No-one could argue with the logic. Something had to change.
Even though I’d been working in the Rapid Response team for a year and a half, I still struggled to understand what all the other teams and departments did. What should have been a comprehensive meshing together of services to act as a safety net for community patients sometimes felt like a haphazard net to snag the unwary. Even simple things were difficult, like finding out what number to call, and who to ask for if you made it through the bewildering menu choices. Phone calls, faxes, emails, scrawled messages in the day book – often it felt like finding your way through a blizzard of referrals and re-referrals, passing colleagues in the deluge, everyone with their eyes down, groping for spare capacity, balancing the budgets, moving things along.
The latest idea was to merge a few sections into one large department with one single point of access, one number that would connect you to a dedicated triage team who would then farm out the work according to need. It needed doing. There were already far too many overlaps and duplications; the bulging yellow folders in the patients’ homes were a testament to that. The other hope was that it would encourage mutuality, a sharing of the workload. Once the new team was established, if one section was struggling to cope, the other could more easily step in to help, and vice versa. That was the theory at least, and it balanced out nicely on paper. And when the change came – slowly, heralded by a growing number of meetings, emails with Powerpoint attachments, flowcharts, timetables, managerial edicts flashing and thundering way-off in the managerial highlands – no-one could say it was a bad idea. And then suddenly, after months of talk, we were one team.
Early days, of course, but so far the only noticeable differences has been a busier office. We had always been busy, of course, but now it is more like a loud telesales centre or mainline ticket office, with a constant buzz of people coming and going with folders and pieces of paper, crossing each others’ paths, flying around at full stretch, queues at the copier, hot-desking, not-desking, while the shelves in the kitchen fridge groan under seventeen independently labelled cartons of milk, and a Tupperware of blackening noodles.
As far as work-sharing goes, I’ve had a few extra patients here and there, but nothing too out of the ordinary. Today is different, though. Today is the first time I’ve been abstracted from the rota completely, and sent across town to work at a bedded rehab unit.
‘You’ll just be helping out with obs and bloods and whatever else,’ said Jenny, one of the clinical leads. ‘I’ve told them to expect you.’
At least I know where it is. I’ve visited Bevan House in the past, when I worked as an EMT in the ambulance service. A brisk, self-contained place, tucked away on a tributary arm of a Brutalist housing estate on the edge of town, Bevan House is a busy unit of some twenty beds, four beds per section, each section divided by colour-coded walls and flowery canvas pictures back-lit on the walls. Patients are transferred here from the main hospital to prepare them with physiotherapy and so on prior to their release back into the wild. It’s underfunded, of course, another pinch-point in the whole discharge process, but there’s not much to be gained by thinking about that too much. Whilst Austerity beats on with its relentless mantra of More for Less, there’s no time or room down in the galley to do anything other than row.
It’s still early. The automatic door hasn’t been switched on yet, but I can see a woman behind the desk in reception, hanging her coat up. I knock on the door and wave. She hesitates a moment, then presses a button and lets me in.
‘Morning!’ I say, striding forwards with my rucksack on my shoulder. ‘I’m Jim, from the Rapid Response Team. They’ve sent me over to help out.’
‘Oh?’ she says, her eyes drifting down to look at my badge. ‘I’d better get Bee.’
She hurries out from behind the desk and disappears down a corridor.
It’s utterly quiet.
A ginger cat is staring at me from under the branches of the lobby Christmas tree.
‘Hello there!’ I say, crouching down, making kissy-kissy noises and holding out my hand. The cat thinks about it for a second or two, then sprints away in the same direction as the Receptionist. I watch as it skitters in a panic across the laminate flooring and skates round the corner.
It’s like he’s gone to fetch help, because almost immediately the Receptionist appears again, this time with a nurse.
‘Hello! I’m Jim, from the Rapid Response team,’ I say, straightening up.
Bee shakes my hand.
‘Who sent you?’
‘Jenny. She said you might need some help.’
‘Well we always need help’, she says, but from her expression I can tell that Jenny hasn’t phoned ahead.
‘Come into my office and I’ll tell you how it all works,’ she says.
I pick up my bag to follow.
‘I’ve met the cat already,’ I tell her.
‘Brandy? He’s not our cat.’
Bee is a small, pinched woman, compacted by experience. Even her name is clipped to save time.
I follow her into her office, a closet-sized space with just enough room for two chairs, a desk, computer and shelf upon shelf of files.
‘Here’s the list,’ she says, sweeping a space clear on the desk and laying out a piece of paper. ‘It’s very simple. I’ll mark the ones you can visit today. These are on the ground floor, these are upstairs. You’ll need the blue folder for each patient. You’ll either find them in the kitchen or common room on each floor, or failing that, on the trolley in the office. Or on reception. Give me a ring if you have any trouble. Here’s my number…’
She explains about the blue folder, and what to write in the notes.
‘Good luck. It’s all pretty straightforward,’ she says. ‘There are plenty of people about to ask if you get in a jam.’
A change of routine is certainly energising. Even though I’m doing much the same as I do out in the community, here in Bevan House everything is brand new – the protocols, the people. I have to explain who I am and what I’ve come to do half a dozen times. It gets so slick even I don’t believe it. Added to my unease is a feeling that however neutral I try to be I might inadvertently be stepping on someone’s toes. The whole thing has that First Day level of stress, and I’m glad to find when I check my watch that’s almost lunch.
My final patient of the morning is an elderly man called Jack. I knock on his door, and when he calls hello? I go in.
I shake his hand.
‘We’ve met before,’ I tell him.
‘Have we?’ he says. Then ‘Yes! I think we have!’
I remember him lying on a single bed in a box room, a dressing on his leg, a row of perfectly constructed Airfix planes on a shelf above his head.
‘How are you, Jack?’ I say to him.
‘Shoot me now,’ he says, turning to lie fully on his back, so he can get a good look. ‘Anyway, what are you doing over here? Changed jobs?’
‘I’m just helping out. They were a bit short-handed.’
‘Well they are busy,’ he says. ‘But I shouldn’t moan. They’ve been absolutely wonderful.’
It’s good to see a familiar face. We chat about things whilst I run the obs and write the notes. He tells me how long he’s been in Bevan House, and when he hopes to get home.
‘If I make it,’ he says with a sniff. ‘You never know, d’you?’
‘Didn’t you have a load of Airfix planes?’ I ask him. ‘And you were a mechanic in the RAF or something?’
‘That’s right!’ he says. ‘I was. Oh – them model planes, they was just a bit of a laugh. They kept me out of mischief. It’s silly really, but whilst I was putting them together, they helped me remember what the real things were like.’ He thinks about it a moment, then smiles. ‘Bigger, for the most part,’ he says.
I finish the exam, shoulder my bag and shake his hand again.
‘Good to see you, Jack. Hope you feel better soon.’
‘Have bag will travel,’ he says, nodding at the rucksack.
‘Yep. That’s me. The Dick Whittington of the health service. All I need is a cat.’
‘I think there’s one downstairs.’
‘I know. He scarpered as soon as he saw me.’
‘He’ll be back,’ says Jack, relaxing back into the pillow and pulling the duvet snug about his neck. ‘He knows a good number when he sees it.’