I was having tea with my neighbour in her second-floor flat when a man, a stranger, appeared in the room. This is quite a regular occurrence at Alice’s. She’s deaf and she can’t really walk so any number of agency staff have access to her front-door key. They materialise wearing gloves and usually a face mask, and because Alice relies on lip-reading she hasn’t a clue what they’re about to do to her. Is it bath time? Injection time? Oh, it’s fun to be housebound and old. This time the man had a clipboard which he consulted, then said: ‘We’re going to hospital.’
Alice turned to me: ‘What did he say?’ Over the years, she and I have worked out a decent way of communicating, mostly though eyebrow raises: ‘What’s the world coming to?’ And shrugs: ‘What can you do?’ This wasn’t in our repertoire, so I turned to the man and asked: ‘What’s it for?’
He looked at the clipboard again. ‘She has an outpatient appointment.’
When the whole system is failing, nit-picking and nagging is all you can do while the ship sinks
‘But how is she getting there?’ I asked him. ‘Ambulance.’ He gestured to the window and, sure enough, there was one parked in the street below. Alice had fallen a few months before and broken her hip so the idea of a check-up made sense, but not much else did. ‘How will you get her down the stairs?’ I asked. The man looked at Alice’s set-up: bed, commode, armchair, all side-by-side with a Zimmer in front. Then he looked at Alice, who isn’t fat but isn’t bird-like either. And we were quiet for a moment, considering those two flights of stairs.
Then Alice, who’d picked up the gist, began the painful process of leaning forward, gripping the Zimmer and tipping weight onto her swollen feet. ‘I’ll try. Though this is how I broke my hip in the first place you know.’
‘Stop!’ said the man, ‘we’ll reschedule. We need a stretcher and two people. Her file needs updating.’ He shook his head. ‘It should say she’s immobile and deaf.’
‘What does her file say now?’ I asked, peering over his shoulder. There was Alice’s name and address on a piece of paper and underneath that two words: ‘immobile’ and ‘deaf’. We contemplated this, the man and I. ‘So… what would you add to that?’ I asked him. ‘Nothing, really,’ he said, equably. ‘Then why have you come alone?’ ‘Cost-saving,’ he said, and shook his head at the sorry state of the NHS. ‘One man is cheaper than two.’
‘Shall we add something to the notes then, so this doesn’t happen again?’ The man looked horrified. ‘I can’t add anything to the notes! It’s not my business. It’s an automatic system!’ ‘Can you tell the hospital to add something then?’ He looked at me as if there was some basic fact I wasn’t grasping: ‘This is an automatic system. An automatic appointment.’
I looked out of the window again and thought about all the octogenarians who might have fallen across London and might right now be lying with their own broken bones, waiting for an ambulance like this. The man was right. I wasn’t grasping it.
‘If you reschedule with these same notes, won’t the automatic system just trigger the same response?’ I asked. The man smiled and something about the Zen-like calm that had descended on him suggested that this wasn’t his first time at this rodeo. Perhaps he’d even been to Alice’s house before. She wouldn’t necessarily remember. Perhaps it would go on like this until Alice died, an endless series of ambulances and endless automatic rescheduling. I had the sudden, vertiginous feeling that there might be ambulances all over London idling in the streets waiting for outpatients they can never pick up; men with clipboards calmly popping in and popping out like cuckoos on a cuckoo clock.
The government has, I read recently, spent £164,000 on a guide to ‘inclusive communication’ to ensure that clinicians ask patients their pronouns in exactly the right tone of voice, for fear of triggering offence. At the time I wondered how on earth cash-strapped management justified the spending when nurses were striking and patients dying for want of care. Now I see that when the whole system is failing, when various parts of the service just don’t connect any more, nit-picking and nagging is all you can do: have a meeting, print more posters, obsess on progressive protocol, give yourself the illusion of control while the ship sinks.
Wes Streeting described the health service recently as ‘still salvageable’. It’s quite something to hear the Labour shadow health secretary so downbeat about ‘our’ NHS. But Wes is wrong.
The man was by now sidling out of the door so I had one last crack at fixing this tiny broken link in the system. ‘Can anyone add to Alice’s notes? Who should I tell so we get two men next time?’ I asked. ‘Maybe her GP?’ The man said this gently, sorrowfully, as if there was no reason for me to meddle, and as if the process was all taking place exactly as it should. He needn’t have worried. I’ve tried to call Alice’s GP before. They never pick up.
When he was gone, I turned to Alice. ‘Mistake. It was all a mistake,’ I mouthed. ‘Don’t worry. I’ll make a cup of tea… by the way, your hip, the one they operated on, does it hurt at all?’
‘It’s all right,’ she said. ‘There’s bits of me that are worse.’ So there’s your outpatient appointment, Alice.
This was on Sunday, and shortly afterwards the government tested its emergency alarm and the air was full of shrieking and I had to resist the impulse to smash my phone to make it stop. Not because a nationwide alarm is a bad idea – I’m sure it works very nicely in countries that suffer from storms or tsunamis. But because of the impression it seemed to give of an efficient government which keeps its citizens so safe and well that all it has left to do is fine-tune the emergency protocol.
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