find a way to un-discharge me, un-medicate me, and forget about the blood tests. I assume they weren't even on my records.
That took about an hour and a half, between multiple telephone calls to Rebecca organising several other patients.
Once I was in a the correct state on the system, she personally ran over the the pharmacy on the other side of the hospital to fetch my meds. One I'd downed the pills, I was free to go.
So, that's about three hours wasted in A&E. Three hours that room could be available for someone else, an hour and a half Rebecca could be sorting someone else out, and (if they do it) a meds count at the Pharmacy that could have been out by a number of tablets.
Conclusions,.
1. The brand spanking new A&E unit at the QA hospital is not fit for purpose. The reception area is too small to house the influx of casualties on a normal day, let alone during a crisis period.
Portsmouth city on it's own houses 210,300 people. If 0.0001 percent of the population has an accident or illness, then that's half of the seats in the reception area taken up.
The hospital itself identifies their catchment area includes 675,000 people. 40 seats. For the walking wounded and at least one relative to be with them.
Just by the scenes of chaos yesterday, the reception area was grossly under-specced.
The fact there were a number of temporary measures like things taped here an there suggests the specification of the building and it's fittings doesn't match the actual requirements of the staff using the facility.
2. The process is the treatment. I've said it before and I will say it again, the NHS is all about process. Treatment is a secondary priority. Cure and Recovery are way down the list of priorities. They are almost incidental.
If you're lucky the process will eventually lead to cure and recovery, but not necessarily. In the majority of cases, the process is king and recovery is incidental. Unless you are in an area that has a specialist clinic for your ailment.
3. The "system" within the NHS is not fit for purpose. The computer system especially. Instead the "system" relies on people like Rebecca going above and beyond to plaster over the gaping holes in the actual system. Watching the interactions, the system only works based on favours and people working outside the computer system. It's the "can you just" system of asking someone to do something outside the computer system.
While I appreciate it gets the job done to some extent, it also leaves the NHS vulnerable to human errors. Sadly this has been obvious in a number of cases where tests or treatment that should have been done, weren't, and a diagnosis was missed.
Well, it remains to be seen if that doctor I saw actually booked the follow-up calls and tests for next week.
I remain sceptical.
4. The NHS diagnosis team are ripe for replacement with AI. I machine learning algorithm could ask the questions and come up with better investigation and diagnosis. It'll eliminate the human aspects of the "system" and to be honest should deliver a better quality of care, because an AI can be programmed to care, to ask questions and get to know the back story before coming to a diagnosis. It can reference millions of different cases and over time as it builds up a database of symptoms and cures can outstrip the quality of NHS care.
And that's where I think eventually the NHS is going to go. Sadly from what I can see from yesterday, it'll deliver a better level of diagnosis eventually. It's just that it'll take time to build up the database of cases, because I'm convinced the NHS data is tainted. If you use it, you'll end up with an incompetent AI doctor.
It's sad to see the decline of the NHS since 2008. Back then I had world-class treatment and surgery, then in 2013 I had excellent treatment for my TIA with scans all done in a matter of two days.
Then in 2020 when I had my heart attack it starts to go a bit wrong. I had a stent put in, but only a balloon to open another blockage. I think I needed another stent. Because since then, I got the Angina diagnosis. So thanks, no mechanical fix, just fob me off with drugs.
And then my mother's and my mother-in-law's abysmal treatment.
And now yesterday. I just don't have words. I'd call it organised chaos, but it's not at all organised. There is huge waste of time for starters, as people redo things which should be done correct first time. Time is a resource and the NHS is so huge, wasting hours here or there across the whole organisation can run to billions of pounds just frittered away due to poor systems.