Chapter seven
HOSPITALS
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Chapter sevenHOSPITALS |
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General information
Hospital waiting lists
Who's who in the team looking after you?
Who's who in the nursing team?
Financial aspects
Patient Advice and Liaison Services (PALS)
Suggestions and complaints
General information
As outpatients or inpatients, we younger people with arthritis are likely to have a fair amount to do with hospitals. You might like to know where to find out more about them:
Most hospitals now publish online or printed guides for patients, outpatients and inpatients. Do make sure you get a copy — You'll feel much more confident knowing beforehand what to expect, how best to prepare, admission procedures, what to take with you, what happens at each stage after arrival, who to ask about what, going home, etc. As an example you could look at those produced by University College London Hospitals (NHS Foundation Trust).
Hospital waiting lists
Waiting times for hospital treatment vary but the government says you should expect to wait no longer than:
By December 2008, the government aims to guarantee a maximum of 18 weeks (known as the 'pathway') between referral and the start of treatment. See Delivering the 18 week patient pathway for more information.
You may like to compare this with the referral recommendations for people with inflammatory arthritis set out in the Arthritis and Musculoskeletal Alliance (ARMA)'s Standards of Care for People with Inflammatory Arthritis (other ARMA Standards of Care focus on other rheumatic disorders). Referral times are just one of the very many aspects the Standards cover. — Two referral times examples:
People with symptoms of inflammatory arthritis should be seen by a specialist within 12 weeks of referral from their GP and children should be seen within four weeks; the aim should be to reduce the 12 weeks maximum to a six weeks' maximum.
Another Standard (13) recommends that all people with a sudden 'flare-up' in their condition should have direct access to specialist advice and the option for an early review with appropriate multi-disciplinary team members.
Who's who in the team looking after you?
The Consultant heads the team. S/he has spent many years specialising in a particular area of medicine. You could be referred to a consultant in rheumatology or orthopaedics, for instance. Besides treating some patients directly a consultant may also teach and carry out research. As an NHS patient you don't have an automatic right to direct treatment by the consultant in person.
You may instead see and be treated by the Specialist Registrar (SpR), who comes next in the hierarchy, and is responsible to the consultant. The SpR is aiming to be a consultant, and already has several years' general and specialist training and experience. Next comes the Senior House Officer (SHO) and the House Officer (HO). The house officer is a newly qualified doctor working on a six-month contract. Every doctor must work as a pre-registration house officer (PRHO) before becoming fully registered and being allowed to work outside the hospital service. The SHO has completed this requirement and is beginning specialisation.
The house officer is the doctor you'll probably see most of as an inpatient. S/he will be responsible for your care under the direction of your consultant. When you first arrive s/he will take your detailed medical history, examine you thoroughly, prescribe any drugs you'll need in hospital, and arrange various tests. Even if it seems strange to have to go over what should already be in your notes, this is the time to mention any allergies, the drugs you're already taking (don't forget to include any drugs for depression, anxiety, steroids, the contraceptive pill, and any over-the-counter drugs). Make sure you know and agree with the doctor the exact doses and timings.
It's also a good time to ask questions about what's going to happen to you. If the house officer doesn't know the answer, ask if s/he could find out for you. Many people mistakenly save all their questions until the consultant's ward round when time and privacy are very limited. Try to get at least some of them answered beforehand. Remember however that it's the consultant who's ultimately responsible for any decisions made about you. S/he might not always agree with what other members of the team have told you!
All members of staff wear name badges. Other people you may see as part of your multi-disciplinary healthcare team are the physiotherapist and occupational therapist, social workers, radiographers and other allied health professionals. Each ward has a pharmacist who makes regular visits, and you can ask them questions about the drugs you're taking. Look too at 'Who else might be in your healthcare team and what do they do?' in chapter 4.
ARC's colourful leaflet A Mind Map on the Rheumatology Department tells you who's who and what they do (downloadable or in print). ARC also publish many booklets on specific treatments and surgical procedures, and there's more about surgery in chapter 8 of this book.
If you're going for a scan or other radiology procedure, you might like to look at one of the patient information leaflets produced by the Royal College of Radiologists, which include MRI scan, bone scan, barium meal, CT scan, ultrasound, chest X-ray, pelvic X-ray, etc.
If you're invited to take part in research, ARC has a leaflet Taking part in research (downloadable or in print).
Who's who in the nursing team?
You can usually tell who's who by the name badge and the uniform they wear (eg colour of dress/ tunic, belt). The Ward Sister heads the team (call her 'Sister', not 'Nurse'!). If a male nurse is in charge, he's called the Charge Nurse. Then come the Registered Nurses (RN)s who have completed a training course of at least three years. As an inpatient you will have a 'named nurse', a registered nurse who is responsible for your nursing care, although s/he won't be there all the time. There may also be student nurses and Health Care Assistants (HCA)s, sometimes known as nursing auxiliaries, who work closely with the registered nurses.
There's more about members of the nursing team in 'Who else might be in your healthcare team and what do they do?' in chapter 4. Look too at ARC's booklet The Rheumatology Nurse Specialist (downloadable or in print).
Do put questions and worries to the nursing team as well as the medical team. They work closely together, and the more experienced nursing team members often have specialised knowledge of medical and surgical procedures. They can help explain some of what the doctors have told you, and make sure other questions and worries get through to the doctors. If you have any personal, domestic, social or financial worries, ask your named nurse or ward sister if you can talk to the hospital social worker or to a PALS worker (see below).
Ask the nursing team to explain some of the ward routine to you. It helps, for instance, to know when the Consultant and/or Registrar are likely to make their ward rounds. Find out, too, when the nurses' shifts start and end, as they usually spend time round about then in conference or 'hand-over', a good time to avoid asking for bed-pans, etc, if possible! Find out about meal times and visiting times too. And it's handy to know when a volunteer might be coming round who might be willing to do a bit of shopping for you, or help with some other non-healthcare task such as tending your flowers or posting some letters.
Financial aspects
You may qualify for help with some hospital-related costs such as travel to hospital — see Help with health costs (leaflet HC 11), or contact the PALS office of your hospital, or phone the Department of Health orderline on 08701 555 455 for a copy (or email: dh@prolog.uk.com). Guidance for professionals administering the scheme is at The hospital travel costs scheme (HTCS).
Look too at Going into hospital? (leaflet GIHA5DWP) . If you become an inpatient you'll need to tell whichever DWP office deals with your benefits — some benefits may be reduced or stopped, though usually only if your stay is for a few weeks. Remember to let them know when you come out, too.
The Disability Alliance's Disability Rights Handbook, has a chapter about hospital and benefits, and there's an online alphabetical list of benefits in hospital which details how your benefits will be affected if you go into hospital.
Patient Advice and Liaison Services (PALS)
There's a PALS office in each NHS Trust/hospital in England, where patients and public can get support, information and advice on hospital, NHS and other health-related issues. To find contact details for PALS try the PALS website, your phone book, or ask NHS Direct on 0845 46 47.
Suggestions and complaints
If you have ideas for improving services in your hospital, or are unhappy with something, you could try having a word with a member of staff, perhaps the Sister or Charge Nurse at the clinic you attend, or ask the PALS office for advice.
Every NHS Trust also has a Complaints Manager responsible for dealing with formal complaints. PALS can give you information about making a formal complaint and, if you would like impartial help from outside the NHS, PALS can put you in touch with the Independent Complaints Advocacy Service, ICAS.