On the Receiving End!

Dr Gary Masterson, President of the Society, recently experienced NHS care from the relative’s perspective. He reflects on some of the lessons he has learnt.


An elderly family member recently sustained a fractured neck of femur. I would like to share my observations with you as, having looked at our provision of care from a relative’s perspective. I think there are some useful lessons to take away.

The ambulance service, although slow to respond, was excellent. The paramedics were kind and caring. It’s easy to forget how important these simple human traits are.

The Emergency Department (ED) experience was less than ideal. A 12-hour wait for a ward bed is understandable in the context of an over-stretched NHS, but a significant delay in the administration of analgesia isn’t. The ED was full of patients in cubicles waiting to be seen, yet I couldn’t help but notice multiple doctors and nurses sitting around chatting together, drinking tea or soft drinks. Now I like to think that these talkative, thirsty staff were discussing clinical problems and making plans for patients, but that’s not how it looked to me, or I suspect, anyone else. Perception is important: remember that the next time the banter gets excessive at the ITU nurses station.

I couldn’t help but notice multiple doctors and nurses sitting around chatting together, drinking tea or diet soft drinks

Anaesthesia and surgery were undertaken the next morning with impressive efficiency and professionalism. No complaints. What about the post-operative period? Not so good. The orthopaedic surgeons certainly didn’t consider themselves responsible for my relative’s non-surgical care and I must say I understand this. The problem was that this particular hospital didn’t have an ortho-geriatric service. Therefore, the post-operative care was essentially left to the nurses who were either too over-worked or lacked the skills to help.

Interpersonal skills are essential for all staff groups. While we’re all under pressure to meet targets they’re only part of the story. If achieving those means we forget to be helpful, polite, and courteous we lose vital ingredients for effective health care.


If …. we forget to be helpful, polite & courteous we loose vital ingredients for effective health care

As for rehabilitation, well I didn’t witness any although we were told repeatedly how well she was doing!

My family member eventually made it home with a social support package apparently arranged by the hospital, but in fact it never had been. When we eventually sorted that problem out the level of support on offer was, I am afraid to say, lamentable. The support from primary care wasn’t what we’d have wished either.

Forgive my venting and perhaps tendency to over-generalise. I’m not saying for one moment that all ED staff, all ward staff, all GPs, and all of social care is poor. However, I was struck by these three key issues:

  1. Little seems to proceed automatically even for a straightforward clinical pathway as a fractured neck of femur. The family or patient is forced to accept the burden of moving things forward.
  2. No-one seems to have an overview of the care pathway. Different staff members tell you different things. Basic sharing and communication doesn’t always happen.
  3. A perceptions that some core caring values could be significantly improved.

So, what’s my point?

Well, I think we need to remember that in critical care we’re better off than other parts of the NHS. I’m not for one second pretending that things are perfect for us, but they could be so much worse. I believe we have a caring, committed, and dedicated multi-professional workforce. Our processes, including relatively high staffing levels, are protected by our professional standards that allow us to deliver world class care. Standards are all about the patients and, even if they can’t easily be met, they still set a forward momentum to help us help the patients. We must never dilute them.

Secondly, even at the ripe age of 53 years, it’s never too late to learn. I’m going to be even more careful about how my team and I conduct ourselves in front of patients and their families. Behaviour we all take for granted to be totally acceptable might cause distress for patients and families. I am going to be more careful and try harder!