Peter Lapsley: Little things that matter

Peter LapsleyThe past week spent as an in-patient in the Charing Cross Hospital in West London served mainly to reinforce my respect and admiration for the staff there. Once again (this was revision surgery for a whole hip replacement done last year) there was not the slightest sign of any of the unpleasantness one reads of in the popular press. The doctors, nurses, physiotherapists, catering staff, and cleaners could not have been more attentive, caring, kind or professional. It may seem churlish to pick on the one thing that irritated my fellow patients and me to distraction, but it is a matter that concerns clinical and support staff scarcely at all, and it is one which could be put right with so little thought and at so little cost but which has presumably been embedded in the system for years.

At some time in the past, when the ward was being equipped and furnished, the manager or committee responsible realised that they needed bedside lockers for the patients. So, someone sent for a catalogue and selected a model which would fit into the limited space available. It had a slim, five-foot hanging cupboard, four drawers, and a surface about two and a half feet deep and a foot wide. It looked fine, and they ordered it by the lorry-load. Did they seek patients’ views on them, or try a couple to see if they worked? Er, no, they didn’t, and they don’t. They are quite hopeless.

Not unreasonably, they are set as far back in the bed space as possible, hard up against the wall. Bed-bound patients with any condition – not just orthopaedic ones – spend most of their waking hours with the head ends of their beds elevated to varying degrees. The hinge-point is about three feet in from the wall. Therefore, reaching anything on the locker’s surface, or in its top drawer, or even seeing anything like a clock, requires an extraordinary feat of contortion by patients who may well have been told to avoid twisting. Access to the lower three drawers from a lying position is impossible; it requires the patient to lower the bed, swing his or her legs over the side and lean down to access the drawers.

The inevitable consequence is that all the things to which a patient requires access – water jug, tumbler, squash, radio, book, and maybe fruit and a clock – tend to be stored on over-bed tables, cluttering them to the point at which it becomes difficult to make space for a meal tray.

Have patients protested? No, of course not. There would be no point. Ward furnishings are not the responsibility of the clinical and support staff they see day-by-day, and they suppose – almost certainly correctly – that any complaint about the lockers would simply dissolve into the ether. As if to show how resigned patients can become about such issues, two of the lockers in the ward I was on actually had their backs to the patients for whose use they were intended. We discussed this in a jocular, light-hearted way, but no one raised it with any member of staff. All that may seem to suggest that patients don’t really care about such things. They do; it is simply that they can see no means of having the problem corrected and are understandably reluctant to make a fuss about a matter that may be perceived as trivial.

The Imperial College Healthcare NHS Trust has an interesting, computer-based, specialty-specific system of questionnaires for collecting and recording patient experience. As I went through the orthopaedic in-patients’ one, I studied it carefully to see if there was anywhere to record my reservations about the lockers. There was not.

I am no designer, but am confident that I could quite easily design a bedside locker that would meet both the NHS’s requirements and patients’ needs. I rather doubt, though, that anyone will invite me to do so. Inertia rules, ok.

Peter Lapsley is patient editor of the BMJ.