The little boy wants to know whether he can go to school yet; his Mum is waiting for her op too. She is clearly unwell and is distracting the boy, smiling at him. I’m sat, gowned up and pressure-socked, fresh from my meeting with the anaesthetist in which we have talked in great detail about how he will manage the vomiting I get post-surgery, and pain relief because I’m allergic to morphine. I feel reassured, and I tell him so. I am hopefully to be in the anaesthetic room for 0830 and the theatre for 9, although there might be a short delay as we wait for a bed.
Ah, the B word.
The time begins to slip by. Patients trickle into the blue bay (ready to go), and a couple of go off for their surgery. Gaggles of green-gowned theatre staff pass in the corridor, carrying notes. Interesting that it’s called theatre; I guess it’s because those surgeons of old used to perform operations in front of an audience. This is also a kind of immersive theatre, those little tableaux, separate yet in it together, wondering what the other is in for. There’s doubtless a dramatic template in our heads. My old ambulance boss, Dougie, once asked a doctor in the ED what was the most difficult part of his job; Holby bloody City was the reply.
So, we talk to our relatives or friends, half watch the BBC news, keep half an eye on each other. From time to time a surgeon or anaesthetist leads another patient off to make their pre-op notes. Nurses and HCAs, smiling and chatty, pop in and out and talk to people, bring pre-op medications. I’ve already had my paracetamol. I’m not worried, just glad to be on the way to knowing what’s what, tempered by the knowledge that in the near future I will know and there will no longer be room for that little miracle I’ve been carefully holding in a little pot in my head with lid screwed firmly down.
The little boy and his Dad say goodbye to the woman just down the row; the man clutches the top of her arm and squeezes for a couple of seconds, pulls her towards his chest. She smiles. The little boy, red school jumper (he loves the badge) and big winter coat, holding hands with Dad and walking away. I tell her how lovely the boy is, and we strike up a conversation. I have to ask her permission to talk about it here, so for now it remains between us.
The woman’s surgeon appears, asks her to come with him. She returns with a nurse who is visibly upset; her all-day surgery has been cancelled because there is no critical care bed. She knew when she saw the surgeon’s face. Her surgery should have taken place now, within a strict time-frame after the end of some other treatment. Now it will be another two weeks at least.
A nurse comes to tell me, at 1100, that there is a bed meeting just starting. Someone will come and talk to me when the meeting is over. It’s been a slow, Hunt-like dawning, the signs and symptoms accruing into the jolt of knowledge that my operation is in jeopardy despite having been first on the list in theatre 4.
At 1215 a bed manager appears. We go to one of the consultation rooms.
“Good news or bad news?” I ask.
“Bad news, I’m sorry”. He shakes his head.
He is clearly wondering whether I’m going to be angry. I’m floating, having known this was coming, and a lump of something clunks in my chest. We sit, and I ask the bed manager where the problems are.
He is open, apologetic, a kind man.
There is a flood of medical admissions at Derriford, which does not have the spare bed capacity to manage. Social care of course is in crisis also and we are stuck. There are two emergency neurosurgery admissions including a trauma, which of course get the theatre slots based on their clinical need. This isn’t about patient choice, or a truly 24/7 NHS, this is about saving lives. There are a couple of more urgent cases than mine which have gone into another theatre; again, cases whose need is of a higher priority. Mine, and presumably some others in similar need, have been dropped.
“I could let you sit here all day and hope, but in the end there will most likely still be no bed.”
I should receive a phone call on Monday to tell me if there’s any chance of surgery next week; but that again depends on clinical need and the bed situation. I thank the bed manager and tell him that I don’t blame the hospital at all for this. I really don’t. There is one proviso, however – I’m going to blog about my decision to go to the BBC with what happened later, and Derriford hospital really must at some point come out publicly and explain the situation to all of us. How are we to know the real causes of this crisis when everyone is apologising and not telling it like it is?
As with all these issues, the picture is complex and nuanced. Yet here we are, with these poor staff buffering the ire of upset patients as they tell us that we can’t have our expensive surgery and that the surgical teams who want nothing more than to do a fantastic job and who’ve prepared and planned and explained, are now as angry, stressed and upset as we are. We had talked, the woman and I, about trusting our surgeons. I’d made the point that they’re all obsessives, immersed in their art and in their science, in their patients, in the planning and the discussions and the human fears. These aren’t people who are motivated by money.
What has this relentless financial framing of everything done? All the grand political speeches about efficiency and management and patient choice, and unaffordable costs to the taxpayer. We are told endlessly of the legendary effects of competition, enforced tendering (enshrined in the NHS by the Health and Social Care Act 2012), the driving down of costs. You can’t make a silk purse from a sow’s ear.
It’s resulted in a simplistic, self-perpetuating notion of efficiency and target cultures, a hogwash of corporate branding and a grand FUBAR of squandered surgery, buckets of cash effectively chucked down the drain. The waste of today is obscene.
It’s left people in dire need floating away on a tide of political spin and lies, blaming each other while the offshore hedge funds that are often behind ‘investment’ in our public services channel all our money away in order to fulfill their purpose in life – to make a profit, preferably without the annoyance of having to pay any tax. How is that good for patient care? Why this profiteering model and not one of social enterprise? Look to our tangled political culture of donations the vested interests for your answer.
The nurses offer me tea, a sandwich, biscuits. They say that the day case ward over the way is now a proper ward with 12 beds, in an attempt to up the capacity. But they’re operating on the edge, with no leeway, no resilience in the system. They think the hospital should cancel the routine cases for a couple of days, let it all breathe. They are upset, empathising. I go off on a rant. They tell me I’m allowed.
Meanwhile, in parliament, Caroline Lucas had sponsored the NHS Reinstatement Bill, developed over the past couple of years by Professor Allyson Pollock. With a cross-party group of MPs in support (but no official backing from Labour – why not?), it was being filibustered by Tory MPs. Smug at their cleverness, waffling about deporting foreigners. They don’t like the bill, so they talk it out, all part of parliamentary process in which we cannot interfere; it’s a tradition, a religion even.
This link explains that we now no longer have an NHS. And we don’t. The bill was our chance to get it back.
So a challenge: venture from your grand Gothic theatre and sit here on our lowly stage, you puffed up parliamentary performers, makers of pig noises, and farters in the general direction of democracy. Join us, in the blue bay on Fal Ward, and watch the fear flitting across faces, listen to the conversations, the little jokes, the stories. Then account to me, and to my new friend, for what you are doing to our NHS and our democracy. We are angry. Come and sit with us. Come and look us in the eyes.
Incidentally I have yet to receive a response from Geoffrey Cox QC MP. I’m going to ask to see him in person. I’m going to look him in the eye and hold him accountable.