Saturday, 2 January 2010

Za Nu Labour’s NHS for the old this Xmas.

This week, having had to dig ourselves out of snow at ND Central to get into work while on call, an hour of hard graft with a shovel followed by another hour’s worth of driving on congested roads, we encountered one of the many benefits of NHS reforms for the worse.

We will call it the rotating door of being old.

During our professional lifetime the population has increased by 10 million from 50 to 60 million, got older and more debilitated. Despite this the Party has ensured a decrease in resources to cope by decreasing hospital beds by possibly a 100,000.

Hence, in a grid locked Northernshire town in winter, due to 2 inches of snow, the local hospital discharged a patient who could not walk, lived on their own and was incontinent all of a sudden. The patient was admitted to hospital by us the day before in the exact same state.

Today we had a call to visit the same patient who could not walk, was still incontinent and lived on their own and who had not moved since their early morning discharge from a local hospital funded by a “world-class” PCT.

Lots of lots of phone calls from local care agencies insisting on a home visit.

There was no need. Care in the community could not cope. This was a direct failing of centralized NHS control and pressure on less hospital beds with more elderly needing to use them.

The patient needed care. This was being compromised by prats.

Some were talking Mental Capacity issues who were afraid of doing anything quickly for fear of impinging their “client’s human rights” (like being able to go to the toilet or walk without a carer) versus a patient’s need for acute hospital care.

Other prats, called “modern” matrons, aka work avoiding administrators incapable of do any real nursing, were trying to clear (sorry “manage”) hospital beds and bouncing anything that flickered an eyelid back home as by doing so they had passed a mobility assessment.

More elderly = more illness = more dependency leads to less beds = more care in the community = less resources for an aging and more dependant population. A classic success story unless you work in the real world and see its inevitable failure.

Net result: an old, incontinent, immobile biddy sitting in chair and admitted to hospital, assessed and returned to the same chair as the same old incontinent biddy sitting in a chair came from. Clearly 12 years of bringing the UK health expenditure up to the rest of the European GDP expenditure has achieved what?

The same but worse. Care on the cheap and the crap.

This will get worse and winter has not yet officially begun according to the Met Office but the Thickerrazi are hard at work blaming everyone and ignoring the one person that should be sorted by all of their ever increasing numbers.

The patient.

We wish this were just an isolated incident but we will each here at ND Central see several this winter. All will request home visits for patients who need hospital care but have been denied it. We used to visit but this is increasingly a complete waste of time as all you do is see the patient in the same state you saw them in the day before, unable to cope and needing care in a hospital.

We just sent the patient straight back in via A&E and via 999 ambulance to avoid talking to the bed managers who had already refused social services request to readmit the patient. Not the best use of resources but at least 2 lots of doctors (A&E and medicine) will look at the patient and hopefully one of them will realise that the patient cannot manage at home. It is usually easier to get into hospital than to get out (unless there is pressure on beds when the reverse applies).

The managers will not see this pattern as they do not see patients. They will see increased turnaround of patients in terms of admissions = income but will chastise GPs for 1) increased use of ambulances and 2) increased use of A&E services.

Such is the “joined up thinking” of current NHS managers they fail to see that early inappropriate discharge of patients actually leads to more expenditure and harm to patients.

They, however, do not see real patients only spreadsheets. They have tunnel vision and see only that early discharge saves money via the NHS Tariff whereby if old bid is admitted with a condition with a “trim point” * of 10 days for say £ 3,000 then 24 hours in a hospital = 9 days profit and a double whammy as there is an A&E Brucie bonus and a new admission tariff as well.

*(Our understanding is that the trim point is management speak for number of days a patient can stay in hospital for a given condition).

They will be wetting themselves with excitement in the same way that our patient was wetting themselves in their chair. All that profit and all that patient experience of the new improved “world-class” NHS.

Praise be to the Party and welcome to the “world-class” Northernshire NHS. “World-class” it is not unless crap is now the “world-class” NHS.

Plus ca change plus c'est la meme chose? Plus ca NHS change plus c'est la meme malhereuse chose?

(With apologies for our poor use of French.)


the a&e charge nurse said...

"hopefully one of them will realise that the patient cannot manage at home".

I have simply given up being surprised at how some people manage.

Some living in appauling squalor.
Some with no meaningful social network.
Increasing numbers who are cognitively impaired.

Remember this?
And this?

More beds are not the answer apparently - the 'community' will provide?
Doesn't seem to working, does it?

Anonymous said...

Heartbreaking, but increasingly frequently true. And how terrible that the only way to get some elderly vulnerable person admitted is to use A&E (aka bunker full of drunken riff-raff with hours of distressed waiting). Yet this is what I (a GP) also find to be the case.

Keep blogging so that people know.

Dr Delilah

pj said...

The other side of the coin is that acute medical/surgical beds get filled up with 'social' admissions - they are not the place for these people, and neither is being left at home in the community - unfortunately we have minimal intermediate care beds in the NHS and bugger all provision from social services.

What this means in pracrice is that GPs and hospital staff are involved in a constant revolving door battle.