Britain’s National Health Service six months before Brexit – my own little road test

Road-testing Britain’s National Health Service six months before Brexit was not something on my agenda for this month. But fate, or rather an appendix teetering on the brink of becoming toxic, intervened. I try never to miss the opportunity to write about an unusual experience. And this was unusual: my first ever NHS operation.

As far as I’m aware, every other piece of surgery I’ve undergone has been private. Not because I’m fabulously wealthy, but because from the age of thirty I’ve had medical insurance, and nothing has gone wrong that has caused me to race to hospital with blue lights flashing.

I’m a fairly frequent user of NHS primary healthcare. Regular screening for this and that. Occasional visits to the doctor for reassurance or antibiotics. But generally speaking I’m far more healthy than I deserve to be.

So when I noticed a pain in my lower abdomen, I was thinking gastroenteritis or a muscle strain – something fairly innocuous. As it got a bit worse, my imagination turned darker – bowel cancer, kidney, prostate – the kind of things guys in their sixties and upwards tend to dread.

Then my wife, who in a previous life used to be a registered nurse, mentioned appendicitis. Not something that occurred to me. I’d forgotten I even had an appendix. Only happens to young people, doesn’t it? Well no, apparently. It hits all ages.

Anyway, she was right. A call at 8.30 to the surgery produced a callback from the doctor, and an appointment for 10.20. A couple of jabs that felt like Aunt Lydia’s cattle prod in The Handmaid’s Tale satisfied her that she should send me to the Surgical Assessment Unit at the hospital. I showed up there at midday, and a CAT scan confirmed the diagnosis. The told me that they wanted to operate later that day. The appendix wasn’t about to burst, so no dramatic rush into theatre, as happened to one of my daughters a few years ago.

So I ended up hanging around, reading, dozing, watching and listening, until they came for me at 10pm. Mask on, breathe deeply and goodnight. I woke up a couple of hours later, the proud recipient of three little holes in my abdomen, keenly awaiting a visit from the appendix fairy.

By 3pm the next day, after being invited to sample an NHS lunch (not great, but designed not to offend), I got my discharge letter and checked out.

Here are a few observations that I shall be submitting in my formal report to the Secretary of State for Health, assuming of course that like his predecessor he’s not too busy hunting Stalinists in Brussels to remember he asked for it.

Staff: everything you read about the NHS being reliant on foreign staff is true. Of the 20-odd people I encountered, about 30% were British and the rest from a wide spectrum of countries. NHS recruiters seem to be stuck on countries beginning in the letter P: Pakistan, the Phillipines, Portugal, Poland. Other nationalities included Lithuanian, Nepalese and Romanian.

Of the two junior doctors I met, both seemed younger than my kids, which was slightly disturbing. One was a charming lady from Islamabad, the other a Brit who looked as if he’s just finished his A Levels.

It was hard to tell from their uniforms what other staff members did – no more starchy collars and rigid hierarchies in evidence. But the standout characters were a livewire charge nurse from the Philippines, and a young Polish nurse whose demeanour reminded me of Villanelle, the psychopathic Russian assassin in the BBC’s new series Killing Eve. When I told her as a matter of politeness that she was too kind, she took on a wistful expression, and murmured “yes, you’re right, I am too kind”, leaving me to figure out her meaning.

Surgery team: well obviously I didn’t meet all of them. I was in la-la land by the time they got to grips with me. But from those I did meet I was able to figure out that it was mainly a female team, from the anaesthetist who told me of all the horrible things that had a less than one percent chance of happening to me, to the surgeon who did the cutting. The consultant was nowhere to be seen. Perhaps he was otherwise engaged on more serious stuff, or at home on call watching Killing Eve.

Either way, apart from the Portuguese anaesthetic nurse, there wasn’t a man in sight, which was a welcome difference from the big swinging stethoscopes you see in TV medical dramas. I did get to meet the surgeon after the op. She was a smart, friendly British woman in her thirties who has probably done more appendices than I’ve had cheeseburgers. Should my appendix grow back, she can have another hack at it any time.

Wards: I don’t remember much about the ward they took me to when I was waiting for the op. I was too busy reading or fighting my phone for a signal so that I could catch up on stuff going on outside the hospital bubble. But I woke up in another place to find my wife whispering in my ear “you’re in the geriatric ward!” This was not something I really wanted to hear, since I’m unused to thinking of myself as geriatric just yet. But certainly there were several elderly patients groaning, grunting and farting in nearby beds.

Next door, on the other hand, was the neo-natal unit from which bawling babies could regularly be heard. The very same unit from which my grandson emerged nine months ago. An interesting co-location. Shakespeare’s Seven Ages of Man minus the middle five.

Actually, as the anaesthetic fug cleared, it became evident that the ward was not for geriatrics. It’s just that more old people get to have operations than young. More disconcerting was the constant clattering of beds being jacked up and down, and the various minor medical dramas going on around me. An old guy in the next bed getting colostomy training, which sent the occasional whiff of excrement drifting my way. A chap across the way anxious that something was leaking. And the gentleman on my other side, who was obviously deaf, not responding to instructions to sit up, lie down or whatever. Everything was audible. Life stories, plaintive conversations with relatives in the reedy, high-pitched tones of elderly men, obviously so different from the strong voices of their prime.

The guy with the colostomy told me that his wife suffered from dementia and had been put in a home, and that he wasn’t allowed to see her because it would be too distressing for her. His kids had put him in a home too, but he escaped, and was living in his own home again. He hadn’t been out of the ward for three days, so I did a Jack Nicholson in One Flew Over the Cuckoo’s Nest and took him to the café downstairs. I was a bit worried that he might also have dementia, so I was relieved to see Chief Bromden making it back to his bed fifteen minutes later. I had visions of him wandering aimlessly round obscure parts of hospital for hours. But I guess they’re used to rounding up lost souls.

The wards themselves were kept clean, despite my attempts to spread biscuit crumbs around the floor. It was not obvious whether or not the hospital was using contractors for cleaning or catering. You certainly couldn’t tell through distinctive uniforms or badges.

Process: the administrative process was as you would expect from a large hospital. A referral letter from the local surgery, a consent form and a discharge letter, with a separate letter to the treatment nurse at the surgery. It did take about three hours for the discharge letter to arrive signed by the doctor, but then I imagine that he had more important things to take care of beyond sending me home.

Brexit fears: despite the imminence of Brexit, morale among the staff seemed reasonable, at least to a patient’s eyes. But I did ask one of the nurses from an EU country whether she was worried about life in Britain post-Brexit. She was concerned at the extra costs of remaining here, especially if the pound fell further against the Euro. She told me that she wouldn’t be recommending any of her friends to take jobs in the NHS at the moment, because of the uncertainty over finance and status. She herself was quite prepared to go home if necessary.

I asked one of the younger health assistants who took my bloods how she enjoyed working for the organisation. She’s British. She’s been with them for a year, and she’s now thinking of leaving to go into retail. “Why wouldn’t you go into nursing?” “The pay isn’t good enough”.

Hospital: the hospital itself seemed in good shape. Plenty of staff bustling around. There’s some refurbishment going on, and the place seems reasonably well maintained. Volunteers are much in evidence, including a rather intimidating lady who reminded me of Rumpole’s wife (She Who Must be Obeyed) in charge of an information desk around the corner from my ward.

My overall impression is that the organisation seems to be holding up pretty well. But luckily for me, October isn’t a peak time of year. How things will look when winter sets in again, and floods of admissions put the hospital under severe stress, remains to be seen.

It would make this account much more entertaining if I was able to tell some shock-horror stories about my experience and that of others around me. But I can’t. Sorry. I saw a team of people who were friendly, compassionate and giving a high standard of care. I even managed to extract two packets of biscuits from the tea lady.

Outlook: I do worry about staffing on two counts.

Being able to hold on to people because of uncompetitive salaries is one problem, and recruiting foreign staff is another. The nurse who trained my neighbour to use his colostomy bag became a ward sister at 25, and has been with the NHS for over thirty years. She was a rarity. Most of the staff were young. How many of them will be prepared to devote their working lives to the NHS, especially if they are from abroad? Staffing levels are one thing. Continuity of the workforce and preservation of knowledge are another.

This little quotation from a recent report by King’s College London’s Economic and Social Research Council encapsulates the challenge of foreign recruitment:

EU27 staff are pivotal to the operation of the NHS, especially in London, the South East of England and Northern Ireland.

The UK has never trained enough doctors for its own needs—some 28,000 doctors are non-UK nationals, around a quarter of the total. NHS England alone depends on some 11,000 doctors from the EU27, which amount to about 10% of all doctors.

Add in the further 20,000 NHS England nurses and around 100,000 social care staff from the EU27 and the sheer scale of reliance on EU migrant workers becomes clear.

In anticipation of a “Brexit effect”, the NHS has already invited bids for a £100 million contract to recruit overseas doctors into general practice. And this in a context in which the NHS already has many unfilled posts.

Apart from the difficulties of importing sufficient numbers of foreign staff, which the Government, by dreaming up new barriers to entry doesn’t seem to be doing much to overcome, I keep coming back to another old bone of contention: the morality of draining other countries of their healthcare resources to satisfy our ravenous appetite for staff.

Why are we not training more doctors and nurses? If our concern is that they will disappear to other countries to work, then that’s surely a quid pro quo for what we’re doing in the NHS. Or are we once again looking to have our cake and eat it?

Our National Health Service is still working. It may be fragile in places and battered around the edges. But I’d rather have it, warts and all, than other systems that depend on the ability to pay. Those whose knees jerk at the thought of socialised medicine are talking about something they’ve most likely never experienced. It’s time we stopped making it a political football every time an election is in the offing.

No single interest group, be it politicians, clinicians, administrators or patients, has all the answers to its problems. But all have ideas to contribute. So a little more humility on the part of those who have the power, and patience on the part of those who don’t, will go a long way towards helping the NHS to evolve successfully.

Of critical importance in a country racked with inequality, it’s free. It’s something we all need from time to time, especially in an emergency. We can share it equally, rich or poor. And this user is profoundly grateful for its existence.