The small NHS failings that let down patients like my mother

I would be the first to admit that the NHS has done a lot for my mother this year. It gave her the emergency blood transfusion that undoubtedly saved her life, followed by several iron infusions and umpteen scans and tests. It has treated a series of infected leg ulcers and provided consultations with senior medical figures and countless more outpatient appointments. It has supplied her with swanky new hearing aids and nursed her through Covid. During her four months in hospital, in two separate stays of nine and seven weeks, it came up with three meals a day, not all of them involving ravioli, mash and gravy, and a regime of (almost) daily physiotherapy. If my mum were American, I have reflected more than once, her money would have run out several rounds of ravioli ago. The one thing the NHS has failed to do, however, is cut her toenails.

I now know more about the toenails of the elderly than is healthy for a fortysomething theatre critic. This niche subject constitutes one of those infamous and bewildering mini black holes in NHS provision. Complex procedure? Sure thing. Letter informing the recipient in good time of a vital pre-operative assessment? Touch and go. But a nurse who will perform a small, menial task to restore a modicum of dignity to an elderly and frail patient? Not happening.

There is a reason why, at the beauty salon I used to go to, an elegant elderly gentleman was often to be found amid the young women awaiting their turn for a pedicure. He simply required his toenails to be cut. GP practices used to perform this service. Most no longer do. An image of that man, this personification of the small and quiet indignities of old age, has always stayed with me.

While my mum was in hospital, all the important issues were under control and her haemoglobin levels were subject to daily scrutiny. Yet her uncared-for toenails grew to such a length that I started to fear for her safety during her daily physio sessions, especially given that she had been issued with a special yellow bracelet that read: ‘At risk of falls.’ Because of her vulnerable immune system, the hospital staff didn’t want me to touch her (I was even tutted at just for lowering my mask to speak to her), so attempting a rogue cut-and-run myself didn’t seem feasible. In normal times at home, both Mum and I have our feet seen to by the lovely pedicurist Natasha, but these were not normal times. In lockdown, I could only manage to trim Mum’s tough toenails with pruning shears.

I asked the ward staff if they could help, only to be met with sharp intakes of breath. ‘We’re not allowed to touch patients’ toes if there’s a risk of diabetes,’ they said (Mum is low-risk borderline). ‘That’s a job for the district nurse.’ I pointed out that district nurses are famous for going to many places, but not to hospital wards. ‘We’ll refer her for a chiropody consultation,’ they said. This seemed a sensible, albeit roundabout, conclusion, so I left it at that.

Time passed, Mum was transferred to another hospital and her toenails kept growing. Of the chiropodist there had been no sign. Closer investigation revealed that the consultation had not only not been booked but was not even a possibility. There was, it appeared, not a single professional in the entire hospital who was permitted to touch my mum’s toes. Her nails must, instead, be left until she got home, no matter how many weeks or months this ended up being.

More time passed, and at last Mum did indeed come home, armed with every piece of mobility equipment the NHS could dream up. Her toenails were by now not only exceedingly long but obviously in need of some specialist attention – putting on shoes seemed a very distant dream. The district nurse arrived to change the dressing on her leg ulcer. Had the glorious moment finally arrived? ‘I’m not allowed to cut her toes,’ said the nurse. ‘That’s a job for a chiropodist.’ Does the NHS provide such a service, I asked, more in hope than expectation by this point. ‘No,’ she said.

How does this story end? Reader, the private chiropodist came last week. For a mere £65 and after only four months as an in-patient, Mum’s toes were tended to by a professional at last. I’m just relieved I could leave my shears in the shed.