"A&E where did the simple human interactions go?"

About: Lincoln County Hospital / Accident and emergency

(as a parent/guardian),

Visit to A&E for the treatment my daughters minor injury following a fall.

I drove her in myself after applying a dressing, and a cloth over the top to stop her seeing any blood when removing her hand as children do to check periodically. On arrival in A&E we stood, in front of a glass cubicle which contained 5 members of staff (housekeeping and admin). All seemed to be griping about their payslips and about another staff members lack of action (ironic). None of them turned to see the mother holding her daughter in arms, blood now dripping from her elbow despite the dressing and the cloth.

A passing paramedic alerted the chatting staff to my presence and a receptionist raised their head, slowly, peering over the top of their half moon specs, and without making any direct eye contact assumed their keyboard position for "booking us in".

I had wanted someone to meet me as they did at the Bostonian when I had an appointment there. I'm not sure why a receptionist in A&E should be any different at all to a receptionist in the Bostonian. Let me summarise the Bostonian (private wing) experience where I was looked at directly, my details were taken, I was invited to take a seat, there was smiling. Surely this should not be a "private care only experience"?

I tried to find a seat. All of them were taken, but that wasn't difficult because 50% of them were labelled "out of order" or were just pieces of metal were a seat used to be. I sat on a coffee table, without back support, with my injured daughter on my lap, and my second daughter standing by our side.

The stench of a woman who was quite evidently incontinent of her urine and bowels was causing an olfactory nuisance to the public, she sat in her own faeces and urine in the waiting area behind us, she appeared intoxicated, but in any case, embarrassed and uncomfortable.

My daughter needed the toilet, but on making the trip past the wet and soiled floor, the toilets were a disgrace, and we decided not to use them. The men's toilets were out of order. The only disabled toilet had been used by the men and had not received a check in some time. The seat was wet, soaked in urine, and the floor covered in wet toilet paper. Not somewhere I could allow my daughters to use. I had left my seat for a time and it had been filled, so we stood by the wall next to the chocolate vending machine (who would want to eat anything near those toilets? ) anyway trying to stay out of the way and observing the surroundings.

A gentleman dragging his leg behind him as he entered the department, displayed he was in lot of pain, yet everyone, including the receptionist watched this poor human drag himself to the counter, asking for help, for a chair. The receptionist immediately started booking him in with all the urgency of a tortoise exploring its need to come out of its shell and taste the air. In fact they didn't look at him, as he held himself upright on the counter, saying, "please can I sit down, please " imploring them to listen, but they picked up the phone and answered a call as though he was not there.

It felt as though this man was an interruption to her existence in the tank, unaffected by him completely. I cannot express my level of frustration at the attitude of this person who is the absolute opposite of everything that should represent the NHS as a care profession. I was appalled by this the most.

My daughter (11 years old) was the first to jump up and find the gentleman a wheelchair, and placed it behind him, his gratitude was evident from his face and his eyes. We waited for him to complete his "booking in" and we parked him as a joint effort in the waiting area where he explained he had a bone condition which meant they broke easily, and that he had fallen and his sister had driven him to A&E because he didn't want the NHS to fund an ambulance, she had gone to park the car and he had stumbled in alone from the entrance hoping to find someone to help.

We waited for triage, for about twenty minutes, not long. The nurse told us that my daughters injury needed some glue (no kidding), and they could probably do that their self straight away and let us get out of here (we didn't see them again).

We returned to the waiting area, and watched as a disgruntled looking taxi driver arrived, to be met by the receptionist who was wielding disposable sheets (like the ones you put in a child's bed when they are potty training), they waved them in disgust, the taxi driver took them in disgust, and the receptionist proceeded to point at the women sitting almost unconscious, in a state of apparent intoxication. Whilst the audience in the waiting area looked on - tennis match style. The taxi driver grunted at the patient and the woman staggered outside with him. Soiled badly, clear for all to see. I felt bad for her. I imagine most would feel that the NHS isn't a care centre for alcohol abusers. But neither in 2014 do you envisage that you could be exposed to that kind of disregard for someone's dignity in a modern healthcare environment. It made me wonder how the nursing team had permitted her to leave in such a state and what other service could have dealt with her.

The receptionist demonstrated their disgust expressively, theatrically, and returned in a plastic apron, gloves and wipes and cleaned up the mess. The smell remained. My daughters and I had fought our gag reflex, until after the poor lady had left, in order to spare her blushes.

So on to our clinical "care". We were taken to a stuffy little cubicle called "minor injuries", where a Doctor, suffering from sleep deprivation (nodding head, dark circles around their eyes, slurred speech, unbalanced a little). Anyway they tried their hardest to string a sentence together which sounded something like " any nausea". I asked if they were tired, to which they said yes, and I finished their clinical assessment for them, reassuring them that my daughter had not been knocked out, or sick, or had any blurred vision. They nodded gratefully, and said it needed glue (no kidding) then stood up, falling over the chair, leaving me with a stack of no less than 3 other patients case notes on the desk in front of me. None of which were ours thankfully, I wondered whose cubicle they were in. Anyway they were all just there for me to peruse if I had been inclined to know the addresses of the people who were currently busy in A&E, perhaps there home was empty, or perhaps one was my neighbour?

The Doctor closed the curtain behind and, I was surprised when 2 nurses immediately burst in, arguing over the staffing ratio between minor injuries and A&E, and who was not pulling their weight. Arguing about how commissioners funded 2 staff and their was only one and one of them should be in triage. Neither apologised for the intrusion, or their outburst having discovered us in what must have been a cubicle office of sorts. I felt like I was in a carry on movie, only the injuries were real, and no one was laughing.

By this time it was getting late, we were a tired little family, just needing someone to give us some "second aid" and let us out. Eventually a friendly and accommodating student nurse, wet with sweat from the heat of the cramped quarters, took us into another room and very crudely and somewhat tentatively (and a little unskilled in honesty) applied glue to my daughters head. They were unsupervised, and I felt a little disarmed by their obvious lack of experience, but at least they were pleasant. I took the role of information provider to my daughter, talking her through the procedure, and keeping her calm, as the nurse did not speak. I know my daughter, I know when she is in pain and to cry is not usual for anything minor, it hurt her, and I was the only one to take control of that pain management. Had I not have known that stinging was to be expected, neither would she, and I wouldn't have been able to tell the nurse to stop as she poised to apply the glue, whilst I prepared my daughter to take a breath, and reassure her that it would sting for a few seconds quite badly, but that it would then stop, and to squeeze my hand and count together. The experience for me was one of keeping my daughter calm, in a chaotic environment which reminded me a little like London Underground, only add people bleeding and urinating and vomiting, and staff shouting and laughing about their weekend in contrast. I was the only calm for my children, it was a coaching exercise in "how to get through this" environment.

The nurse looked at me strangely whilst I was coaching my daughter through the procedure and the pain. Perhaps learning something from my technique? I don't know - I hope so. It wasn't their fault that they came across as massively under-experienced, they were doing their best and I was grateful for that, but their best did not meet my expectation at all. I expected compassion and gentleness and a little calm for my child's first experience of hospital treatment and in honesty my experience had already started badly with the receptionist, my brain was alert for any other apparent risks.

So - four hours later, the eight minute procedure was over, and we were free to leave. I was offered a leaflet re head injury. Thank you, that was helpful. Incidentally I would have preferred to have gone to my clean, kind GP surgery, and avoid the NHS paying for me to experience this. I am certain our nurse could have treated this in the practice, but it was 1900 on Sunday evening. A&E was unavoidable. We needed help now.

I have included quite a lot to share with you my experience, but the key trend here for me is that it was the simplest of things that were so painful to watch in their absence and that the delivery of 'care', has turned into a delivery of "treatment". There is a distinct difference.

I wasn't asked to provide any feedback on my way out, I did look for a Friends and Family Test Card, as is at my GP surgery, but I didn't find one.

My message to A&E reception staff is this - you are the front line of the healthcare profession to all those people who see you first. You are their first aid. You are the most important face that a distressed relative or carer will see. even if these might be nothing in comparison to what you hear about, day in, day out, you will still be everything to that person in that moment where someone feels very vulnerable. You are the measure to which the rest of their journey will be compared. You need only smile and be professional and quick to respond. In the tank you sit in, you are observed, often for longer than medical professionals are observed, let that observation be of a hard working, dedicated, healthcare profession, kind and caring. Not distant from the patients you care for, chatting about other aspects of life with your back turned whilst people struggle around you. You have the power to impact on patient views, heavily, believe me. Give the private sector something to aspire to. Challenge them to be as good as the NHS.

My message to Healthcare professionals is - leave your discussions about the frustrations of your role, the length of your day and your weekend in the staff room. It must be so easy for you to forget that this environment is your office, but to patients, it is A&E. It is the cornerstone of a National Treasure. It is where people have come to get help. It is where they are most vulnerable. We look to you to take care of our well being in those moments whilst we are within your hospitality. We are your clients, and we have expectations of what we can expect of a Doctor and a Nurse, and those expectations start with "care". Never would we expect to nurse our crying families, our sick or even dying relatives, or to share our most vulnerable and dignity challenging moments in an environment where staff can be overheard complaining about how busy they are and talking about facebook/the weekend/your payslip/how much money the organisation gets for 2 nurses in triage from the commissioners. Leave it in the staff room.

Doctors - you cannot deliver care tired. The best staff put their health and well being first, to enable them to provide effective care to their patients. If you are a risk, then you are not helping us, we wouldn't want you too, I would choose to say no - find me someone who is awake - you are putting us at risk too. Is that me complaining? ! Should I not expect you to be at least awake? Or are you so good that you can dream yourself to my diagnosis? Please - the first thing you can do for your patients is be well yourself or go home.

Managers - I implore you to look at patient experience, before you look at targets and figures, they should take care of themselves if the care is good. Stop trying to take care of the masses as though we all fit one profile - we don't. Treat us as individuals, make sure your staff can provide responsive healthcare and the outcomes you are chasing will come. Please empower your staff to care and to go home if they are unwell or tired, and to run your department as though each patient was your loved one.

To Lincoln A&E Dept - I am sure you all started this job to care. As individuals I am sure you are all committed to delivering great care. Maybe you are just tired of being cogs in a faulty machine. You have the capacity to be the difference, the capacity to change, to deliver the care you want to deliver. Deliver that care. See what happens.

I hope that one day, in the future, if I return to Lincoln County A&E, I will see that change. Maybe I will just be one in a voice of many service users public voices struggling to really help you to deliver what we know and trust that you can. Maybe one day you will be the vulnerable patient. I do hope you leave a legacy to be proud of.

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Responses

Response from Sharon Kidd, Patient Experience and Engagement Manager, Patient Experience, United Lincolnshire Hospitals NHS Trust

picture of Sharon Kidd

Hi

I was so saddened to read your account of you and your daughter's appalling recent experience in A&E. Please be assured that I have escalated this to the A&E matron and the lead A&E consultant who are investigating all of your comments and as soon as I receive their full report I will post it.

In the meantime if you want to talk to me further please contact me personally either via email Sharon.kidd@ulh.nhs.uk or telephone me direct on 01476 464560.

Regards

Sharon

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Response from United Lincolnshire Hospitals NHS Trust

Thank you for your feedback, I am sorry that we did not meet your expectations during your visit to A&E. All feedback is shared with the team to allow them time to reflect on the impact their actions can have. I note from your comments that it is a while since your attendance as I am now happy to report that following a refurbishment in the A&E department new seating, lighting and flooring has been in place for a while which has considerably improved the appearance of the Waiting area and the toilet facilities.

Should you wish me to investigate your concerns on an individual level, please provide your daughters details to Sharon Kidd, Patient Experience manger (sharon.kidd3@nhs.net) and I would be happy to do so.

Karen Hansord

A&E Sister