My Christmas in Croydon University Hospital

By - Tuesday 2nd January, 2018

A seasonal tale of shortages, stress, and exceptional doctors and nurses

On Wednesday 27th December, I called a doctor to my house for the first time in my life. The previous night I’d considered ringing for an ambulance. My partner was away for Christmas with his adult children and I knew that I couldn’t drive myself anywhere. I was raging hot, shaky, and couldn’t talk or walk very far. It was hard to breathe. My cough could have woken the dead. I can’t believe that I didn’t raise the alarm sooner.

The doctor’s visit was prompt – and brief. “Go to hospital”, he said.

Texting and chatting with no sign of accident or emergency

I arrived in Croydon University Hospital A&E at 4pm. It was full and there was a long wait on hard chairs which I found difficult as I was breathless and feeling very ill. Some of the others waiting seemed well – texting and chatting – with no evidence of either accident or emergency. Attending to these people was taking a lot of time. Quite a few also had more than one other adult with them. One woman had four shopping bags. A group of three was eating in the corner. As a result, the waiting area was much more crowded than it needed to be. I understand that the Trust is taking steps to reduce unnecessary attendance at A&E, and that this is a nationwide problem. But when you are truly unwell or in pain, it’s hard to sympathise with somebody chomping on a packet of crisps.

After several stages of assessment, an x-ray and a period in a soft chair area receiving intravenous fluids, I was told that I probably had pneumonia and was taken in a wheelchair to the Edgecombe Unit just after 9:30pm. Throughout that night and the following day everyone there was lovely, but my favourite has to be the hospital visitor – a retired gentleman – whose duties included bringing patients drinks and offering chats to anyone who was alone. The ward was extremely busy.

At 4:50am on Friday, I was transferred to the Acute Medical Unit. Pneumonia it was.

Important things seemed to be in short supply

Staff here were under obvious pressure, rushing from task to task and not collecting requested samples for long periods of time. In particular, I became aware of the workload of the unit’s staff nurse who was constantly doing several jobs at once (observational checks on me whilst dealing with requests from other team members over her shoulder, for example), making decisions, managing other staff, continually on her feet and breaking off from one task to take on another. By late afternoon she seemed to have been there a very long time and I asked her how long her shift was: it was 8am-7:30pm. I enquired whether she had had a break and she said yes – “but often I do not”.

Quite a lot of her problem-solving concerned items which the unit did not have, and where else they might be obtained. Some important things appeared to be in short supply in Croydon University Hospital, a problem not just in the AMU but later on Purley 3 ward, where a request for an item as basic as an emergency tampon led to the issue of an incontinence pad. I said “seriously?” and the nurse and I laughed – but seriously, there was nothing else.

The staff nurse was in a super-stressful situation

Along with her professionalism, the AMU staff nurse displayed unfailing patience, politeness and kindness. At one point she swung off course in the middle of the unit because a newly-arrived patient was in tears, and went over to comfort her. She spotted across the room that an elderly lady was lying on a tube and that her drip had therefore stopped flowing. She was, however, in a super-stressful situation and observed – with a smile – to a colleague that she would like to hide where no-one could find her.

She showed humour, but I was concerned. Any of us would experience a reduction in clear thinking and decision-making capacity after many hours doing such a complex job. There are obvious risks in putting one individual, however competent and professional, under such pressure.

Quite suddenly, Alice appeared alongside me in the dim light

At 6:30 pm on Friday 29th December, I was transferred to a general ward, Purley 3.

Purley 3 had a less demanding pace and a rather different set of problems. Staff were finding it hard to prevent Alice*, a senior patient who was very confused but also mobile and energetic, from roaming the ward, touching other patients’ possessions and trying to move things. The two nurses on the unit were constantly distracted from other duties by having to pay attention to her, stop her from leaving and make her put things down. At first, this just seemed very sad. I then started to notice how aggressive some of Alice’s responses were, and became more worried. The nurses never once reacted in anything other than a kind and calm way, while I grew increasingly unhappy as the evening progressed. Her behaviour made it impossible to rest, which I badly needed to do.

Once the lights were dimmed and everyone else was asleep (I barely slept during my stay at CUH due to my cough), Alice began to pay attention to me. She would not return to her own bed when asked and needed to be coaxed away from the foot of mine, arguing each time. I had begun reading on my phone when quite suddenly Alice appeared a foot away from me in the half light, making me jump badly. Ten minutes later, this happened a second time.

By now it was after 1am. The nurse drew my curtains and instructed Alice to stay in her own area. Five minutes later there was rustling, and she was again alongside, at least this time outside the curtain. As the nurse once again began to persuade her to go to bed, Alice responded by threatening to ‘thump’ her.

“She should be cared for somewhere else – but we have nowhere to put her”

Exhausted, ill and close to tears, I complained. I asked why a patient who clearly had complex needs was in a place where there was insufficient capacity to care for her. The nurses, who were polite and caring at all times, explained that she should not be here but in a separate area being ‘specialled’ by one staff member attending only to her. But “there is nowhere to put her”.

I’d like to think that I’m not prone to over-reaction, but these were not normal circumstances. I was angry and upset. It was proving impossible for staff to prevent one patient from repeatedly harassing another. Complaining assertively was the best chance of getting something done. I asked for the CUH night duty manager to be contacted. It is, however, very hard to voice a grievance in hospital. Any patient feels vulnerable and disorientated and fears antagonising caregivers. I anxiously emphasised to both nurses that my complaint was not about them, but the lack of resources to care appropriately for Alice.

It was then agreed that one staff member would remain with Alice to prevent further wandering. She argued about this for some time, then fell asleep. Had the ward been busier, however, it would not have been possible for a nurse’s time to be diverted in this way.

She tried to tear off another patient’s wristband

Next morning on Purley 3, things remained difficult. Alice woke up another patient, Beverley*, who was very unwell and more or less immobile, and tried to tear off Beverley’s wristband with identifying details, which all patients wear. A nurse hurried over and told Alice to come away because Beverley was resting. Alice shouted that “she’s rested enough!” and told the nurse to “go away!”. She started to pick up Beverley’s things, saying that they were hers, then grabbed her bedside tray. The nurse had to very firmly take it back. All this happened a few feet from my bed.

The way that Alice grabbed at everything the previous evening had made me scared that she would try to grab me. Her grabbing at Beverley was quite foreseeable – but what could the busy staff do? The whole episode was miserable and alarming.

There were also two unconnected public disagreements between staff on Purley 3. The first was between a nurse and the breakfast attendant, who clashed when the nurse told her loudly to return to another bay where patients were saying that she had served them all porridge rather than asking what they wanted. The attendant indignantly insisted that she had not done this. She had certainly asked everyone in our bay for their choices. The second argument I could not follow, but it took place on the ward between two nurses and was also witnessed by my startled partner on a visit. Neither conversation should have taken place in front of patients. These were the only lapses in high professional standards I witnessed during my stay in the hospital. They contributed to my feeling that Purley 3 was the least reassuring environment that I had experienced in CUH. By now, I was desperate to leave.

Superhuman effort and dedication keep our health services going

The ward then became quieter as many of us were waiting for discharge and one nurse was again able to give a lot of attention to Alice. I was discharged and am now happily at home, recovering.

I am very grateful indeed to everyone who looked after me. I was treated with unfailing professionalism, courtesy and kindness throughout my stay, and saw the same shown to others. My thanks go to everyone in A&E, the Edgecombe Unit, the Acute Medical Unit and Purley 3, and also to the non-medical staff (those responsible for the regular arrival of the tea trolley, for example) who were so friendly and good-humoured.

However, my experiences this Christmas confirm my belief that the health services that Croydonians rely on are overstretched and fraying. They continue to function only because of the near-superhuman effort and dedication of those on wards and in health centres who work so hard to deliver patient care.

*Names have been changed.

Liz Sheppard-Jones

Liz Sheppard-Jones

Writer and editor. Views personal, not representative of editorial policy.

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  • Anne Giles

    Amazing. I would have been terrified!

    • John Gass

      As would most people. Do you see how a majority of people would find themselves unable to fight back? Yes, we’d all be terrified, but it needs positive action to empower the terrified and to make things better.

      • Anne Giles

        I have been lucky with the A&E Dept. In January I had a fall and banged my head, with a lot of blood. I pressed my personal alarm button and Croydon’s Care Line sent the paramedics, who took me to CUH A&E. After blood tests, X-rays and scans they sent me home. They omitted to tell me that there was a tiny bleed in the brain, but informed my haematologist, who was not worried. In July I suffered a subdural haematoma and went by ambulance to CUH A&E, had another scan and my husband was told what it was. I then went in another ambulance to St George’s trauma unit and was admitted straight away. I had brain surgery the next day and was in intensive care, where the nurses were fantastic, then back to the ward, where again the nursing and medical care was second to none. The surgeon was amazing, as were the younger doctors and the patients a nice bunch of ladies who had suffered a great deal. I was discharged at the end of a week.

  • Charlotte Davies

    Not an untypical experience – if I had realised that you were alone I would have come because I have had other neighbours having an “Alice” experience. I always tell everyone NOT to go to A & E alone; when you are really ill it is all too much you need someone with you to negotiate and guard possessions. But it is important to go and to experience it first-hand. But for me I have not been an in-patient for some time and I have no intentions of going back as such, I honestly would rather be dead; last time was so frightening. After an operation I was taken by ambulance, dumped in Tooting A & E, no-one would check me in or take responsibility for me or give me water, eventually my brother and former partner found me hours later….

    • lizsheppardjourno

      Thanks so much, Charlotte. I’m so sorry for what sounds like an awful experience. I wasn’t on my own in A&E, in fact – there was too much clutter to include it in the article, but when I called the doctor, P was already on his way home from the Midlands. I knew how long the journey takes and that he would arrive soon – as he did within 20 minutes of the doctor’s departure. My back-up would have been E with me in an Uber :) (which is what I should have done on Boxing Day night). I have to agree about not attending alone.

  • lizsheppardjourno

    A friend has emailed me in the last few minutes. He does not wish to reveal his identity and has asked me to post the following here:

    “I suffer from mental health issues and twice in the past few months have had to use my crisis plan, which tells me what I should do if I become at real risk of committing suicide.

    “The first time was when my psychotherapist told me I needed immediate support and that I should go to the nearest A&E. This happened to be St. George’s in Tooting. There I was triaged within fifteen minutes and immediately taken to a quiet, safe place close to the A&E nurses’ station. Within half an hour of walking in to the hospital, I was being supported by the hospital’s psychiatric team. At least one team member stayed with me, and talked things through with me, until I felt safe enough to be able to go home.

    “In comparison, when I went to Croydon’s A&E, although I was triaged quickly, everything after that was a blur of confusion. I was, over the next four hours, subjected to many routine physical health checks… blood tests, temperature, an ECG etc. Finally a doctor saw me but was confused when I told him my issue concerned my mental state, not my physical health. I asked if there was somewhere safe and quiet I could be put until the psych team could see me – as Liz says in her article, the current waiting area is shambolic and definitely felt unsafe for me given my acute anxiety. But there was no alternative.

    “So I had to stay in a noisy, overwhelming and inappropriate space for four and a half hours, despite me going back to the triage nurse to remind her that I was still waiting and was becoming even more desperate. In the end I had to walk out because the situation was adding to my suicidal intent.

    “Strangely, Croydon’s A&E is rated higher than St. George’s regarding the four hour target for receiving treatment after arrival. I’ve spoken with a few health professionals who told me my suspicions are probably correct… that I was given random treatments well within the target time and so added to the hospital’s success rate, even though I never once saw anyone from their in-house mental health team – the reason that I’d gone there.

    “What I’d like to know is who instigated this false-reporting scam. My guess is that it’s most likely someone not on the frontline rather than any of the A&E staff, who all treated me with care, despite the obvious pressure they were working under and not being able to meet my real needs”.

    • lizsheppardjourno

      Just adding my agreement: I was also looked after in A&E as well as the pressurised, though clearly caring, staff could manage. Once I was out of the waiting area and had been assessed as needing serious attention, I felt safe.

      • Ian Marvin

        My understanding is that CUH has limited ability to provide mental health support of any kind. I don’t have actual numbers but this seems a particular problem where patients with complex needs are admitted for other issues. What you say bears this out.

        • John Gass

          Limited… probably. But there is an in-hospital psychiatric team. After all, mental ill-health underlies many admissions. Having said that, it’s unlikely that anyone’s immediate mental health needs are complex – a term that carries specific meaning.

          Having been a trustee/director for a local mental health charity, experience suggests to me that those who go to A&E are usually driven by one overwhelming fear.

          It’s a well-worn comparison, but imagine an A&E patient being told their broken leg isnt life-defining, so they should just go home and rest. For those of us who suffer from mental health issues and are suicidal, this is the routine response.

          You need to hope that you’ll never be so abandoned and that someone, somewhere, cares for you. Without that, you’re screwed.

  • Alan Reynolds

    What a well written piece about what actually happens at Mayday. I think until we can persuade those with flu not to go to hospital or GP (as neither can really do anything to treat it), we shall not reduce the queues at A & E. Likewise with drunks.

    • John Gass

      I think the problems are more nuanced than your post suggests. Trivial health issues should never dictate hospital policy. And, undoubtedly, the problems caused by excessive drinking are real, relevant and cost the NHS a lot. But, in my experience, alcohol abuse is generally tied to a deeper issue… isolation, lack of professional support, mental ill-health, the threat of losing your home and so much more.

      What’s needed is caring, non-judgemental support framed within a reality check. There will always be people trying to survive at life’s margins, clinging desperately to the idea that they might, some day, deserve to be supported.

      The care system no longer exists; it’s come down to a minority of public service employees who dare to go many an extra mile to try to improve things for disadvantaged groups or individuals.

      The post that mentions ‘complex needs’ is right on the money… many people can deal with a single issue, most can’t deal with attacks coming from all angles. Lucky anyone who hasn’t experienced catastrophic lack of understanding and support. To them I’d say, please don’t retreat to the ‘I coped, so anyone less able than me is just a failure, deserving to be abandoned’. Instead, be grateful that you survived and have had better luck than many.

      • Alan Reynolds

        John. I agree that Society (however defined) should help those who cannot help themselves (for what ever reason). But going to A & E for something you have done to yourself (like over drinking) or which A & E can do nothing about (like flu) I still maintain is a waste of resources we all fund. What the right route should be and who should pay I leave to others more knowledgeable than me. Alan

        • lizsheppardjourno

          The issue of why so many people go to A & E is so complicated. In its current Black Alert (the highest level of crisis) the NHS is introducing consultant-led triage: I presume the goal here is to put someone on the gate with the authority to turn people away and the skill to prioritise the others.

          I could have said a lot more about my experiences in A & E but the focus of my article is on my in-patient care. There was quite a kerfuffle being caused by a young man who I suspect had been taking drugs (or perhaps not taking medication he required): he was agitated and noisy and kept going on outside. He was accompanied by a police officer who’d brought him there and was keeping him there until he could be seen.

          I don’t think his problems were self-inflicted (and I think there’s a big difference between an alcoholic with underlying problems and someone who’s just been out on the lash) but his presence was very disruptive. Whether he needed to be there I don’t know. He certainly needed social care and support and I greatly doubt he will get that. I suspect he was just one example of a vulnerable person ending up in A & E because there was nowhere else for him to go.

          • Alan Reynolds

            Liz. I feel sure you are right about the case you describe : nowhere else to go. But one swallow does not make a summer. If you look at these ONS figures for 2016:
            “There were 525,048 deaths registered in England and Wales in 2016, a decrease of 0.9% after the large increase seen in 2015.
            Age-standardised mortality rates (ASMRs) decreased in 2016 by 3.0% for females and 2.4% for males; similar to the general trend prior to 2015.
            In 2016, there were fewer deaths at ages 75 and over, while the number of deaths at ages 65 to 74 increased compared to 2015.
            Cancer remained the most common broad cause of death (28.5% of all deaths registered); there was an increase of 1.1% of deaths to this cause compared with 2015.”
            You will see 1/2 million of us die anyway each year in E & W and nearly 3 in 10 will have cancer as the cause. Let’s be realistic. We cannot treat everyone for everything. We should make sensible, effective choices. I still maintain that going to a hospital with flu or too much booze should not be accepted, and the places given over to those who can effectively and economically be helped

          • lizsheppardjourno

            And I agree with you. I did make the distinction above between someone with an alcohol problem, presenting drunk but with a whole raft of underlying issues, and a good-time drunk with no judgement.

            I’m hoping that the introduction of consultant-led triage will make a difference and focus time and care on those who need it. That must be the intention.

  • Tanya Marie

    My mum was in AMU at the same time as you, having been taken in on Christmas Eve. She has severe COPD and can barely manage 3 metres, but the nurses in AMU demand that she walks to and from the toilet as getting a commode is too much work.
    Her sats (oxygen saturation) drops to 72 when she moves from the chair to the commode, but still they get agitated when she requests the commode.
    On one occasion we requested her pain meds and were still waiting over an hour later, with the nurse we’d asked managing to see to another patient who had come up half an hour after we’d asked.
    Some staff are amazing, but some is not good enough, when dealing with ill, vulnerable people, all staff should be on a higher level.

    • lizsheppardjourno

      That sounds terrible – I am so sorry for all of you. Feeling unhappy or angry with hospital care creates an impossible dilemma: if you complain, you worry that staff will be angry and your care (or your relative’s care) will suffer. It’s a very real fear; the sense of vulnerability is intense. But at the same time you suspect that the people who make the biggest fuss will be attended to (which is usually true). No-one should be put in this position.

      I only had limited space in the piece above to make a lot of points, but the ‘on the edge’ feeling in AMU was palpable; they were barely on top of the workload. It’s very disturbing.

      I hope your mum is feeling much better now.

  • NeilB

    Many articles about the NHS seem to suggest that it is at breaking point and cannot cope and is in crisis while at the same time saying that it is the envy of the world and marvellous it is (though not one country has copied it as far as I know) . I don’t think it can be both.

    Perhaps we should look at how our European neighbours manage Health services and copy the best practice there.