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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 November 10; 335(7627): 994.
PMCID: PMC2071994
Personal View

So, you want to know what's wrong with the NHS?

I sat in the waiting room, feeling self conscious. I am usually on the other side of the door, inside the interview room. Now, I was outside, waiting. After five minutes the consultant came out; the big man, the one in charge. We were NHS. He was having trouble interviewing my mother: would I, as a psychiatrist, help him please?

I went into the room. My mum was on the edge of her seat, looking towards me hopefully, giving me that look she had, assuming that everything would be all right now (because “my son” had entered the room). Trusting me. It was then that I learnt what it is like to elicit the first rank symptoms of schizophrenia from your own kith and kin, your own flesh and blood. The great man couldn't manage it. He had the cufflinks but not the questions. He had the style but not the substance. I had the greatest pain I had ever felt in my life. A virtual knife went through my chest as I asked her about the voices, about the thoughts that were not her own, about what the messengers said.

I have often wondered about the doctor's approach that day, whether he had any feeling at all for what it might have been like, to be us, to be her, to be me—because I really doubt it. I doubt it because it was all in vain. The consultation did not achieve anything. “Follow-up” did not occur; appointments were not kept; action was not taken. And when she went missing so did her notes: there was no “paper trail.”

Years went by. Eventually, others would apply the Mental Health Act when the squalor became too great, but only when I had complained to the chief executive of the trust. A note to the wise: complaints in psychiatry are pretty much a waste of time. To be able to proceed you need the “consent of the patient,” something of a problem if the patient is missing or does not accept that she is ill. Those who cannot do their jobs, who cannot elicit histories, are curiously diligent when it comes to applying the rules under which complaints can be made against them. They're sticklers for protocol then.

Schizophrenia gave way to Alzheimer's disease. She came to live with me. Times are good and times are bad, and there are times when you need help. You visit the GP, talk to his shoulder, peruse the back of his skull. He sits there with his back turned, looking at his computer screen. He doesn't touch patients; always refers. You wait and see, wait and see.

Recurrent falls take us to the casualty department. We end up on the ward. My mum, now: an elderly woman migrating across five wards over 14 days under at least three different consultants. No one has a plan. Everyone is “waiting to see.” You arrive to find out that you are in the wrong place. “Who? No, we haven't got anyone by that name here. Oh . . . oh yeah, they moved her out this morning.” Some tests are done twice (brain scans); others are not done at all (blood tests, which “can be done in the community by the GP”).

She sits on the fourth ward, frightened, staring across at a woman opposite who is naked except for a nappy, her head stuck between the rails (she's in a cot). The nurses are sitting there, a couple of metres away, chatting, laughing, four of them. My mum wants to get up, to go across. She's been up and down all day. I make her sit. Don't get involved; don't make a fuss; you cannot win: you're an interfering patient, a “busybody.” I feel ashamed, ashamed of myself. Ill as she is, my mum has far more guts than me. I want to look away, praying that the naked woman in the cot will soon do something so extreme that someone will come and care, that someone will come and do something, cover her up at least. The nurses are laughing. They appear happy.

The fifth ward, and things are worse. My mother tells me that there are children, running up and down. I cannot see them. There is a man “washing children” in the hall. I go to see the sister, saying, “Actually, my mum is worse.” She says, “Well, you know the ward is haunted. Lots of them see children here. I keep an open mind, myself.”

Do you laugh or do you cry? And what can you possibly say? Instead, you walk away and make other plans, internally. Walking out to the car park: it's a beautiful, crystalline spring night, yet I feel hollow. It doesn't matter what you do because the “carers” do not care. It does not matter what you say, because they do not listen. We have GPs with computers and consultants with business plans, we have wards that are “haunted,” and sisters with “open minds.” We have demented women in nappies, their heads wedged between cot rails, smelling of shit. That's what's wrong with the NHS. I took my mum home the next day. We'll take our chances, thanks.

Those who cannot do their jobs, who cannot elicit histories or examine the sick, are curiously diligent when it comes to applying the rules under which complaints can be made against them


The author wishes to remain anonymous.

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