It’s no secret that there is a bone of contention between myself and NHS Fife’s senior management, namely that they fail to listen. This is based on over a decade of failings with respect to my own healthcare and that of my mother. One event being the 11 months admission to their Victoria Hospital facility due to sepsis, only for her to be diagnosed with bladder cancer, be prepared for surgery, be denied that surgery mere hours before its conduction, a 5-month fight for two tests and a second opinion in which the first attempt was corrupted by the interjections of people who were told not to involve themselves, and when a proper second opinion was eventually rendered, it transpired surgery was not required because THEY MISDIAGNOSED HER WITH CANCER.
What you don’t know, because I withheld it (due to the political blowback for a certain party) was that during her admission I witnessed, and informed both the board and health secretary, Jean Freeman, about three major issues with respect to the hospital.
The first was in relation to a situation over heated humidified oxygen. My mother was placed in an elderly care ward when first admitted. She was put on high-flow dry oxygen. This congealed the mucus in her lungs meaning she couldn’t expel it. National guidance states that in the event of a patient unable to expel such, from their lungs, who has been on dry high flow oxygen for 24 hours, should be automatically considered for heated humidified oxygen. In my mother’s case she was nil-by-mouth (no food and drink) so couldn’t derive moisture for her throat and lungs. The mucus was dried by the high flow oxygen meaning she couldn’t expel it.
What makes it worse is that humidification was not available on the ward itself. It had to be prescribed and implemented by another ward (respiratory). The ward had no machines, which is odd considering that over 65’s have the second-highest instance of acute (emphasis on acute) respiratory issues in the country (the first being the under 5’s).
When you have a ward with a very high instance of respiratory issues, you’d think the equipment would be to hand, but you’d be wrong. We actually had to fight to have it administered, and when it eventually was, nobody on the ward was trained to operate the machine. And so when it was eventually administered, our family were forced to watch a horrid situation.
The crystalised mucus would be moistened. This would result in a chunk breaking off and expelled which would lodge in the airway. My mother’s oxygen level would plummet.
The standard practice in this situation is to deal with the drop in oxygen levels by turning up the amount of oxygen given to the patient (seems simple enough), however, none of the nurses on the ward being trained to operate the humidifier meant the adjustment had to be done by the respiratory ward. So the nurses would put through a request to respiratory, and they would immediately fall back on the training they did have – treat the most severe issue with the knowledge you have. And so they’d take off the mask immediately, and replace it with standard dry oxygen set up a 100% 15L/min.
Of course, what would happen? You guessed it! It immediately dried the mucus in her lungs again. It wouldn’t be so bad, but it took respiratory a long time to respond. On one occasion when this happened, it took 6 hours for them to respond and it wasn’t autonomous. Over that period, the family sat watching my mother in serious anguish, because you have to remember she was nil-by-mouth and was being given no oral fluids in case she aspirated it into her lungs, which not only dried the mucus but her nose, mouth and throat. It dried them so badly that her skin, lips and throat were red raw and blistering.
At the 6 hour mark, and after 3 calls by the nurses on the ward to respiratory, I got understandably pissed and I picked up my phone, called through the hospital switchboard and asked to be put through to the respiratory ward. I spoke to the charge nurse and asked where they were. It transpired nobody had come through, and an hour previous the shift had changed. Nobody had bothered to inform the incoming shift that the call was outstanding. I reasonably and directly requested someone to attend, and they did eventually, but not before lecturing me about how inappropriate it was that a patients son would be so brazen as to call through and ask why his mother had been left to languish for hours because none of the nurses on the ward had the training, and the ward that did, hadn’t bothered to send anyone.
Machine adjusted (eventually) she begun to breathe easier, another mucus plug broke off – rinse and repeat. This question was eventually put to the health secretary, about why nurses on an elderly care ward didn’t know how to adjust a humidifier (or even the charge and senior charge nurses), but just as important, why there wasn’t the equipment on the ward for a cohort of patients who have a high instance of respiratory issues – it’s not like it was a secret, the statistics are there for all to see.
Intermingled in this situation with nurses administering treatment that they are familiar with, was the vacuum. Because removing the plug was so important, and because the nurses couldn’t simply increase output on the humidifier instead, on switching to standard oxygen, on several occasions they relied upon the method of vacuuming out said plug. For those of you not familiar with the procedure – it involves stuffing a very large plastic tube down the patient nose into their through and using a vacuum to suck it out. In this case, a patient with dementia in serious distress having her head held down.
The health secretary never could come up with an answer, neither did the hospital.
The second issue that we faced was restraints. On Christmas Day, I came in with my father to discover that the night before, staff had put my mother in restraints to stop her canulating (ripping her IV out) because (and I’m not joking), they were short-staffed.
This situation was unacceptable. As my mother’s guardian, under law, there is a requirement that the hospital seeks consent for restraints except in a dire emergency. In my mother’s case, she was fighting an infection (caused by NHS Fife because that misdiagnosed tumour turned out to be a 7cm x 3.5cm bladder stone and recurring infections are common. It would not have happened if she’d been diagnosed properly because it would not have been there to cause said infection). She was not in serious danger. Stopping her pulling her IV could have been achieved easily without such extreme measures as using restraints, by simply applying light pressure to the back of her hands to stop her going for it, or to have inserted the canula for the IV in her shoulder or leg where she couldn’t get it.
The head of patient relations contradicted herself in response to the complaint about these being used. Firstly, she said that the hospital thought they had consent from my sister to use them from previous usage of them. which was ironic, because on another matter with respect to a procedure, the same woman told me that my powers as a guardian could not be devolved to someone else. It seems that can only happen when it suits NHS Fife’s own narrative. Secondly, she told me in an email that the restraints usage was “risk assessed” but in the same email, she then told me that despite the restraints, she had pulled out the IV. A risk assessment is something that should be changed in light of new information, in other words, the minute she pulled out the IV even with restraints on, they should have been deemed to be ineffectual and further steps taken.
What makes this so serious is that hospitals are under a duty to take the least restrictive option. In this case, mild pressure would have stopped her from going for the IV. Restraints were unnecessary – and all the hospital had to do was call me and ask me to come in if they were short-staffed. They didn’t. Indeed they didn’t tell me they had even applied them. I only discovered it the next day after their application. So in other words, they deprived the liberty of a patient without consent.
It wouldn’t be so bad was it not for the fact that the restraints were properly applied, the end result being that the padding wasn’t in the right position and the nylon straps cut into her wrists. When I discovered they had been used, I immediately checked her wrists and this is what I found:
Jeane Freeman was advised of this, I never got a satisfactory answer. The board was advised about it, the obfuscated as usual. It later transpired that just after this, Jeane Freeman had secretly sent a letter to hospitals telling them that they needed to have a proper policy for restraint application, and records show an admission that they were “keen to have a policy” but didn’t. You read that right, NHS Fife did not have a policy on the use of these restraints.
The third thing I raised with the health secretary and the board and never really got an answer to was the subject of this article in the title. I warned them that the infection control measure of NHS Fife’s elderly care wards was inadequate. And what was my basis for that? Well, in simple terms, I watched the flu rip through the ward. A patient was brought in, they had the flu and were put in a side room. I witnessed medical staff not wearing PPE entering that room. I witnessed staff (because the ward was short-staffed) dropping like flies, and the ones sniffling their way through the day were not wearing PPE when in the rooms with other patients, when they knew they were in contact with the patient who had the flu, and they were coughing and sniffling themselves. At least two of those staff went off sick with….you guessed it….the flu.
And there are those who will say “you’re just grinding an axe”, and that might be the case, were it not for the fact that a survey conducted by the GMC a few months after this, led to junior doctors opining they wouldn’t put their own family members into that hospital (you can google it). This led to the NEC deanery inspecting the hospital and reporting the same as the 11 things I’d raised with the health secretary (which were ignored). That report was not published until October. The details were hidden.
Of course, we all know that NHS Fife was criticised at the start of the pandemic for COVID getting into palliative care and other wards in that same hospital, so my point here is, when the inevitable enquiries start happening after this pandemic, MSP’s would do well to ask themselves if things like heated humidified oxygen were available, whether staff on the wards were trained to operate the machinery, and whether any changes and improvements had been made to infection control procedures in the wake of the flu ripping through the elderly care wards. Why? Because both the board and the health secretary were warned that the procedures and processes for respiratory equipment and for infection control in wards catering for the cohort of patients most at risk from death from COVID 19. I know, because I warned them about it! Twice!
With the release of statistics that 210 people have died from COVID in the Victoria Hospital, I think it perfectly reasonable to ask how many died as a consequence of poor infection control, lack of equipment, and lack of training. If that answer is more than one, then a radical overhaul of NHS Fife’s procedures are required – no whitewashing which seems to be common in this particular board.