Views From the Inside: Reflections on the Modern Hospital

• There's a constant refrain in the press, on social media and from populist politicians that the NHS is dying on its feet. But how accurate is this picture?
• The Queen Elizabeth is now the biggest workplace in Birmingham. Its 12,000 staff reflect the multi-racial diversity of contemporary Britain.
• There is a basic decency and humanity here; somewhere that generates civic pride.
• In a measured contrast to those purveying doom and gloom, there is a core resilience within the hospital service.

There’s a constant refrain in the press, on social media and from populist politicians that the NHS is dying on its feet. How accurate is this picture? Based on interviews with staff and patients this article takes a behind-the-scenes look at daily life at the Queen Elizabeth hospital, now the biggest workplace in Birmingham.

Life in Accident and Emergency

Real life is demanding. On average between 350-400 patients come through A&E’s doors every day. Many go to the minor injuries unit but to cope with the more serious cases -36,500 came by ambulance in 2025 - the department has just forty-one beds and resuscitation trolley spaces plus six more in corridors to manage surges in demand.

Helen’s job is to make it work smoothly. She is a senior sister with responsibility for co-ordinating shifts and the 200 nurses working there. She feels her job ‘is challenging but in the right way. Every day is different. A&E is unique in its variety. On a ward, you have a speciality. It’s much more structured. Here we’re the jack of all trades.’

It's a diverse workplace with people from African, Caribbean, Asian and Filipino as well as British backgrounds. And it is diverse at the top tier too: Helen has senior black, Asian and gay managerial colleagues.

On the wards

Much of the business of the QE takes place in its 32 operating theatres with patients either being prepared for or recuperating from their operations in the more than forty wards that the hospital has on site. Gheevan gets up at 4.30 a.m. in order to travel to the hospital for her regular shift. She is one of the team of phlebotomists -some from Britain, many from around the world - whose job is to take the blood of in-patients each day. It’s repetitive work but she likes it even if the pay is relatively low. However, taking blood from patients isn’t always easy with some reluctant to cooperate. ‘It can be difficult. Sometimes, when the patients are unwell, they take it out on us, especially in the early morning.’

Dave’s job is to keep his ward running efficiently. A working-class man in his early 60s, he’s one of the 44 housekeepers who control the logistics of each ward. He came to the hospital twenty-four years ago, after the closure of the Boxfoldia factory in nearby Selly Oak. Dave joined as a porter. Then seven years ago, with the help of in-service training, he was able to progress to a housekeeper.

Martin is a resident doctor, an anaesthetist for elective surgery, working on average 48 hours a week. He says that talking with patients can be tricky. ‘It is really difficult to explain to people who are critically ill – or their spouses – what may happen. You need to be honest. In intensive care, I am just doing my night shift, but at times you’re having a conversation with someone for whom this is the worst day of their life. It’s something they’ll never forget.’

One of the elite

The QE also serves as a regional and national centre of excellence for a range of specialist conditions. These factors add to the prestige of the hospital, seen by many as one of the top hospitals in the country. This makes it attractive to doctors like Seema, a consultant in renal medicine. She enthusiastically tells me of the advances in medical technology over the last twenty years which have resulted in a remarkable growth in kidney and renal services. In that time the number of kidney transplants has more than doubled. ‘I love it’ she tells me. ‘An enormous range of good work happens here.’ With its specialist units, the QE has become a hub for cutting-edge research, opening 150 new clinical trials a year while over three hundred staff engage in research and development in thirty clinical units doing trials on all sorts of cancers and other illnesses.

Outpatients

The other key leg of the hospital’s activities is out-patients, people being called for check-ups; attending for scans; imaging; and learning the results of tests. Seema shows me the small renal out-patients area on the ground floor. Her department now has 1,500 kidney transplant patients under its care, delivering life-long follow-up. Each year they have 10,500 out-patient visits. Overall, 2,500 people a day pass through all of the QE out-patients departments, either pre- or post-treatment. Outpatients account for the majority of the over one million visits made by patients to the QE each year.

Wider issues

The second half of the article looks at the workforce; the botched merger of four hospitals into a huge trust followed by a reversal to place-based management focused on each hospital; controversies over staff bullying; and the fostering by the new trust leadership of a more open, participative culture. It concludes by showing how the QE is not insulated from the wider pressures on the NHS, notably the funding of social care. Seema sees the lack of bed capacity each week in the two renal wards. ‘Social care is a massive problem. Social workers, physios, they don’t work seven days a week. We have repeated delays in the organisation of care packages. We can have someone medically fit to go on a Friday but then care can’t be arranged over the weekend.’ As the new Prime Minister has recognised, this remains the most intractable issue facing the entire UK health system.

Conclusion

Walking around the QE; listening to patients; seeing the multi-racial calm of the place; it all puts the lurid tales of ‘civil war’ Britain in the press and on social media into perspective. There is a basic decency and humanity here; somewhere that generates civic pride. Like the England football team, it’s clear that the QE depends on people with a migrant background. Whatever the brickbats and controversies it faces, here we find a resilient institution which continues to provide invaluable public services.