First names and last names

Even in the informal, everyone-is-equal world of today, first names and last names are still used as indicators of status. This struck me most recently when flying home from Venice. The captain did the usual welcome announcement once we’d all boarded the plane. He referred to himself and his co-pilot by first name and surname, yet introduced the cabin crew by first name only. Why? I assume because pilots are considered more senior in rank, hence ‘better’ than cabin crew. But in fact these two professions are just different – it doesn't make any sense to compare seniority across the two.

The same applies to the health professions. Doctors are referred to by surname and nurses by first name. In the past, of course, nurses were also referred to by surname – back when everyone was known by their title and surname in the workplace. So why have things changed for nurses, but not for doctors? Again, I assume it is to do with perceived seniority. I remember my surprise when the doctor who was called to assist with the delivery of my first child introduced herself by her first name. Even after hours of labour, this struck me as unusual! When the midwives told me that this doctor was coming to assist, they described her as ‘lovely’. She was also young. Maybe that’s why she bucked the naming convention. Or maybe she was keen to establish a rapport with her patients quickly. Either way, this is not the norm.

Some of my elderly relatives lament the fact that it is now usual to call someone by their first name rather than their surname. One of them mentioned this in the context of being a patient in hospital. Now all patients are referred to by first name, whereas in the past they would have been referred to by title and surname. My elderly relative found it demeaning that someone sixty years her junior should address her by her first name.

So, in the past, surnames were the norm outside one's circle of family and friends. But nowadays first names are the norm, except in professions which are considered particularly prestigious or in some way special. It's interesting how these things change.

Hospital aftercare

Some time ago, I wrote a blog post about psychiatric hospitals and what it is like visiting a relative who is detained there.

Something else that we have become familiar with over the past few months is the after care that people receive once they are released from psychiatric hospital. This support is (predictably, I suppose, given the strain that the NHS is currently under) pretty minimal.

Our relative was released from hospital, but was still detained under the Mental Health Act. This meant that they were obligated by law to take the medication prescribed by their psychiatrist and to comply with any request to attend out patient clinics or indeed to return to hospital.

But the only support or monitoring they received was one visit per week from a psychiatric nurse. And when it was half term and the nurse was on holiday, our relative received no visit at all. Shortly afterwards, our relative was discharged from detention under the Mental Health Act.

Interestingly, our relative reduced the medication that they were taking as soon as they were released from hospital and stopped taking it altogether within a few days of being at home. This was obvious to us and so was surely obvious to the mental health experts as well. But it seemed to make no difference. Our relative was still discharged from detention under the Mental Health Act on the understanding that they would continue to take their medication -- even though they had already stopped taking it when they were still obligated by law to do so!

This is obviously a very difficult area to manage. It's all about balancing the safety of the public against the liberty and rights of the patient. I don't think our relative ever posed much of a threat to the public, but clearly some people with severe mental health issues do. And, given our experience of care and support following release from hospital, it's not surprising that sometimes poor judgements are made and tragic consequences result.

The problem with hospitals: a very personal experience

My elderly mother recently had a spell in hospital. It was a pretty standard story for someone who is almost eighty--she fell while doing some cleaning at home, couldn't get up again and had to call 999. She was diagnosed with a fractured hip and had to have an operation to mend the fracture, which necessitated her staying in hospital for a short period.

We are hearing a lot at the moment about the poor state that our hospitals are in--how A&E departments are near breaking point, how low standards of care can be. My experience of my mother's spell in hospital gave me a very personal perspective on this state of affairs.

I live a two-hour drive away from my mother and I am the only relative (my mother has no other children and she divorced years ago). This means that all responsibility in this kind of situation falls on me. I don't mind this at all, but it does mean that I need people to be understanding and, sometimes, flexible.

The visiting hours on my mother's ward were 2.30 until 4.30. I needed to visit my mother during the week (as soon as possible after she'd been admitted) so that I could see her and collect some things that she needed from her flat. I also needed to be back home in time to pick up my kids from school. So, visiting hours of 2.30 until 4.30 were no good to me at all. I explained all this over the phone to the staff nurse (Jan) and she said that she couldn't give me permission to visit outside visiting hours on my planned day because she wouldn't be there then. She advised that I ring the ward before I set off on the day that I planned to visit to check with the staff nurse on duty then that it would be alright for me to come.

I did exactly as I was told--rang the ward number before I left. The ward phone was answered by an answerphone telling me that the ward couldn't take routine patient enquiries between 7 and 11.30 am (!) but that if my call was an emergency, I could ring an alternative number.

I rang the alternative, emergency number...and rang and rang. I must have tried about six times before I left and then again several times en route. The phone was never picked up. And this was the EMERGENCY line!!

When I eventually arrived at the ward, I was met by rude and unhelpful staff. They implied that I was lying, saying there was no staff nurse with the name of Jan who worked on the ward, and denying that the phone was never answered. I did get to see my mother in the end, but only after a lot of arguing on my part. The whole experience left me feeling angry, frustrated and sad.

While I understand that hospitals are overstretched and that the primary role of staff must be to care for patients rather than to worry about relatives, I do expect that wards should be answering their emergency phone lines. I also expect to be treated with courtesy and respect by ward staff, even more so when I have exactly followed the instructions that I have been given by the nurse in charge. If ward staff fail to treat relatives--people who can fend for themselves--with courtesy and respect, then one seriously wonders about the attitude they adopt towards patients--the people for whom they are meant to be caring.

Psychiatric hospitals: what are they really like?

Before Christmas, we spent quite a bit of time visiting a psychiatric hospital. One of our elderly relatives was ill--suffering from schizophrenia--and we travelled to see her when we could at the weekends.We learnt an awful lot over that period, not only about the illness itself, the therapies used to treat it and the legislation surrounding mental health, but also about the physical institutions in which people suffering from severe mental health problems reside.

People's perceptions of mental illness have, I think, softened over recent years. There probably still exists fear of mental illness, but not to the same extent. It's talked about more openly--is in the media even--and is no longer considered something to be ashamed of.

Our relative has been ill for a long time, so we're very used to the symptoms of mental illness, but this was the first time that we had set foot in a psychiatric hospital. And it was quite an eye-opener. The hospital is situated in an affluent town on the south coast and you reach it via a pleasant drive past what look to be very expensive executive homes. The hospital is indicated by an innocuous NHS Primary Care Trust signpost--no mention is made of 'psychiatric', just 'hospital'.

But once you are on site, things feel quite different. In order to gain admittance to the hospital you have to report to the (very friendly) receptionist, explain who you are visiting, sign in and put on a visitor badge. Much the same procedure as when visiting any workplace, you might think. But going onto the ward is quite different again. The doors are locked, because most of the people on the ward are being detained under the Mental Health Act, which means that they are only allowed out unaccompanied if they have been granted leave by their doctor. All entry to, and exit from, the ward must be noted by a member of staff. Thus, when you arrive at the ward, you must ring a bell for admittance and, because the staff are very busy, it can often take a long time before anyone answers the door. Children aren't allowed on the ward, which meant that when we weren't taking our relative out, we had to meet her in the hospital's designated 'family room', away from the other patients.

Walking around the wards is also quite an experience. The patients are suffering from all kinds of mental health issues. Some are very pleasant and friendly, but others can be unpredictable and verbally aggressive. In the 'acute assessment unit', the ward to which all patients are initially admitted, it is common to see police officers, since new patients are, often, brought in as an emergency by the police.

I wouldn't exactly describe the hospital as Dickensian, but despite friendly and helpful staff, it is undeniably a bleak place, and the locked doors and police presence lend it an air of detention rather than one of caring treatment. Our relative has now been discharged, thank goodness, but there's a high likelihood that she will need to return at some point in the future. And that is something that none of us will relish.

Sadly, NHS not so different from (some) other workplaces

I, like many others, was shocked by the reminder in the news this week of the dreadful failings at the Mid Staffordshire NHS Trust between 2005 and 2009 which led to terrible neglect of patients and many unnecessary deaths.

This kind of dereliction of duty in the hospital sector is particularly shocking since it really is (or can quickly become) a matter of life and death, and also because when someone is ill in hospital we expect that people around them, and most particularly nursing staff, will be caring and compassionate.

Yet this kind of breakdown in work ethic and respect for persons is not restricted to the healthcare environment. It can occur anywhere and is something that I've experienced in my past, working in an office environment for a large organisation.

Sarah Montague on Radio 4’s Today programme interviewed a number of individuals who work, or used to work, in the NHS in order to try and find out why a situation such as that in Mid Staffordshire might occur. The people she interviewed talked overwhelmingly about employees who didn’t care and senior management who failed to listen; a culture in which complaints were ignored and in which whistle blowing by staff was met by bullying, coercion and the threat of dismissal; a culture in which underperformance was not challenged and in which underperformers were moved sideways rather than disciplined. The net result: an environment in which the best performers leave and the worst performers stay, and in which people behave exactly how they please without check. A veritable recipe for disaster.

All of this I recognise from my past. The environment that I experienced was one where the senior managers (who had had been in place for years) were interested only in keeping complaints to a minimum and making sure that their own positions were safe. They ignored internal complaints about underperformance and unacceptable workplace behaviour. This meant that people simply suited themselves—turning up late for work, failing to do their jobs properly, and being (sometimes shockingly) rude to their managers and those with whom they worked. When the head of department retired, a new head was hired who recognised all of these problems and set out to change them. She really rocked the boat and (surprise, surprise) was fired (or ‘asked to leave’) in less than a year.

I found it incredible that this kind of situation could exist and be allowed to continue, and I left the organisation as quickly as I could. My experience was of course far less shocking than the situation at Mid Staffordshire. For starters, people didn’t die as a result. But nonetheless, the situation that I experienced was harmful to those it touched and unacceptable. I also find it interesting, from a purely intellectual point of view, how people—some people—will behave in the absence of a strong, engaged and moral leadership, no matter what the sector.