Mark Bothwell, who's on jobseeker's allowance. He says he hasn't been eating properly for years.
Mark Bothwell, who’s on jobseeker’s allowance (JSA). He says he hasn’t been eating properly for years.

Mark Bothwell (above) came into the London food bank today. He’s had a painful problem with his shoulder for some time that leaves him unable to accept many types of physical work, and he also has depression. He’s been waiting for months for his claim for employment and support allowance (ESA) to be processed. Not that this 29-year-old is likely to be better off financially by transferring over from JSA, but he would at least be relieved of  some stress. He says: ‘It’s a job-stopping illness, so the positive thing (about changing benefits) is not having to worry about job hunting.’

Last week, he described two recent trips to the accident and emergency (A&E) unit at the local hospital – the Queen Elizabeth in Woolwich. He says that terrible chest pain drove him to seek help, and that a viral infection causing inflammation of the outer lining of the heart was suspected. Mark, who is already on strong medication prescribed by his GP for his shoulder pain, had an adverse reaction to one of the medications given at the A&E. It upset his stomach and caused ‘a lot more pain’. This extra pain meant he had to make a second visit to A&E later that week. While the doctors took a family history during his visits to cover heart issues, and did blood tests, an ECG and X rays, he says the doctors didn’t ask about his circumstances. ‘They didn’t ask if I’d been eating properly for the last few months. Actually, I’ve not been eating properly on and off for years. Money has come and gone for years since I moved out of the house at 21. I was homeless for 18 months. Although I’ve had the foodbank vouchers, which has been good – it’s not been enough to cover the last four months. Even during this time (when he’s had some help from food vouchers) there have been a couple of days when I’ve not been able to take my pills because I haven’t had enough food.’ He says that recently, when he hasn’t had enough food, ‘shoplifting has crossed my mind, and this is how desperate people can get’.

Why didn’t  the doctors in A&E ask him about his circumstances, which may have flagged up the effect poor nutrition for many years could be having on his health? Could it be because the A&E unit, like many in the NHS in England, is understaffed and generally in crisis? The hospital is part of the Lewisham and Greenwich NHS trust, and this week health inspectors the Care Quality Commission published a report that was highly critical of many aspects of services at the trust, which it says requires improvement. The A &E unit at the Queen Elizabeth is deemed to be inadequate, and ‘not fit for purpose’. The inspectors, who visited the hospital in February, have serious concerns about the safety of A&E services there . They note a shortage of beds for admission to the hospital, causing a block in the system, particularly for patients in A&E. Ambulance personnel told inspectors there were regular delays in booking patients in and patients often had to be treated in the back of ambulances. They also pointed to the low staffing levels in A&E, with 29 full-time equivalent nurse vacancies and vacancies for four consultants and six junior doctors. The report also says that since the closure of the accident department at the nearby Queen Mary’s Hospital  in 2012, attendances had risen from around 300 to over 450 a day. Because of a lack of space, patients who ‘would have benefited from being able to lie on a trolley or bed were having their treatment on a chair in full view of other people’. Against this background, do the A&E staff  have the time to take detailed enough case histories?

Mark’s  food budget of about £2 a day and spells without eating adequately over many years must be impacting on his health, yet none of the doctors treating him in hospital asked him about his nutrition.  Is the NHS really capturing the facts about how many people are becoming ill, or having their health conditions made worse because of malnutrition and food poverty? The steep upward trend in the number of people being driven to use food banks indicates a rise in the number of individuals and families struggling to eat well. But as the Faculty of Public Health so clearly points out, actual food bank numbers are ‘an inadequate indicator of need, because many households only ask for emergency food help as a last resort’. So the true scale of food poverty remains hidden.

In Wales, hundreds of patients have been diagnosed with malnutrition in the past few years. New figures from a Freedom of Information Act request show 1,229 patients have been diagnosed since 2007/08. In England, primary and secondary diagnoses of malnutrition in hospitals rose from 3,161 in 2008/09 to 5,499 last year, according to figures released by health minister Norman Lamb. In November 2013 an early-day motion in the House of Commons from MP George Galloway noted a ‘doubling of the diagnoses of primary and secondary malnutrition in Bradford Teaching Hospitals NHS Foundation Trust in the years 2010 to 2013 compared to 2008 to 2010’.

Are all cases of malnutrition as a primary or secondary diagnosis being clearly identified, given the levels of understaffing and the workloads in some A&E units?  What information is being gathered by GPs? These are issues the All=Party Parliamentary Group on Hunger and Food Poverty may want to start examining closely during its inquiry.

The outlook for Mark this weekend is more positive, and he didn’t need a food voucher this week. His MRI results show a frozen shoulder, and he’ll be referred for physiotherapy by his GP.  Mark is relieved that he doesn’t need surgery, and he’s been told he should receive a letter within 10 days telling him when he’ll start receiving ESA payments. He’s finally got an appointment to access  group pain management talking therapy, which will take place once a week for 10 weeks. The depression is still there, but is ‘starting to feel a lot better’.

9 thoughts on “Can England’s A&E units spot the malnourished? Mark’s story revisited

  1. And so the coalition has brought the hospitals down to this level just so they can privatise them. Of course. As we knew. Sick to my stomach. Happy to hear the good news for Mark. I’ve had RSI and my father had a terrible frozen shoulder at one time, so I know something of what he’s going through. Not to mention knowing about the depression and the lack of food… What a dreadful world is being created. Keep up the excellent work, Ann. So valuable.

    1. Thanks Sarah. Mark’s very stoical, considering all. But he shouldn’t have to be stoical all the time. I appreciate your support for what I’m doing. Sometimes I just need to be reminded that these stories must be told and shared. I’ll plough on with this.

      1. He sounds stoical but no, he shouldn’t have to be so constantly. I know stoical all too well and sometimes one just needs to let go so that the stress of being stoical isn’t damaging; without an outlet, it can be as damaging as stress unleavened by stoicism, if you get my drift!

  2. Reblogged this on vicmart009 and commented:
    Hi Ann, Enjoyed your article & would feel pleased to receive more from you. I am a registered disabled 73 year old pensioner campaigning by myself in North Wales.
    Got hacked last night by some one who doesn’t like who listen to or who blog to . Took me over 5 hrs to remove & isolate him from further affecting my Twitter page on my desktop PC but they still keep sending me their emails (over 60) which I keep in junk folder.

  3. So the socialists got no mention in the media at all, despite running in 1 in 7 councils during these elections. The BBC ignored them. The newspapers gave them no mention. Yet these parties would have stopped the imposition of bedroom tax and the evictions it causes. And would have done things to directly feed the hungry.

    But the public never got to hear about them in anywhere near as much as all the negative campaigning that saturated so-called left wing forums and blogs about UKIP, which helped them win councils not lose them.

    Only politicians in government can end the ever greater hunger in England today.

    But all we hear is about Labour and The Greens, who are believers in austerity that is welfare reform aka abolition of the welfare state. The Greens have tried to raise council tax in councils.

    But who cares about negative stuff about parties. Talking about the positive things about the new socialist parties would actually save lives.

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