I am not someone who likes to criticise the NHS. I know its staff work tirelessly under immense pressure and with limited resources. I know they are well trained, dedicated and, in most cases, genuinely compassionate. I know they save lives every day.

The NHS is one of the few institutions in the United Kingdom that still embodies the principle that healthcare should be available to all, regardless of wealth. It is a precious institution, one worth protecting.

But defending the NHS does not mean pretending it is without faults. If we truly want to preserve it, we must also be willing to confront its failures and ask how they can be addressed. This account is intended as a reminder—a wake-up call—that serious problems remain within what was once a remarkable and essential public service.

This is the story of a man living with dementia.

He had started losing his mind about three years earlier. It was progressive: it began with little lapses of memory and mistakes in his speech, eventually developing into a very difficult condition in which he no longer recognised half of his family and would start ranting and talking complete nonsense. The whole family was deeply distressed, as this man had always had a strong personality. He was vivacious, at times a little bossy, often generous and always very charismatic.

The NHS had been following him through GP and hospital appointments, but he had never spent longer than a few hours in hospital. This man loved his home, where he had his routines and his habits.

But one day, the NHS became over-present. The man could no longer get up; the family, fearing he had suffered a stroke, called an ambulance. And so began a journey into the meanders of the NHS. After he was taken to A&E for some tests, he stayed for about ten days. No one in the family understood exactly what he had suffered from. The man spent two whole days and nights in A&E with his family by his side. He endured numerous tests and assessments in a very noisy and distressing environment. For those who are not familiar with A&E, the NHS emergency system often has people waiting in corridors because of a lack of staff and resources.

The man had no privacy. He did not know where he was. His devoted spouse stayed by his side most of the time, and the rest of the family visited regularly. But the constant rotation of staff was distressing for him.

When he noticed a cannula in his wrist, he tried to pull it out, splashing some of his blood over himself. That made him even more distressed. The medical staff then surrounded him to force him to keep the cannula in, but the man still had a great deal of strength and started pushing them away forcefully. That was when the consultant, a very elegant lady in high heels, arrived. She first suggested that he be sent home before recommending a tranquilliser instead.

None of the family members were consulted about this course of action. The man resisted and resisted, and the family eventually asked for the cannula to be removed and for the antibiotics to be administered orally.

After two days, he was transferred to a “room”; this was not really a room, but simply a bed beside three other patients, some of them extremely ill.

Yet the family still did not know what he was suffering from. They were told he “might” have an infection, then that he “might” have been dehydrated… Other doctors told them that he had to remain in hospital because of safeguarding concerns.

Some of the family members had mentioned that it was becoming difficult for his spouse to look after him. This is not a statement to make lightly to the NHS, as it can trigger a series of consequences. The safeguarding process was initiated; this meant that the man had to remain in hospital until the social work team could put carers in place to help his wife cope with caring for him at home.

The man was eating very little and was becoming increasingly distressed. Whenever the family visited, he would ask whether he could leave, but they had to tell him that he could not. A few of them challenged the decision and researched the issue, so they finally organised a meeting to discuss a “discharge to assess” process. This meant that the patient would be assessed at home while a team of carers was put in place, and that the family would arrange private carers afterwards if necessary.

But this process, which could have been initiated immediately, particularly considering that the patient was clearly not coping well in hospital, was unknown to the family.

Here, as in many other situations, the NHS does not inform patients and their families of their rights; they are simply expected to follow, obey and agree. And if they respond, challenge decisions, or even merely ask questions, they may feel as though they are being reported or threatened with social services themselves.

Some of the family members felt that the hospital, and the NHS behind it, resembled a prison more than a hospital.

Opposite the man’s bed was another man, at least twenty years younger. He had been there for five weeks, saved by a consultant after suffering a cardiac arrest.

That man seemed happy; he had died and had been resuscitated by a team of heroes. Of course he was grateful. He smiled and helped others kindly.

But the man opposite him had not died and been resuscitated by a team of medical heroes; he had been brought into a strange environment, underfed and forced to remain in unfamiliar surroundings, far from his loved ones, and from his wife in particular. Instead of being brought back to life, he had been taken further away from it. Fortunately he was soon to go back to his beloved home.

The NHS: an institution for life, really?

References

• Alzheimer’s Society (2024). Symptoms and diagnosis of dementia. London: Alzheimer’s Society.
• Care Quality Commission (2022). Brief guide: Discharge from hospital. Newcastle upon Tyne: Care Quality Commission.
• The King’s Fund (2024). The NHS workforce in numbers. London: The King’s Fund.
• National Institute for Health and Care Excellence (2018). Dementia: assessment, management and support for people living with dementia and their carers (NICE Guideline NG97). London: NICE.
• NHS England (2022). Hospital discharge and community support guidance. London: NHS England.
• NHS England (2024). NHS Staff Survey Results. London: NHS England.
• Royal College of Emergency Medicine (2024). Crowding and Corridor Care in Emergency Departments. London: RCEM.
• Department of Health and Social Care (2014). Care and Support Statutory Guidance (Care Act 2014). London: Department of Health and Social Care.
• NHS England (2019). The NHS Long Term Plan. London: NHS England.
• National Audit Office (2018). Discharging Older Patients from Hospital. London: National Audit Office.