NHS

being a patient

I am obsessed with service, to borrow a phrase from Richard I think I am as close as it gets to being a service junkie. This means that  I spend my days devouring every tweet, article and policy about the health service, patient experience and the role design can play in that. In the early hours of Thursday morning I woke up with unbearable pains in my stomach. To cut a long story short, I phoned the NHS 24 hour help line twice, on the second phone call they referred me to the out of hours GP, who then referred me to casualty who then took me to a ward.  They kept me in for two nights and I had an ultra sound scan, blood tests, all kinds of other bodily tests ( ! ) and the conclusion is they think I had an infection in my appendix that has sorted itself out.

I have never been a patient before so there were many things that I noticed, appreciated, felt could be better, even when poorly those " design lenses " picked up detail and feeling.

It was the absence of communication that increased my anxiety. The taxi driver drove us to the hospital in silence - which made me think of Barry Schwartz's talk on our loss of wisdom and the way he describes the role of a hospital janitor. I've just moved into a new flat and had no idea where we were, if he had let me know we were only five minutes away it would have made the journey a little easier.

When I arrived I was asked to put a gown on, and my first instinct was why? Then being moved to the surgical ward, my first thought was does this mean I am going to have surgery.

And at shower time... where was I meant to go? are there towels and shampoo in there? well I didn't want to ask, what if they thought I was treating the place like a hotel! Alice, in the bed next to me filled me in , there is only hair mousse ( or moss as she called it ) so I asked another long haired lady for some shampoo ... the nurse gave me a towel.

Walking in to all these things for the first time, in pain, in a strange place, was the time I needed that extra bit of reassurance. I'm sure when you work in this environment all of the time you can take for granted the normality of it, and also the pressures of being emotionally attentive to people must be tough. But an explanation of the simple things between each new experience would have made a difference.

After those first few hours though, and into the rest of Thursday, Friday and Saturday, I was able to immerse myself more in to the ward. My bed was straight across from the desk so I could eavesdrop and watch all the goings on.

The staff seem like best friends, constant winks and giggles brought sunshine into the ward and I knew they were happy to be there. They come to work every day and genuinely laugh out loud, I don't think there are many people who are lucky enough to feel that way at their work.

The last experience I had with the NHS in Stoke Mandeville Hospital was horrific and inspired me to write an article on why the NHS needs service design. This experience was totally different and has inspired me to make a thank you card for all the staff in ward 16!

The NHS help line was particularly good and they helped me so much. Simple things like reassuring me they would call me back if our line got cut off and telling me they would make sure I got the attention I needed.

It's all about people, from how we communicate to how we smile. The staff in ward 16 are faced with people who are bored, stubborn, tired and anxious. Yet they see past that and go out their way to make sure you are comfortable and as at ease as you can be. The doctors really explained what was happening to my body and why and the nurses really cared. You can't buy that, or teach it. That's what I call true service.

Direct to the patient

The UK's first academic health science centre in partnership with Imperial College London has a shiny new website. Picture 16

It is full of good stuff such as the patient experience section:

"Welcome to the patient information section of our website. Here you can find all you need to know about your hospital visit, such as how to get here and what to expect as an outpatient or inpatient."

and Project Smile:

"To help ensure our maternity patients are treated with dignity and respect, we have created a short training film to raise awareness of how different behaviours might look and feel to women. The film will be used in mandatory training sessions for all doctors and midwives."

Good find from Kate!

Treat me right

Giving people with learning difficulties a say in their hospital treatment is helping transform services. "When her 62-year-old brother went into Ealing hospital in west London at the end of last month for a routine operation, Amanda Burroughs was worried that staff would not take account of his learning disabilities.

She was both relieved and delighted to find that he was one of the first patients to take part in a scheme called Treat Me Right!, which aims to improve the way hospitals treat people with learning disabilities.

Burroughs's brother, who also has dementia, was asked to help draw up a document called About Me, which detailed his likes, dislikes, needs and wants.She also contributed to the document, which was hung at the bottom of his bed and made staff aware of issues such as the need to talk to him in straightforward language and to give him plenty of time to make decisions. She was so impressed with the scheme that she wrote a letter to hospital bosses and to Ealing MP Stephen Pound, stressing "its importance and the need to publicise it more widely".

Ealing-based Support for Living, a not-for-profit organisation that provides housing and social care for people with learning disabilities, proposed the project just over a year ago to help rectify the inadequacies in hospital care revealed by Mencap's Death by Indifference report, published in March 2007. The extent of those inadequacies was highlighted again last month when an investigation by the health and local government ombudsmen upheld complaints of maladministration against seven NHS trusts and two local authorities involved in six unrelated deaths between 2003 and 2005.

Nigel Turner, Support for Living's chief executive, says of the scheme, which is being funded for 15 months by Ealing primary care trust: "It isn't a kneejerk reaction to the ombudsmen's report. Hospital staff are used to bringing in a specialised piece of equipment to treat a disease. We want them to get used to bringing in a specialised approach to treating people with learning disabilities."

Elsa Grigg, project manager at Treat Me Right!, says the first step was to ask people with learning difficulties and their carers what they wanted to change. "The main thing that came up was communication, which can include really simple things such as extending an appointment to give someone more time to understand what's going on," she says.

New hospital information packs are being produced that will include photographs or symbols allowing a patient to point to a picture showing how much pain they are in or what foods they prefer. Some staff at Ealing Hospital NHS trust have already begun learning Makaton, a signed language for people with learning disabilities. From June, staff will receive more general training in dealing with people with learning disabilities.

The scheme is aimed at adult in-patients, but it may be extended to include outpatients, children and adults who have difficulty communicating because they have dementia or have had a stroke"

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This article was written in response to Support for living's new intiative: Treat Me Right!

"Comes in response to local concerns and national campaigns regarding the treatment of people with special needs when they enter the hospital system. Often communication difficulties, poor staff training and lack of accessible information lead to tragic results in hospital."

Goverment apology over NHS care

Health Secretary Alan Johnson has apologised to the families and patients who suffered appalling care at Stafford Hospital.

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"He announced a review of current A&E services and a second inquiry to look at how long problems had been going on for at Mid Staffordshire NHS Foundation Trust.

He said: "On behalf of the Government and the NHS I would like to apologise to the patients and families of patients who have suffered because of the poor standards of care at Stafford Hospital. There was a complete failure of management to address serious problems and monitor performance. This led to a totally unacceptable failure to treat emergency patients safely and with dignity."

Between 400 and 1,200 more people died than would have been expected at Mid Staffordshire NHS Foundation Trust over three years, a report said.

Although it is not clear how many of these deaths could have been avoided, the Healthcare Commission said patients undoubtedly suffered as a result of lapses in the standard of care.

Its investigation, based on more than 300 interviews and an examination of over 1,000 documents, found inadequately trained staff who were too few in number, junior doctors left alone in charge at night and patients left without food, drink or medication as their operations were repeatedly canceled.

Some patients were left in pain or needing the toilet, sat in soiled bedding for several hours at a time and were not given their regular medication, the Commission heard.

Receptionists with no medical training were expected to assess patients coming in to A&E, some of whom needed urgent care."

A service disaster.

Complaints breed complaints

The NHS is failing to deal adequately with complaints about its services, according to a recent report by the Healthcare Commission, the watchdog responsible for reviewing complaints that cannot be resolved at a local NHS trust level. The report reveals that the proportion of complaints upheld rose last year by 50% - and in less than a fifth of the 9,000 cases it looked at, the watchdog sided with the trust. 42-15997889

Most worrying for those who believe in the importance of listening to user feedback as a means of improving services, the main issue raised by complainants was the way in which the NHS handles complaints. In other words, what bugs people most is not the issue that led them to complain, but the way in which the NHS responded when they did so. Complaints, it appears, breed complaints about complaints.