Feeling the heat

The current unprecedented heatwave in Britain is having unforeseen consequences – especially for the NHS.
 
The extreme heat (up to 40C) is causing computers and other machines to collapse and making the existing NHS crisis a whole lot worse.
 
The heat is knocking out a wide range of equipment - MRI scanners, radiotherapy machines, other machines used to treat cancer, diagnostic facilities, operating theatres, various IT systems, other electrical equipment.
 
On top of that health workers are struggling to do their jobs after several sleep-deprived nights caused by the heat and in some cases hospitals with broken-down air conditioning.
 
As a result of the equipment failures, many consultations, operations and treatment sessions are having to be cancelled.
 
And this is only June. Presumably there will be equally extreme heatwaves in July and August.
 
Fortunately Northern Ireland is not much affected because temperatures here are much lower than in the rest of the UK – possibly reaching the upper twenties. So although we’re sweltering we’re not completely wiped out by the heat.
 
Jenny and I are glad we’re not living in London any more. It looks like the temperatures there are pretty unbearable.
 
PS: Some London pavements have reached 57C.

Smoking dilemma

As a life-long non-smoker, I'm intrigued by the British government's latest attempts to reduce cigarette-smoking and reduce tobacco-related hospital admissions.

They're hoping to pass a new law that would ban the sale of cigarettes to anyone under 15, with the age limit rising each year.

A similar law proposed in New Zealand was heavily opposed and it has now been scrapped by the incoming New Zealand government.

I must say I'm of two minds whether the proposed English law is a good idea. Yes, I'm all in favour of anything that makes people healthier but would people observe the new law or would they try to find ways around it?

You could get an older friend to buy the cigarettes for you, or you could lie about your age, or there would no doubt be a black market in fags you could resort to.

And how would shopkeepers know if you were over 15 or not? If they asked for ID, they could be insulted or threatened.

On the other hand, the sale of alcohol is subject to a similar ban, which says you can't sell alcohol to anyone under 18. It seems to work quite well and nobody is lobbying for the age limit to be scrapped. And young people are consuming much less alcohol anyway, largely because they're more aware of the long-term health risks.

I think on balance I support the new law, if nothing else because it would emphasise the dangers of smoking.

Still covering up

Almost ten years ago I wrote about Julie Bailey, a whistle-blower who was relentlessly persecuted and harassed after she exposed sub-standard care and unnecessary deaths at Mid Staffordshire NHS Trust.

Supposedly, since then whistle-blowers have received stronger protection and support and can expose malpractice without being treated as the guilty party.

Well, that's the theory. In practice it seems that little has changed and whistle-blowers can still be told to shut up and stop making trouble.

The recent case of Lucy Letby, the nurse who murdered seven babies at the Countess of Chester Hospital and could easily have murdered several more, showed that pointing out wrong-doing can still be seen as a hostile act rather than a necessary warning.

Two medical consultants, Dr Stephen Brearey and Dr Ravi Jayaram, both raised concerns about unexplained infant deaths at the hospital as early as July 2015.

But both were rebuffed constantly by hospital managers. Dr Jayaram was told "not to make a fuss". It wasn't until June 2016, after repeated complaints, that Letby was finally removed from her clinical duties.

Of course it's obvious why whistle-blowers are so badly treated. The members of staff who are at fault are desperate not to lose their good reputation, and in this case the good reputation of the hospital. So they turn on the whistle-blower to save their own skin and they refuse to admit to any mistakes.

There needs to be a new attitude that says it's okay to make mistakes, we all make them, and that admitting mistakes as soon as possible is a positive move and not a negative one. Confessing promptly to mistakes shouldn't damage your reputation, it should enhance it.

How many dangerous mistakes are still being covered up?

Pic: Lucy Letby

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No, I haven't died. Jenny and I have been in Liverpool for the Art Biennial, and to see two old friends in Chester. We had a great time and saw loads of wonderful artworks.

A nurse's story

When I was in hospital for my prostate operation in 2017, I was aware of how busy the nurses were, scurrying from one patient to another checking their vital signs, keeping an eye on whatever equipment they were plugged into, giving them help of one kind or another. But I didn't know the half of it.

A book by the former nurse Christie Watson* reveals the reality of a nurse's job and just how demanding and meticulous and scary and messy it can be. I can only admire those resilient souls who take on such a difficult job and do it so well.

• They have to clean up shit, piss, vomit, diarrhoea, blood and all sorts of foul liquids that a sick patient produces.
• They have to give patients the right medicine, at the right dosage, in the right way, at the right time. One tiny slip can lead to a major emergency or even death.
• They may work very long shifts (often night shifts) of 12 hours or more with barely time to eat or use the toilet, such is the relentless pressure.
• They have to be familiar with hundreds of common or less common medical conditions and how each is treated.
• They need to be alert to the smallest change in a patient's condition that means urgent action is needed.

It's not a job for dawdlers or the faint-hearted. They do it for the satisfaction of helping very sick people become fit and healthy again, and seeing pain and terror and misery replaced by smiling, grateful faces. They want to do a job that really means something, not just a pen-pushing office job.

Quite a few nurses don't last the course. Sooner or late they realise they're not up to the unremitting demands and responsibilities of the job and they quit.

Jenny was a nurse for a while. My sister Heather was a nurse for a while. My niece Lucy has just qualified as a Registered Nurse and I applaud her for it. I think of all the pain and suffering she will relieve and the many hundreds of lives she will save.

*The Language of Kindness: A Nurse's Story by Christie Watson

Money to burn

What's the best way to squander £90 million? Simple - relaunch your local bus service with flashy new buses that aren't needed and aren't any quicker than the old buses.

To a fanfare of hype and gushing soundbites, along with free doughnuts, our local number 4 bus route in East Belfast was relaunched this week with purple bendy buses, pre-paid journeys and  drivers who no longer interact with the passengers.

I sampled the new bus earlier in the week and was totally underwhelmed. When I tried to validate my bus pass, the machine said it was faulty. Not a problem though as I could board the bus and travel to my destination without meeting any ticket inspectors (apparently there are very few).

Unlike the old buses, all the seats were taken so like many other passengers I had to stand for the whole journey to the city centre - which at around 15 minutes was no shorter than previously. The bus lanes now operate all day but that didn't make the bus any quicker.

So £90 million was spent on buses that offer no visible improvement on the old buses, and will be a magnet for fare dodgers who can hop on and hop off tourist-style. It will be fun to see how many journeys I can make without seeing a ticket inspector (now grandly renamed as Revenue Protection Officers).

The bendy buses are also less flexible than the old double-deckers. On tight corners they have to swing right into the middle of the road to clear the kerb. And there are plenty of tight corners in the city centre.

Just think what we could have done with £90 million if it hadn't been squandered on this pointless exercise. In particular it could have drastically reduced hospital waiting lists, which are shockingly huge (I had to wait 18 months for a routine prostate operation).

Spending scandals? I'm sure there'll be another one along in a minute....

In hospital

Well, having been in the Ulster Hospital for 4½ days, I must say I was totally impressed with everything. It was the exact reverse of all those media stories about English hospitals, with their long trolley waits, staff shortages, bed shortages, cancelled operations, lack of cleanliness etc.

I was admitted at 7 am on Thursday and operated on at midday. I was then transferred to the brand-new inpatient block that opened a few weeks ago, and they kept me in for several days to ensure there were no problems. I was seen as "high risk" as I'm over 60!

The new block is absolutely state of the art. Instead of the old communal wards, there are private rooms with en-suite bathrooms throughout, giving patients as much quiet and privacy as they want, and no long queues for communal bathrooms.

Everything in sight was pristine, with cleaning staff hoovering and mopping and wiping, and bed linen changed, every morning.

The food was fine - hardly cordon bleu standard but tasty enough not to be left on the plate. There were plenty of vegetarian and gluten-free options.

The TV was free so I regularly watched the news and also the final episode of Line of Duty. There was a zapper to control the light, the blinds, the TV and call for a nurse.

All the medical staff were wonderful - friendly, helpful, conscientious, well-trained. They kept a close eye on my vital signs like blood pressure, pulse and temperature, ensured I wasn't dehydrated, and kept checking if I needed any pain relief (strangely enough, despite all the nerve endings in the prostate, I had no pain whatever). They explained anything I wanted to know and kept me updated on when I might be discharged.

Before I was admitted, I was nervous that my stay might be such an unpleasant ordeal I'd be desperate to leave. As it  happened, it was so comfortable and relaxing I was almost sorry to go.

My humble apologies

I'm good at apolog-ising. I'll happily apologise for anything if it oils the wheels of a relation-ship. Be it a misunder-standing, an unintended insult, an error of fact, or an unpopular opinion, I don't mind humbling myself and admitting that maybe I got it wrong. What's the big deal about that?

But there are so many people who'll do anything rather than apologise. Apologies are apparently a huge humiliation, a huge blow to their ego, something they have to avoid at all costs.

They'll deny doing anything wrong, or find some absurd excuse or justification, or say they were only joking, or say you're over-sensitive. Anything rather than drop their pose of infallibility and admit they're only human and sometimes they drop a clanger.

My father hated apologising. No matter how obviously wrong he was about something, he would never back down. He had to be right, his authority couldn't be challenged, he couldn't bear it that I might actually know more about something than him.

I can recall several workmates who were much the same. Apologising was out of the question. It was always someone else who was wrong, not them. Any attempt to extract an apology was met with anger and incredulity.

The one thing hospital patients always ask for when they've had shoddy treatment of some kind is an apology. "I just want them to admit they got it wrong and they have to do better" they'll say. And the one thing the hospital invariably won't do is apologise. They'll prevaricate and obfuscate and do anything to avoid simply saying "We're really sorry, we made a mess of this and it's not good enough."

And while I'm at it, I sincerely apologise for all those nonsensical, long-winded, infantile, pedantic blog posts I've churned out over the last seven years. If there's anything I can do to make amends, just say the word. You've no idea how ashamed and stupid and careless I feel. What a total dufus I've been. What a total toss-bucket. I promise to do much much better in the future.

Whistleblower's error

How tragic that a whistleblowing nurse who exposed the ill treatment of elderly patients has been struck off the nursing register for misconduct.

In a TV film, she showed patients at a Brighton hospital not getting help with eating, afraid to ask to go to the toilet, and screaming with agony without pain relief.

I say the outcome is tragic rather than outrageous because unfortunately the nurse, 58 year old Margaret Haywood, spoilt her case by not getting the patients' consent before she secretly filmed them.

That's why the Nursing and Midwifery Council decided, despite her shocking revelations about standards of care, to strike her off for misconduct.

Clearly if patients are going to be filmed they need to be asked for permission and told what the film will be about. They might well have eagerly consented, but she never asked.

What I would like to know however is, were the patients asked after the film was shown, whether they consented to appearing? If they did, then surely the NMC's decision is unnecessarily draconian and vindictive. The son of patient Hilda Burnham, who has now died, says he has no problem with the filming and has called for Ms Haywood's reinstatement.

The NMC also said she could have taken other actions to address the failings rather than making a TV film. But we all know what happens when you complain "through the usual channels". Often the complaint is ignored or trivialised and the organisation claims everything is just fine. In fact she did report the failings to hospital managers but nothing was done.

It's tragic indeed that someone who does care about how patients are treated is no longer able to nurse and will have to take a quite different job.

PS: I've now read several times that permission to use footage was given by either patients or relatives after filming and before the TV programme. In which case the NMC should reconsider their decision.

Margy was the subject of the Panorama TV programme on April 27 2009. Her absolute dedication to the best possible patient care was clear to see, but the NMC obviously took no account of that. She is now unemployed with big debts she can't pay off.

Photo: Margaret Haywood
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A woman in the West Midlands has been forced to put T shirts on her naked garden gnomes after a neighbour complained they were not fit for her young children to look at. The gnomes' owner says the three gnomes (one male, two female) have been there for 15 years without causing offence and her own grandchildren love them. Nowt so queer as folk.

Dummy run

Airline pilots train on simulators, one reason why flying is so safe. Surgeons hardly ever train on simulators, one reason why a hospital patient has a 1 in 300 chance of dying or being seriously harmed.

No wonder I'd have to be dragged kicking and screaming into a hospital if the need arose. That statistic is seriously scary. I'd probably have a higher chance of survival in crocodile creek.

Britain's Chief Medical Officer says that if all surgeons trained on simulators, or plastic dummies, there would be a big drop in the number of mistakes and mishaps, and surgical expertise would be greatly improved.

It would avoid cases like Elaine Bromley, who suffered irreversible brain damage during a minor operation because doctors weren't sure how to do a tracheotomy (an incision in the windpipe).

Airline pilots do regular simulator training to help them deal with emergencies. That's why a plane can be successfully landed on New York's Hudson River by an ice-cool pilot who knows exactly what he's doing.

Apparently Israel leads the world in training surgeons and health workers on simulators. They use sophisticated dummies that can bleed, breathe, be anaesthetised, be resuscitated, and show tell-tale medical signs.

If they're so beneficial and they could reduce the shocking toll of medical cock-ups, why on earth aren't Britain's surgeons making more use of them? Perhaps when people go into hospital, they should ask if their surgeon's been trained on a simulator. If not - find one who has.
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The abysmal standard of patient care at Stafford Hospital in England, which has caused up to 1200 unnecessary deaths, is quite shocking. It seems the hospital management was more interested in meeting performance targets than in looking after its patients. Thirsty patients were drinking out of flower vases and others were screaming in agony for lack of pain relief. Unbelievable.

Check and survive

As you know, I'm far more nervous about going into hospital than I am of getting on a plane. Hospital procedures can be so erratic and staff so careless that I might easily come out in a wooden box.

My qualms have been more than confirmed by a new study that says a simple cockpit-style checklist could cut the death rate after surgery by 47 per cent and the complication rate by 36 per cent.

What's amazing is that this elementary checklist (Sample questions: Is this the right patient? Is this the right limb?) has never been standard practice and hospitals have relied solely on the surgical teams knowing what they're doing.

Unfortunately even the most experienced and intelligent surgeons and nurses are still liable to human errors that can be fatal and irreversible. Once the patient has collapsed and died, the surgeon's experience is not much comfort to the grieving relatives.

So the sooner British hospitals introduce this checklist the better, and the sooner I can have a bit more confidence about checking in.

Some of the questions on the World Health Organisation checklist:
Is this the right patient?
Is this the right operation?
Is this the right limb?
Is this the right organ?
Have we got all the necessary equipment?
Have we got enough blood?
(And afterwards)
Have we removed all the swabs?
Have we removed all the needles?

Stunningly obvious, you might think - but also so obvious they can easily be overlooked.
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The successful emergency landing of the plane on New York's Hudson River is astounding. It's practically impossible to land a plane safely on water. It usually disintegrates on impact. The pilot's skill and presence of mind was extraordinary.

Wake the pilot

I've never been afraid of flying. So even the story about the pilots being asleep as the plane came into land didn't bother me.

Yes, you read that correctly. It's just emerged that a plane en route from Baltimore to Denver was getting frantic calls from air traffic control as it neared Denver Airport at twice the normal approach speed and well over the normal altitude.

They managed to arouse the pilot and co-pilot from their blissful slumber and the plane fortunately was landed safely.

The blame is put on long shifts and inadequate rest periods in-between. Plus the boredom of a routine flight.

Personally it only makes me more confident about flying when I hear that a plane can land okay despite snoozing pilots. Clearly the safety procedures are robust enough to allow for human errors like these.

In fact I'm far more nervous about hospitals than I am about planes. The death rate on scheduled flights is miniscule, while the death rate in hospitals from superbugs, blood clots, drug overdoses and surgical errors is alarmingly high.

As I've said before, the chances of coming out of hospital with an extra ailment you didn't have on arrival are pretty huge.

So if I get off a plane and someone tells me the pilots were fast asleep ten miles from the airport - no worries. I'll just head for baggage reclaim with the usual spring in my step.

Hypochondria

I told my doctor I was sure I had all the symptoms of hypo-chondria but she said no, I was just imagining it. Honestly, these doctors, they just want to get you out of the surgery.

I've met people with raging hypochondria who know for a fact they're got terminal cancer but the doctors keep misdiagnosing it. I would point out they looked perfectly healthy, only to hear a catalogue of tell-tale symptoms like intermittent light-headedness. Only intermittent? You should be so lucky, says I.

Of course real hypochondriacs don't just imagine they're ill, like you and me reading the worst into a stubborn headache. They pester the doctors and consultants for every scan, blood test and investigation known to medicine, always hoping for something lethal.

Personally, I stay well away from doctors and hospitals if at all possible. You could end up sicker than when you started. Doctors? It's their business to find illnesses so give them half a chance and they'll find one. Your blood pressure's a tad high, Nick, you'd better take some of these little pink pills. Quick, run for it!

As for hospitals, it's a toss-up whether you come out cured of that chronic affliction or adding another one. Blood clots, anyone? Superbugs, fresh today. Oops, just whipped out the wrong kidney. Lucky you've got two, eh? Nowadays the nurses don't just check your pulse, they check your will and your life insurance. Just in case.

But hypochondria's on a roll. If you can't find an actual illness to lay claim to, there's a potential illness just round the corner. Every day the media reports something unexpectedly dangerous, something that'll make us all horribly ill in a few years' time. Mobile phones, lipstick, burning candles - they're all oozing health hazards.

I just know I'm almost ill. I've got all the symptoms. Tell me the truth, doc, I can take it.

Baby shambles

If the NHS is getting better all the time, as the government claims, why did pregnant 22 year old Karen Shaw have to be airlifted from Northern Ireland to a Scottish hospital because neo-natal cots weren't available?

This was hardly a rare medical condition that took the Causeway Hospital by surprise, with the resources needed simply unplanned for.

Karen was expecting twins and her waters broke seven weeks prematurely - as happens frequently to mothers-to-be. But the hospital was unable to cope and had to send her elsewhere.

Her stepfather Paul Parry said she had been "terrified and traumatised" and criticised the local health service as "underfunded and farcical".

Karen has already lost one child after a miscarriage so naturally she was scared of losing the twins. She nearly lost them early in the pregnancy.

The hospital didn't explain the lack of neo-natal cots but claimed there was no risk as two specialist midwives accompanied her on the flight.

But you have to ask why the cots weren't available when premature birth is so common and maternity services are one of the major elements of the NHS.

How can such a basic failure occur when so many billions have just been pumped into the health service? And isn't it ironic that the airlift across the Irish Sea (over 100 miles) probably cost more than the missing cots?

PS: Karen has now given birth to healthy twin boys.

Photo: Karen Shaw