Many people would say that there is no need for a question mark in the title, and whilst I have sympathy with that view, there are aspects that still work and our experiences over the last few days have highlighted the best and worst of our National Health Service.
Our seven year old son was not his usual energetic self when he came home from school on Wednesday and that night (sleepless) we found out why. He had all the painfull symptoms of an ear infection and a temperature of 39C. We gave him Calpol but the pain persisted and his temperature only dropped to 38.6C. We know that Nurofen works best but can also cause him stomach pain but we needed to fight the fever so we gave it to him. He had not eaten much in the evening so the Nurofen caused intense stomach cramps that left him shaking and soaked with sweat. We made it to the morning, taking it in turns to cuddle him, but the next dose of Calpol again hardly touched his fever.
Its now Thursday morning and at 0800 I joined the NHS GP urgent appointment telephone lottery but after waiting in a long queue, as usual the message announced that there were no more appointments available for that day. Not to be deterred, I drove to the practice in the hope of speaking to a human being that could find a doctor with even a few minutes to prescribe the antibiotics he so obvioulsy needed. I did speak to a person but I am not sure if it was a human being because my description of his worsening symptoms should have sounded alarm bells, but did not. Yes there was pain that we assumed to be an ear infection but there was uncontrollable temperature that was hitting 40C and now he had a rash appearing on his upper back. Surely uncontrollable fever and a rash should be taken seriously. Haven't we heard enough about the need to act quickly if there are any symptoms that could be caused by menningitus or sepsis. The person seemed disinterested and the advice was to call the next morning at 0800 to try for an appointment again, go to to a chemist, go to the drop in centre or call NHS 111.
I went straight to the chemist, asked for the pharmascist and as expected he said that he could not provide the obvioulsy required antibiotics and suggested I call NHS 111. He was however extremely helpful, understood our concerns and provided good advice about reducing his temperature. I went home and was happy that our our son had managed to eat a small snack but unfortunately he was then violenty sick. This also meant that he had also lost the nurofen that he had just been given. He was now listless and curled up on the settee so I checked his temperature again, 40C but more worrying was that the probe on the end of the ear thermometer was covered with a dark bloody discharge. I quickly checked the NHS site and this suggested that the infection had now damaged the ear drum due to internal pressure and thus allowed it to discharge. The advice was to call 111.
We did not feel confident because our experience of this service is of a seemingly non medical person asking unrelated questions from a computer screen and then promising that a 'clinician' will call soon. Sometimes there would be a call and sometimes it would just get lost in the system. I called and joined a queue because the message as usual said that they were unusually busy. It sounds like a riddle but they are usually unusually busy! We spoke to a well intentioned person who even advised us that some of the questions might seem unrelated to the issue. We plodded through her questions whilst the discharge from David's ear got worse and trickled down his face. We kept telling her that we felt this was more than an ear infection because the temperature was not controllable, he had a rash and was so listless that he was falling asleep and not communicating normally. She put us on hold whilst she asked for advice but sadly her only response was that 'a clinician would call us soon'.
We wrapped David up drove to the nearest NHS walk in in GP centre and stood in a queue at reception. When we finally got to the receptionist, she took one look at him and asked whether we had called 111. We explained that we had but the 'clinician' had not called back and thus our visit. She gave us a knowing look but was unable to help because they were too busy and could not accept any more patients. She suggested that we go directly to A&E.
We drove to A&E and queued to see a triage nurse. Why are there no seats for the walking wounded whilst they wait to be seen? We understand that her job is not easy but the disinterested and uncaring attitude of the nurse was beyond belief. She suggested that he had measles and did not seem to believe us when we said he had been vaccinated. She did not send us to a pediatrician, we were instead directed to the general A&E full of adults with sprained ankles arms in slings and fisticuff related bleeding noses. After three hours holding our burning hot child we were at last seen by a young doctor but he did not seem interested in the rash or the fact that he was limp and uncommunicative but he did agree that the ear infection had torn his ear drum and he needed immediate antibiotics. He also noted that he had a very inflamed throat and tonsils so would go to the hospital pharmacy and get Amoxicillin and a throat spray. Our quest for antibiotics commenced at 0800 and it was now 2100 but at least we would be able to give him his first dose soon. My phone rung and it was the 111 clinician calling us approximately six hours after we had been promised an urgent call back. We told her we were at the hospital so she closed the case.
The doctor was away for ages but returned empty handed because the pharmacy had run out of Amoxicillin and throat spray. He checked to see if there were any 24 hour pharmacies nearby but there were none available so we left with a prescription. A major hospital and A&E for the region with no suitable antibiotics to treat a child?
We drove home and being on the limit for Calpol we had to give him Nurofen again but this led to a return of the horrendous stomach cramps and incredible pain. At last the pain subsided but he was now curled up in the bed and not making any sense due to his fever. The pillow and bed stained by the blood coming from his ear.
I was at the door of the pharmacy before it opened and the pharmacist let me in immediately. He also nodded his head when I told him that 111 was not fit for purpose but at least we now had the antibiotics that our child needed. He looked in a sorry state with blood caked on the his ear and the side of his face, boiling hot and the rash had now spread from head to toe. The rash felt rough and we were not sure whether it really was disappearing when a glass was put on it i.e. the basic test for meningitis. We gave him the first dose of amoxicillin and I called 111 again.
The conversation was both lengthy and utterly bizarre so I will not go into too much detail but it was obvious that the person taking the call did not understand our concerns. We described the symptoms and expressed our worries regarding Sepsis etc but she was just following her computer screen questions.
'How much blood has he lost?'
'I don't know but the pillows, bed and his ear are caked with it and it is trickling our of his ear'
'Would you think that it is more or less than half a cup full?'
' I really don't know but if we are evening considering that half a cup full of blood may have come out of a 7 year old child's ear, via his torn eardrum then we really are in trouble'
'Which of his symptoms are you most worried about?'
'We are worried about all of them becasuse they cannot be looked at in isolation. A high temperature on its own is not a major concern but an uncontrollable temperature with a head to toe raised rash and obvious severe ear infection was making us worried about sepsis'
We are not sure what answer she entered into her computer because we then heard the dreaded words 'a clinician will call you back very soon'. I picked up my burning hot, listless, bloodied son and we immediately drove back to A&E.
Triage was not busy and we were quickly seen by a very helpful and concerned male nurse who took one look and having registered his high temperature, high blood pressure and elevated heart rate, sent us straight to the paediatric department.
We now entered a different world of care and attention. He was checked immediately, we were taken to a separate room and he was put in bed to await the next available doctor. Blood tests were carried out and cannulas inserted in his arm ready to receive IV antibiotics. The first result came back within about 20 minutes and is showed a very high level bacterial infection. We were taken straight to a ward and the the IV antibiotic started.
It is now Monday and they allowed him to sleep at home last night but even after three sessions of IV antibiotics he has to return this morning for another one. The NHS had one further sting in the tail for us. The blood cultures that should have been prepared on Friday and the results available yesterday, had not been started so the medical staff will need to keep giving IV antibiotics until the potential spread of infection to his blood has been ruled out.
We cannot speak highly enough of the care that he received on the ward or the professionalism of the doctors and nurses but our struggle to get the NHS to treat our very sick little boy or take us seriously is incredible.
The GP service is a joke, a very bad very dangerous joke. 111 is not fit for purpose, the personnel screening and prioritising the calls seem to be clueless and slaves to the questions on their computer screens. The clinicians are obvioulsy too busy to call back so what is the point.
It is no good having excellent care when in hospital if it is so difficult to access that care. Less pushy parents may have ended up waiting for the elusive 111 clinician and then had to call 999.
On balance we do believe that the NHS really is broken.
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