The Future of Hospital Care

The gleaming, new University College Hospital in London is a state-of the art institution. It is equipped with all the latest medical hardware; the wards are discreetly secured from unwanted intruders; many of the phones have mobile handsets so that staff can take calls as they go about their other duties. Although when I took Anna there last week the revolving door at the rear entrance was broken and the visitors’ toilet on her ward was blocked, after two years of use the environment remains impressively clean and well-ordered, and the staff clearly take pride in the high-quality facilities that the hospital provides

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The sense of cutting-edge modernity also extends to the procedures for admitting and treating patients, all of which have a comparably streamlined efficiency. Anna was admitted at 7.30am on the day of her operation, having been trusted to stop eating and drinking as required and take her ”bowel prep” at home without supervision. She went initially not to the ward where she would stay, but to an Admissions Lounge. From here she was called into a bay where she changed and saw the relevant doctors and nurses for her pre-operative consultations and checks. Then, when they were ready for her in the operating theatre, she made her way on foot down to the third floor where she was received by the operating team.

The surgery – which proved quite complicated and lasted a couple of hours – was performed “key-hole” using cameras in tubes and laser scalpels. Afterwards she was taken to a ward on the 13th floor where she spent the night. The next day, just 24 hours after the operation, she was discharged and came home. Twenty-five years ago, the same operation (to remove an ovarian cyst) involved a large 12 centimetre cut across the abdomen, a week to 10 days in hospital, and several months of painful recovery. Last week Anna left hospital – admittedly still weak and sore – with just four tiny incisions, each sealed with a single stitch.

Medicine has made extraordinary progress in recent decades and continues to do so. The sleek briskness with which Anna’s surgery was accomplished reflects the pared-down and highly focussed institutions that hospitals are now becoming. Preparation and recuperation are made the patient’s responsibility, with the hospital offering fantastic treatment but limited care. The patient is not reduced to prostrate passivity the moment she enters the building, but remains independently mobile until almost on the operating table. Relations with the nursing staff are restricted as the stays are so brief, and different people are responsible for admission and after-care.

Although primarily cost-driven, in general these are welcome developments for the patient as well as the NHS budget. No one wants to stay in hospital longer than they have to, and the more patients are able to retain their autonomy the better. Based on our experience last week, however, I do have a couple of small caveats. Anna’s operation was scheduled to take place at 10.30am (she was second on the surgeon’s list for the day) and expected to last up to an hour. Allowing for some slippage and time spent in the recovery room after she came round from the anaesthetic, it therefore seemed reasonable to expect that she would be back on the ward by 2pm. When I rang then, however, she had not returned, and since the ward only deals with the patients after their surgery the staff could not tell me when she actually went to theatre, nor of the reasons for any possible delay. I remained relatively philosophical at this point, but when I rang the ward again at 3.30pm and Anna still wasn’t there I began to fear the worst and imagine dreadful complications on the operating table. In fact she’d been in the recovery room since well before 2pm waiting for a porter to take her upstairs. With patients walking themselves to theatre, fewer porters are available to transport them when assistance is required.

The half-hour of mental torture I endured before a nurse called to say she was all right (sadly we have much experience of things in hospitals not going to plan) is perhaps a small price to pay for having her home so swiftly later. But along with the problems faced by patients who do not have relatives to care for them at home when they are still very weak and needy after surgery; as well as the increased risks of MRSA and other hospital-acquired infections resulting from the system of “hot-bedding”, these are the downsides that need to addressed if the pattern of high turnover hospital care which undoubtedly represents the future is to prove a genuinely brave new world.