JENNI RUSSELL
NHS needs to return to whole-patient care
new
Navigating hospital system with my elderly mother left me disheartened by inefficiencies
Monday July 14 2025, 12.01am BST, The Times
It’s almost a month since my elderly mother broke her hip and was taken into the care of the NHS. Like many of us, I am simultaneously grateful for her immediate treatment but disheartened and bewildered by the NHS’s destructive inefficiencies. Far too frequently its ponderous systems end up serving the process, not the person.
My first surprise was ringing the ambulance service back after an initial call. They had told me to ring again if the patient’s situation deteriorated, and it had. What was incredible was discovering that the dispatcher on the end of the line had, as a matter of routine, no record of the earlier call, no access to the ambulance list and no way of knowing whether one was on the way. It was as if databases had never been invented.
The algorithm required them, and me, to start at the beginning again, taking 15 minutes or so to answer precisely the same questions about the patient’s name, condition, location, home address, recent medical history, her accident, lucidity, etc.
There was no short-circuiting this process. Every time I tried to, the operator repeated robotically that she had to follow the protocols to ensure that the patient received the appropriate care. The fact that the patient’s condition would be deteriorating and other urgent calls would go unanswered while everyone wasted their time, by design, was clearly irrelevant.
If this squandering of emergency capacity is how every ambulance service in Britain operates, it’s a national scandal. If it isn’t, it’s a major failing by management, because it raises the question of why on earth all services aren’t run on the same model as the best.
Call-handlers are already under immense pressure, knowing that lives often depend on whether vehicles arrive in time. They are so burdened that they take five times as much sick leave as the average UK employee, and one in ten posts are vacant.
The second dismal surprise on arriving at hospital was the gulf between the surgical care, which was excellent, the nursing care, which was erratic, and the attention paid to the wellbeing of the whole person who was being nursed, which was non-existent.
It is nobody’s job, in the modern NHS, to take responsibility for the overall progress of the patient. Food, which is so critical to the rebuilding of the body, and to survival, is nothing to do with nurses. What and whether the patient eats is a matter of complete indifference to the catering staff, who aren’t paid to notice or expected to care.
When my mother was too nauseous from painkillers to eat anything for five days, that wasn’t even observed. Family members belatedly brought her food once they realised, but had she been alone, nothing would have been done.
Nobody was overseeing her physical progress, either. Those of us with elderly relatives know how serious broken bones can be. About a third of over-65s who break their hips die within a year. Their muscles deteriorate rapidly when they are immobile, which is why immediate help with standing and moving is essential to their chances of recovery.
Yet for several days my mother had no physiotherapy because she had caught flu and wasn’t allowed to walk around the ward. That she should have been taught to move in her room occurred to no one in the medical teams, so a critical window was lost.
The worst experience came when we tried to get her released. She had fallen far from home. Her first hospital insisted we couldn’t take her; she had first to be transferred to and assessed by her local hospital, or she would get no subsequent home care. Ambulances were arranged and then cancelled; it took a week to get her moved. The NHS was blocking its own beds. We offered to drive her ourselves but were refused.
In the second hospital, nothing medically useful happened for three days — no physio, just further alarming deterioration and expensive, useless bed-blocking — until my mother started to develop pressure sores from being kept in a bed for so long. I know what a nightmarish problem these are for the old and how unlikely they are ever to heal. That the NHS had induced this by keeping her in was intolerable.
I rang the ward to say we would be taking her home that day ourselves. “That’ll mean you won’t qualify for a care package then,” said the nurse, reprovingly. I agreed that was a risk we’d have to take. I wished we’d acted ten days earlier.
The NHS doesn’t have to be this badly organised and this inflexible, or this cavalier about its patients’ experience. It used to be more responsive to people’s needs. I worked for a couple of months in a hospital as a nursing assistant when I was 18, and it was made clear by the matrons who ran the wards that everything that affected our patients’ health was a concern of ours. They were in our charge and we felt proudly invested in caring for all of them, bodies and minds. That overall philosophy has been lost but it could be regained.
Nor, in an age of AI, should the NHS be so oblivious or indifferent to the most efficient ways to use its information. Ambulances are one example; bed blocking, which costs more than £2 billion a year, is another. My mother spent ten unnecessary days in hospital when she could have been assessed much earlier via a video call between her hospital team and local social services.
That’s not part of the protocols but it ought to be. The health service is terrible at sharing good practice. Even within trusts people frequently work in silos, unaware of methods the next department or hospital may have implemented. Attempts to improve are patchy. The NHS is presently preoccupied by doctors’ pay and restructuring but imaginative solutions to inefficiencies are imperative for it to survive. Times.
.jpeg)