Retired doctor writes devastating report on Wales’ broken NHS

Martin Shipton

Wales is in the middle of a public health emergency, with the NHS not functioning as it should and people scared at the thought of getting ill and needing care, according to a retired public health doctor.

Dr Rajan Madhok, who lives in Llanbedr Dyffryn Clwyd, Denbighshire, has written a compelling report in which he describes the experiences four people he knows have had with the health service.

He states: “I cannot tell you how many times I have heard that we treat our animals better than fellow human beings, or ‘where are the leaders, why is no one sorting out these simple problems?’. The soul seems to have been sucked out of the NHS, there is no accountability or anyone taking responsibility, people tell me when they know my background.”

Introducing the four case studies, he writes: “My intention is not to single out any of the services for criticism, as I believe that these cases could have happened, and are happening, anywhere in Wales. These experiences are not uncommon and are reflective of the current state of affairs in politics, society and services.”

Neighbour and friend

Case Number One concerns the late Gordon Stevenson, who was Dr Madhok’s neighbour and friend. He writes: “He was 93 – a very active, independent man, living by himself with the support of his son. When his health started deteriorating, a few months before his death, our conversations became ‘philosophical’ and we discussed the meaning of life and death.

“He had lived a full life and was very clear about his need to maintain his independence and dignity – the thought of not being able to self-care just terrified him. He did not want to live if he got to that stage, and used to ask me if I would help him (sic) – he was aware that I support the idea of assisted dying.

“One night, Gordon fell down on his way to the toilet and another neighbour found him and rang the ambulance. Gordon was taken to Glan Clwyd hospital where he stayed on a trolley for 36 hours and then via an assessment unit he went to a ward. Michael [Gordon’s son] kept asking for support to take him home, especially after the physio felt that he should be home, and not be in an acute hospital bed. Six weeks passed and by this stage, Gordon had given up eating and basically started starving himself, and just lay in his bed.

“He was catheterised, even though he could manage, but with support, and started getting pressure sores. After six weeks he was discharged to Ruthin Community Hospital, and the saga with the local social services continued – who even after the intervention of the GP, felt that he could not go home but should go into a nursing home. Michael ran from pillar to post to organise home support, and was shocked to get a phone call from a local nursing home to say that they were looking forward to seeing Gordon the next day- social services had arranged for him to go there. Michael was shattered, and made more noises. The nursing home was cancelled,bvarrangements then started to adopt Gordon’s home – shower/commode etc for his return, but the bed was only going to come the day when Gordon was coming home.

“Finally, Gordon came home on a Tuesday, by when he was in the last stages. Michael remembers him being carried in and the look in Gordon’s eyes, knowing he was home, is one that he says he will never forget. Gordon survived three days and then passed away at home, with Michael by his side.

“Michael feels that Gordon was no one’s responsibility, was seen as expendable, and he felt totally disempowered. Michael, like most people, felt himself unable to negotiate the complex health and care system, but did pick up that Gordon’s care seems to be due to a wrangle between health and social care, and their budgets. By nature Michael is like his father and a very gentle person, who would not criticise anyone, but he is upset with the social care staff for thinking about money and not Gordon. As a layman, he compares the huge cost of keeping Gordon in an acute hospital (apart from depriving more needy patients) with the small amount that would have kept him at home.

Thoughtful

Case Number Two relates to Paul Marfleet. Dr Madhok writes: “Paul is someone I admire, a thoughtful, highly intelligent and caring person – he has been a councillor and non-executive director on NHS boards who has given nearly 30 years of service to the community, after his early retirement.” In his own words, Mr Marfleet states: “On September 4 2024 I attended the local A&E for the third time in the last 12 months, and I also had six outpatient appointments as well as CT scans and ultrasound scans. In each case, I observed some of the best in clinical care and sadly, some of the worst.

“I am always surprised at the hospital’s dependency on postal communications at a time when the majority of the population now communicate electronically. There also seems to be a problem of delay between the clinician dictating a letter and it actually getting typed and posted. This sometimes runs into weeks rather than days.

“In the same context, I am amazed at how many letters include a fax number. Facsimile communications are as out of date as VHS recorders. Letters of appointment often give telephone numbers that when used have a recorded message saying: ‘This number is no longer in use’. Even when the number is connected the caller is often given options of up to a dozen departments. The complexity of these will undoubtedly confuse many callers and may well contribute to missed appointments. Patient communications need to be considered in the context of the catchment area of the hospital which includes one the UK’s worst areas of deprivation which will undoubtedly include low levels of literacy and numeracy.

“On arrival at A&E by whatever means, the initial triage seems to work well and you are ‘in the system’. From then on it is chaotic and confusing. The waiting area always appears packed. Some of these are multiple family members attending with the patient. As the doors to the outside open and close, there is always the waft of cigarette smoke from those ‘nipping out for a fag’ despite it being against the rules. I was immediately surprised at how often patients’ names are called but no-one answers. I now understand that this is because there is no patient tracking system.

“They may have been sent for a blood test, an ECG or a scan, but are still called by the duty doctor. When they don’t respond, they then go to the back of the queue so when they return to the waiting area, they have no idea that they have missed their slot.

“If it is eventually deemed necessary that they are admitted, they are often pushed into adjacent corridors either on a trolley or in a chair until a bed becomes free. This can be hours if not days. On one occasion I was in A&E for 25 hours despite having been diagnosed as requiring urgent vascular surgery. The limited toilet facilities are often out of use and refreshments are spasmodic at best.

“The vast majority of nursing care on the wards is good although it is immediately obvious as to how much time is spent on admin and ‘box ticking’ rather than direct patient care. Sadly, there are some examples of poor nursing care and this is most obvious on the night shift where predominantly agency staff are on duty. I observed an agency nurse going from bed to bed without washing her hands or changing her gloves. She came to change my IV drip and I asked her why she hadn’t flushed the line first and she replied ‘Oh I forgot’.

“In recent years infections such as C Difficile and MRSA have been recognised as a major risk in hospital environments. The Covid epidemic raised this to a new level. On two occasions as an inpatient in the last 12 months I have experienced a significant hospital acquired infection, with a resulting sepsis and with CRP rates up to 200. Both these episodes necessitated a delay in my discharge and an intensive IV antibiotic treatment plan. It looked to me as though Infection control was another case of ‘must be seen to be doing it’ rather than actually doing it. Some ward cleaning is done by employees and some by contractors. The latter spent most of their time sticking labels on desks, tables and shelves stating the time and date when they cleaned it whilst at the same time missing obvious risk areas.”

Ysbyty Gwynedd 

Case Number Three concerns Paul Taylor, a cycling enthusiast who recently had an accident when a car pulled out in front of him. Dr Madhok states: “He was rushed to Ysbyty Gwynedd in Bangor with suspected neck and back injuries. The local hospital liaised with the specialist unit in Stoke on Trent to assess and plan his care, and he was moved from the ‘Resus’ to ‘Majors’ and then to a general orthopaedic ward.

“Towards the end of day two after the accident, the specialists in Stoke had ruled out serious injury and requested an Xray before he could be discharged. However, this request was only noticed when the orthopaedic team came to do their round the next day at noon. When they read the notes, the senior asked: ‘has this been done?’; the junior said: ‘I will order it now’, but the junior had to wait until the end of the round, then access a terminal to order it.

“Nothing then happened until 6pm, so when Paul asked if someone could check, the nurse rang the department but there was no answer. Half an hour later another nurse rang and got through and was told that the department had been ringing the ward since 1230! The ward nurse however did not see any missed call, and believes they were ringing for the wrong person. He was told that Paul will be sent for at 8pm, but that did not happen. Next day, from 8am Paul started checking and by 1030 he was taken for the X Ray, which was read by the specialists in Stoke who approved discharge.

“Paul works in IT and is a SAP/Logistic expert and was looking at what was going on from a systems perspective and believes there is learning from his experience and scope for improvement. His extra night because of delay in not acting quickly on the request from the specialist must have deprived someone else of a bed – especially for patients waiting on trolleys in A & E – and he asks why did this happen.

NHS manager

Case Number Four relates to Julie Lloyd Owen, a retired NHS manager who started feeling unwell with breathing and swallowing difficulties and rang for an ambulance on a Saturday morning around 630am, as she lives alone. Dr Madhok writes: “After some time, the ambulance triage decided that she was not a priority and sent her to the out of hours GP service. The triage nurse who rang Julie then told her to go to A&E, since the nurse could only offer oral antibiotics which Julie would not have been able to swallow.

“A neighbour drove her to Glan Clwyd A&E by 10 am and where Julie could not be registered initially, as the receptionist could not locate her on the system even though Julie had moved from Shropshire and has been registered with a local GP practice since 2018. Between Julie and the receptionist, they found a way and got her registered and she sat in the waiting area for the initial assessment, which happened after about two hours. The triage nurse could not decide whether Julie was having a heart attack or needed an ENT assessment, and Julie was sent back to wait.

“After about three hours, Julie was seen by an ‘excellent SHO’ who checked her for a possible heart attack, and decided to talk with a senior doctor before doing anything, and sent Julie back to wait. Some time later, Julie was called again, and discovered that she was being seen for an ENT issue so somewhere the decision had been made not to go down the heart attack route- and again Julie was impressed with the care and attention given by the SHO. So, it came to 5/6 pm in the evening, when after these assessments, Julie was moved to a corridor where IV antibiotics and steroids were started, and where she remained until her discharge around 1.30/2pm the next day, a Sunday.

“She has praise for the junior doctors but not for the other staff, some of whom she describes as being unprofessional, not quite falling into the disciplinary category but not far off either. As a former NHS manager, she says her hands were itching to get involved and address the poor practices she observed – from lack of communication about what was happening; being inappropriately questioned- about personal issues in an open space without the staff member introducing themselves; staff coming out and calling patients’ names unclearly since some staff were not familiar with Welsh names, and with no response after one shout, moving to the next; possibly only one senior nurse on in the evening shift; not being able to get the medicines on discharge (pharmacy closed at 1pm on Sunday) and having to go to community pharmacy etc.

“During her stay, the place slowly filled up with kids and then with adults with football injuries on Saturday, who were sharing the space with the drunks still sprawling on several chairs from the night before. The sandwiches trolley came around at 2ish but food was scarce after that- the only other time it came around was about 4/5am next morning when she had dozed off, and missed it. When she asked for something later on the staff were not able to provide anything. Apart from water, patients had to rely on dispensing machines and pay. She had to ask a friend to bring breakfast in the morning.

“She had to stay in an uncomfortable chair (about 28 hours altogether) and used her coat as a cushion, and even then ended up with a sore bottom. She saw an old lady about 80 years old who had been there since Thursday, and a young man, who just could not settle down in a chair.But there was no trolley/bed. Julie uses words like scenes from Bosnia and shambles.

“She says there is no point in complaining since she does not believe that the staff have insight anymore; she is adamant that this is not due to shortage of money – it is plain and simple mismanagement, and we need to get the basics right.”

Difficult

A Welsh Government spokesperson responded: “These are very difficult stories. We are working with the health board to ensure it is doing everything it can to improve its systems to prevent such incidents from reoccurring and we have been clear of our expectations about improvements to ambulance handovers and discharge.

“Staff are working hard to deliver the best possible care despite the many pressures on the health system. We have invested more than £180m to help safely manage more people in the community, avoid ambulance transport and admission to hospital when it is safe to do so and deliver integrated solutions with social care services to improve patient flow through hospitals.”

The spokesperson added: “We have provided £6m in six goals funding to Betsi Cadwaladr University Health Board to deliver improvements to patient access. The health board has this year received a further £2.7m in additional Welsh Government funding to deliver a range of interventions to improve patient flow and reduce pressure on its emergency department.

“The discharge lounge at Ysbyty Glan Clwyd has been enhanced so that it can provide a discharge hub to accommodate patients for up to 24 hours, helping manage the flow of patients through the hospital and reducing unnecessary delays for those people who are ready to go home.”