The NHS and this Year's Winter 'Crisis'.

dreamdaisy

Well, would you Adam and Eve it, various A&E centres around the country have been closed to 'improve' patients' choice and convenience but, because it's the wrong time of year, ambulances are having to queue. :shock: It is expected to be announced that hospitals have failed to meet Government-set targets of those turning up in A&E to be seen within four hours - surely that's hardly surprising - reducing the number of A&Es without reducing the number of patients requiring to be seen is surely a non-starter.

Please read the next bit with your best sarcastic voice: I realise that the winter must have arrived for the first time ever so no wonder the service is struggling but (back to normal voice) I recall these headlines for at least the past eight years and I expect you do too. The Government's response has been that they have given the NHS an extra £70,000,000 to help it cope but has that gone on providing extra doctors, nurses, cleaners, surgeons, physios, GPs etc? No, probably not, middle management will have brand spanking new computers so they can dream up even more unrealistic targets dictated by the Government for a creaking system to meet whilst under-staffed, under-resourced and micro-managed by those who have no medical experience whatsoever but presume to 'boss' those who do.

Aaaaand relax, Daisy.

We have a wonderful resource in the NHS but this happens every year. Reducing its capacity any further will surely result in the complete breakdown of one of our most cherished (and most abused) institutions. DD

LignumVitae

I found myself in the shower this morning pondering what the huge spike in attendance related to. I realise there must be an increase in probably elderly and infant patients suffering with chest infections, flu and the like but do patients really account for the huge spike? I'm guessing alcohol and drug related cases probably spike over christmas too but it's not like there is ice everywhere to create an increase in broken wrists and ankles from falls...who are all these extra patients?!

stickywicket

dreamdaisy wrote:

middle management will have brand spanking new computers so they can dream up even more unrealistic targets dictated by the Government for a creaking system to meet whilst under-staffed, under-resourced and micro-managed by those who have no medical experience whatsoever but presume to 'boss' those who do.

So cynical for one so young Is it true? I don't know. I do know that thanks to the NHS, there are simply more of us, year on year, surviving birth, infancy, accidents and illnesses to grow old and require more medical help. We now manage to keep alive many who would have previously died young but at the price of long-term health problems and greater susceptibility to the usual winter ailments.

Of course the NHS is abused but patients will naturally use A & E when they can't get a GP appointment for a fortnight and are worried. NHS Direct used to be able to field some of these problems but now there's no nationwide buffer and people are unsure who to turn to.

According to the BBC it's not just A&E units that are finding it difficult. Nearly a fifth of patients who go to A&E need to be admitted into the hospital for more complex care. But hospitals are also finding it difficult to discharge patients. A significant factor in this is the squeeze on councils' social care budgets. Many of the patients who end up in hospital are frail and elderly, and when they are ready to be released need support in the community to get back on their feet. If it's not there, they have to stay in hospital, which occupies a bed often needed for other patients.

theresak

Lessons don't seem to be learned from one winter to another, but SW is right when she points out that more people live longer these days than in the past.

Money pumped into the NHS often goes to middle-management rather than the bottom tier where it's most needed.

Our local hospital is one I avoid if at all possible, but about 6 years ago I was admitted as an emergency - the on-call doctor thought it was pneumonia. Beds were in short supply, so I spent a nightmare 24 hours in a 'transit ward,' then 3 days in a gynae ward as they had a bed free. The gynae nurses, bless them, knew nothing about RA,and every morning kept trying to dole out MTX at the drug round. None of them had time to take lids off marmalade sachets, yogurt pots etc. My rheumatologistnever came near me, and after being diagnosed with a severe chest infection, I was discharged with a bottle of Benelyn!! It's one of the reasons I changed hospitals with my GP' s blessing. The other reason was when I had a very bad fall & they said it didn't warrant an X-ray as it would just be bruising. After 4 weeks of insisting on one they discovered I'd cracked my pelvic bone.

Sorry, I didn't mean to go off-track & rant. Apologies to all.

barbara12

Brilliant rant DD and SWs..we are finding it hard to discharge people..out you go after 3 days of major surgery...lets get rid of the managers and there astronomical wages, and get more nurses..and doctors...

applerose

One of our hospitals discharges as soon as the patient no longer needs to be in hospital and it doesn't matter what time of day or night it is. When my dad was in, several patients were discharged in the early hours of the morning and told to ring for a taxi to take them home. On the other hand, several were ready to go home but the pharmacy was so busy, their medication wasn't ready. As the pharmacy closed at 5pm, they had to stay an extra night as they weren't allowed to go home and come back the next day for the medication.

And did the powers that be not know that the medics were helping people to live longer so in the future there would be more people needing to use their services so we would need more doctors and nurses and more hospital beds and ambulances? Surely they could have planned for it. Maybe they need all these people in middle management to work that one out.

Starburst

stickywicket wrote:

dreamdaisy wrote:

But hospitals are also finding it difficult to discharge patients. A significant factor in this is the squeeze on councils' social care budgets. Many of the patients who end up in hospital are frail and elderly, and when they are ready to be released need support in the community to get back on their feet. If it's not there, they have to stay in hospital, which occupies a bed often needed for other patients.

Facilitating hospital discharges forms a big part of my social work role and it is a nightmare. I wade through paperwork, I cajole care agencies and care homes to find vacancies. This is a big part of the problem.

On Christmas Eve, a hospital was pushing me to get Mr X discharged as he was medically fit but unsafe to go home, so needed a care home placement. The area manager of social services was emailing me every hour and the hospital were ringing every 2 hours. At the very last minute, we found one and what did the hospital say? Oh sorry, we can't organise transport or medication in time. It was a shambles but definitely not the fault of any one person.

What happens in Winter time? Increased infections which, alone, may mean a hospital admission but infections can lead to confusion and falls. When older people fall, they often don't 'just' fall, they break bones and need surgery. Re-admissions in the older population are an issue - hospitals are so desperate to clear beds that they put patients at risk of longer admissions/re-admissions when an extra couple of days during the intial admission might have prevented it. Families feel the pressure in December, it's coming up to Christmas and a stark realisation that Grandpa isn't coping as well as they thought. Carers struggle more when it's dark and cold and again, they feel the Christmas strain.

My local authority are hoping to save another million this year. We need an extra one million to go into the social care budget, not out of it.

Slosh

One other problem is difficulty in recruiting doctors and nurses.

stickywicket

My post was never intended to be a 'rant just a few facts as given by the BBC.

As Starburst says, much more money is needed but, if one party suggested raising taxes to pay for it, would they get the votes?

dreamdaisy

LV asked where the spike had come from: when one A&E is closed the patients who would have gone there are diverted to others who still have such a facility (but maybe for not much longer). When my Ma had to go to hospital the week before she died, after a heart attack, she was turned away by her 'local' (ten miles away) hospital because they no longer had an A&E and their heart unit was full. She finally ended up in another hospital, in another county, six hours after the first 999 call. This was in April 2013 so not exactly the winter.

The lack of joined-up thinking about people living longer, and how they are to be cared for as age takes its toll, is worrying but I guess it's a problem the medical profession has created. This is an unprecedented situation in history and, alas, it falls to politicians to solve it. That's scary. DD

stickywicket

I guess:

1. We all live longer.
2. We now live with diseases which require ongoing, expensive treatment and make us susceptible to other problems, especially in winter.
3. This is a much wider, social care problem, not just NHS or A&E.
4. Governments, in power for 4 years, have no incentive to think long-term.
5. Many people assume they have a right to good health and abuse the system with their demands.

stickywicket

I've just seen a YouGov survey in which 43% said they'd support increased taxation to pay for the NHS.

40% wouldn't.

I suggest those that wouldn't should go to the back of the A&E queue

Slosh

I think people do take the NHS for granted, it's a bit like the attitude some have to education in this country where something that is seen as "free" is not valued.

We do pay for both of these services but forget about this.

I know there was also a suggestion to put an extra 1p on Nat Ins but to ring fence this for the NHS. I think this or an increase in Income Tax are needed but that they MUST be ring fenced in this way and I think if that was done more woukd be in favour. I also think people neec to be made more aware of the costs of the NHS. My local hospital have for a while been sending text messages as reminders of appointments a day or two before, when I recieved my last one it included the fact that Outpatients appointments cost approximately £160 a time.

dreamdaisy

Another reason for the increase in 'foot traffic' is 111 advising people to go to A&E, GPs not offering the services they used to provide, and the general idiocy of the general public: they turn up at A&E with sore throats, a small patch of skin rash, cut fingers that only require a plaster etc. Twerps.

There is a suggestion today in one of the Sunday papers that, if you turn up at A&E with a trivial matter, you have to pay to be seen - the suggested sum was £5, I reckon £50 would be more realistic. DD

stickywicket

£5 is ridiculous. It would cost more to administer than could be retrieved in fines. However, ask too much and many will say – possible correctly - they can't pay. And then costly tribunals will take place. Maybe a rising scale of fines for persistent offenders plus automatic relegation to the back of the consultants' queues.

I have personally witnessed:

1. Someone refusing to get into the free hospital transport because they'd only just got up – at 9.30am)
2. An ambulance driver complaining of a couple getting free hospital transport then popping into town to do a bit of shopping before returning to the hospital for their lift home.
3. Someone refusing to go to their clinic because they were 'too tired'.

Why not just ban them from hospital transport at least for a set period? They can still attend the clinics but just have to make more effort and spend more money.

applerose

I do think that if there is to be some sort of 'punishment' for abusing the system, it has to be for persistent offenders and not for one-offs, apart from the sort of person Sticky has mentioned. My sister took her 4 year old daughter to her GP and to A&E quite a few times because she was complaining of a headache. Each time she was told her daughter was attention seeking and to give her paracetamol. She could very well have been accused of abusing the system. Finally a junior doctor insisted on a brain scan. It turned out my niece had a brain tumour. I'm sure this type of thing could happen to an adult too.

My daughter lived in Ireland for a few years. There it cost her £50 a time just to see the GP. Any medication was on top. I'm sure this would put less well off people off going when they really need to.

stickywicket

And there lies the problem in a nutshell, Christine. It has to be free at the point of access so that people like your niece don't slip through the net but there will always be selfish ones who take advantage of that.

Maybe we could all be issued, after every visit / prescription etc with a notification of what our consultations / prescriptions / scans / operations etc actually cost to the British taxpayers. Perhaps some of the problem is a perception that it's all free and no-one actually has to cough up for it.

On a more facetious note, I remember a time when the big disgrace was patients waiting on trolleys for hours. Now you're one of the lucky ones if you can get a trolley and not just be queuing up in the ambulance outside :roll:

mellman01

Our surgery posts how many hours are lost per day by people not turing up it's shocking how much time is lost, it seems that across the UK some people actually multiply book visits just in case they get ill then don't bother to cancel or turn up, thing is they know who they are so why not fine them for abusing the system?. Its also typical of politicians to play punch and Judy with the NHS, each new government changes the goal posts so the poor staff are always trying to learn the new changes, an analogy I use it that of a car, you keep tinkering with it for the hell of it and I will guarantee it won't ever run efficiently. if it aint broke don't fix it.
It would be good if MP's actually started to listen to and empower shop floor staff, it would also be a wise idea to make all office staff do a stint as porters etc within the hospital so they get a good idea of what its actually like to be at the coal face rather then as it is now with them sitting in their ivory towers dishing out orders to the plebs who they have no empathy with.
Sorry rant mode kicked in there!.


Mell

LignumVitae

In defence of people possibly turning up to A&E unnecessarily - I think maybe they are pushed taht way. Last year when the girls were about 6 months old Tegen got a rash and breathing difficulties late one Saturday night. I knew it wasnt a meningitis rash but I also know twins can be more susceptible to a breathing problem because they tend to be smaller and at the time she was (I can't remember it's name). I wanted to discuss it with somebody in the know so I called my out of hours GP. The service is great and once you have logged your call you are triaged and then either a doctor calls you, a nurse calls you or you go to the out of hours GP or A&E. I spoke to the call handler and we went through the triage, because of her age and the problems I was describing the computer system red flagged the call as requiring an ambulance. It took much persuasion on my behalf before the call handler would override the red flag and instead settle for an appointment at the out of hours centre. I would have been happy to speak to a doctor or nurse over the phone. I was confident enough to be able to decline the recommended service option and choose a lesser option but there will be people out there who get terrified at the thought of the 'system' thinking they need such critical and urgent care and despite their judgement opt for what is offered thus wasting resources and facilities for those more in need...we trust and rely on 'the system' and sometimes we need to trust and rely on ourselves more but we have been conditioned not to do that by the provision of what is a fabulous and responsive system for the most part.

stickywicket

Am I right in thinking that's the difference between NHS Direct and its replacement 111 ie the former was manned by trained medical people and the latter by receptionists? Hence more people are referred to A&E because they can't make the decision not to. Drop-in centres also relieved the pressure on A&E.

theresak

The trouble with the service manned by receptionists is that they have a sheet on which they simply tick boxes as the caller answers, eg "are you conscious?," " do you have chest pains."

We had to phone them in the wee small hours once as I had severe stomach pains, and I tried to explain that I had a biologic therapy alert card as I was advised see a Doctor in an emergency. She said there wasn't a box for that. In the end, after I argued my case,she said she would speak to a doctor and get back to me. Within a very short time a Doctor was on the phone telling me to come in asap.

I suppose if there's no appropriate box to tick one can hardly blame the receptionist, as they have no medical knowledge, and are hidebound by rigid questions.

stickywicket

'are you conscious'????

How scary to think that all depends on boxes and that that there's no box for biologic therapy alert :shock:

theresak

"Are you conscious?" was the most stupid of the questions I was asked, but the list was endless. And yes, the system is scary, though as I said, hardly the call-handler's fault, she was just following her script.

applerose

I remember phoning NHS Direct about someone else. I was asked a lot of questions about myself. I told the woman that it was someone else who was ill, not me but she said she still needed to ask me the medical questions. So I had to wait till a GP phoned back to tell him what the real problem was. :shock: :?