Elderly who fall at home unlikely to get an ambulance during strikes.

Casdon

I don’t think it’s the NHS and social care that need an overhaul, the systems will work if there is sufficient funding to enable them to do so. Adequate training, funding and recognition for carers would attract more people into the role, which would enable people who need care at home packages to be provided with them, and care homes to be safely staffed. More training places for the NHS professions, better pay, more beds and diagnostic resources, and a reduction of government interference and bureaucracy would enable the NHS to do what it is perfectly capable of doing already. The very last thing that’s needed is yet more reorganisation to deflect from the fundamental lack of funding issues and temporarily paper over the cracks again.

I think it is both Casdon. We need to look at the structure of the NHS. What is primary, secondary and tertiary care now? Things have changed since 1948.

But we need to be paying for the service we get. Other countries do, so why should we think we can get it on the cheap? Undoubtedly this will mean a lifetime National Health Insurance payment for all. If people then want to pay for private care on top, then, as we are not a communist state, they should be able to. A Health Service designed to keep us healthy or aid us in our illness should be available for all.

Everyone must contribute to the NHS or it is not a "National" Health Service. There is no other system where you can get healthcare for free in older age. The idea we paid enough in our working life only worked when people died close to the end of that working life.

The poorest, those on the National Health Low Income Scheme, already only receive a restricted service. This path, and the allowed and encouraged implosion of the Health Service, is the outcome of a far-right government. They then suggest we can't afford it. This Rachman-style government will then tell you it must be privatised, causing much to be unavailable to many more.

However, those who cannot/do not go privately but have to pay top-up payments are beginning to realise their service will become restricted to a pretty basic service too. They blame the poor because they have been brainwashed to do so but, in truth, it has been this government's deliberate act.

I disagree Casdon. "Bed blockers" don't necessarily need care homes. They would prefer to be in their own homes and just know that there's somebody keeping an eye on them

I agree with Casdon

Sometimes a short stay in a convalescent home with some physiotherapy and occupational therapy could prepare patients who do not need daily input from doctors to leave hospital so that they are able to return to their own homes.
This would give an extra few weeks for a care package to be set up too, if required.

Most convalescent or cottage hospitals have been closed but I know they are still running successfully in some areas.

VB000

paddyann54

We believe its failing because we are being told it is constantly in the tory media .Its that old thing of tell everyone how bad it is so that when you say it has to be dismantled or sold we all breathe a sigh of relief.Of course it will then go on to make huge profits for the friends of government who are waiting in the wings to pounce and snap it up at mates rates!!
Isn't that exactly how it has worked with everything else thats been sold? Post office,rail etc etc .
I'm not saying its doing great but thats down to bad structuring by management ,lack of beds or not even a lack of beds but nowhere to move patiens to when they are recovering like the old convalescence homes .
My sister spent most of her first 7 years in hospital or a convalescent home where she had a bit of schooling and got well at a pace that was realistic.
Nowadays they think sick/just recovering people should be chucked out and left to fend for themselves.Its not realistic especially for many elderly who live alone .A sort of half way house is needed and that would free up beds for those in need .

No suggestions but just to share my experiences....

I went to work for the NHS as an agency admin temp in 2015 for a couple of weeks (someone was off sick). I moved around other departments and was in my last role for 18 months, on a month-by-month basis. Total of 2 years - the agency were making a fortune, though I wasn't!

The last role could have been offered to me on a renewable 6 month contract basis, but never seemed to be an option, due to something called "headcount" - it would have suited me to have some job security!

My MIL was nearly 98 in July and living in her own home, with a carer coming in twice daily, who was the only person we could find. All was well until the carer caught Covid and gave it to MIL. She was waiting for an ambulance for 12 hours in July whilst unable to walk, so DH stayed all night in her in a wheelchair.

The hospital tried to discharge her a few days later, but the carer was still ill. They called my husband (only child) to ask if she could go home with him looking after her - he had to say no, and no the agency couldn't send someone else.... (the agencies had never even returned our calls when we were looking!) She was taking up a hospital bed and they were obviously trying to send her home.

The hospital said she kept asking for "Harry" and DH answered that it was her brother who died about 10 years before, but she thought DH was called Harry... The hospital were obviously hoping that "Harry" was someone to look after her. As her Alzheimer's has worsened, she's now in a care home.

In the last 10 years or so, she'd been in 3 different convalescent homes after various knee/hip replacements, but those places aren't an option anymore.

My conclusion - the NHS and Social Care need a serious overhaul.

Interesting and good observations.

Whilst on my 4-month stint as a patient I was often unable to sleep and, as 'exercise' had been prescribed as an essential recovery 'item' I took to walking up and down the corridors using my drip-stand as a walking stick.

What I saw, night after night - in the wee small hours - were nurses at their computers attempting to enter data and update files, sitting with elderly ladies besides them - placed there for their own safety. Because there were not enough nurses available to patrol the wards (3) and keep them in their beds. Most had some form of dementia and the nurses kept them beside themselves as they worked - jumping up to retrieve them when they wandered off. The fear was for them falling (some inevitably did) - this always reflects badly on the nurses. Can you imagine trying to enter data - correctly - with such a distraction, night after night? The nurses were noticeably stressed out. This was not a one-off, it happened night after night. There were never enough nurses to safely cover the required staffing levels.
And surgeons, who should have gone home at 8pm were still prowling around at 10pm. My own surgeon came in one day with a cut on his head - he actually told me that he was so tired that when he got up in the early hours of the morning for a pee, he was so wobbly with fatigue he fell in his own bathroom and hit his head on the radiator and briefly knocked himself out (his wife found him). But there he was, the next day, on his ward-round.
... just some of my experiences to add to yours, and others.

I disagree Casdon. "Bed blockers" don't necessarily need care homes. They would prefer to be in their own homes and just know that there's somebody keeping an eye on them. For those without family or friends living close, it would be ideal to have more investment in community nurses/carers and/or rehab units. Reorganisation of priorities and funding are required to achieve that.

At the other end of the process, rapid response teams could keep people out of A & E, which is evidently a distressing and unsatisfactory experience for many. Falls are obviously worrying, but many don't require acute hospital care. It would be far better if people could be checked over at home (or wherever they've fallen) and then sent to A & E if necessary or settled in a safe place at home, with follow up from a community nursing team.

The above does need reorganisation.

I don’t think it’s the NHS and social care that need an overhaul, the systems will work if there is sufficient funding to enable them to do so. Adequate training, funding and recognition for carers would attract more people into the role, which would enable people who need care at home packages to be provided with them, and care homes to be safely staffed. More training places for the NHS professions, better pay, more beds and diagnostic resources, and a reduction of government interference and bureaucracy would enable the NHS to do what it is perfectly capable of doing already. The very last thing that’s needed is yet more reorganisation to deflect from the fundamental lack of funding issues and temporarily paper over the cracks again.

paddyann54

We believe its failing because we are being told it is constantly in the tory media .Its that old thing of tell everyone how bad it is so that when you say it has to be dismantled or sold we all breathe a sigh of relief.Of course it will then go on to make huge profits for the friends of government who are waiting in the wings to pounce and snap it up at mates rates!!
Isn't that exactly how it has worked with everything else thats been sold? Post office,rail etc etc .
I'm not saying its doing great but thats down to bad structuring by management ,lack of beds or not even a lack of beds but nowhere to move patiens to when they are recovering like the old convalescence homes .
My sister spent most of her first 7 years in hospital or a convalescent home where she had a bit of schooling and got well at a pace that was realistic.
Nowadays they think sick/just recovering people should be chucked out and left to fend for themselves.Its not realistic especially for many elderly who live alone .A sort of half way house is needed and that would free up beds for those in need .

No suggestions but just to share my experiences....

I went to work for the NHS as an agency admin temp in 2015 for a couple of weeks (someone was off sick). I moved around other departments and was in my last role for 18 months, on a month-by-month basis. Total of 2 years - the agency were making a fortune, though I wasn't!

The last role could have been offered to me on a renewable 6 month contract basis, but never seemed to be an option, due to something called "headcount" - it would have suited me to have some job security!

My MIL was nearly 98 in July and living in her own home, with a carer coming in twice daily, who was the only person we could find. All was well until the carer caught Covid and gave it to MIL. She was waiting for an ambulance for 12 hours in July whilst unable to walk, so DH stayed all night in her in a wheelchair.

The hospital tried to discharge her a few days later, but the carer was still ill. They called my husband (only child) to ask if she could go home with him looking after her - he had to say no, and no the agency couldn't send someone else.... (the agencies had never even returned our calls when we were looking!) She was taking up a hospital bed and they were obviously trying to send her home.

The hospital said she kept asking for "Harry" and DH answered that it was her brother who died about 10 years before, but she thought DH was called Harry... The hospital were obviously hoping that "Harry" was someone to look after her. As her Alzheimer's has worsened, she's now in a care home.

In the last 10 years or so, she'd been in 3 different convalescent homes after various knee/hip replacements, but those places aren't an option anymore.

My conclusion - the NHS and Social Care need a serious overhaul.

growstuff

Just been reading this:

www.bbc.co.uk/news/health-63894311

I have no idea how it works in practice, but it sounds like a good idea to me.

A & E is obviously not a good place to be, unless an acute hospital can offer essential treatment which is not available elsewhere.

Keeping people out of A & E has advantages for patients and would be cheaper for the NHS. It would mean that A & E would be better able to treat life-threatening emergencies.

Maybe I'm being incredibly naive, but it seems to me that investment in integrated community services and "cottage hospitals" is the way forward.

People have been coming up with these sort of ideas for years, but it seems there has been less funding in community services, so I don't accept the "emotional blackmail" about ambulance staff and nurses being the cause of old people finding it difficult to access ambulances. Governments have known about the issues (especially with an aging population) but have done very little.

Maybe I'm being incredibly naive, but it seems to me that investment in integrated community services and "cottage hospitals" is the way forward.

You are not being naive - far from it.

A while back, I spent 4 months in hospital in a ward with mostly elderly patients. I saw what happened when they were fit enough for discharge, but not well enough to cope on their own. I discussed it with the medical staff, some of whom aired their frustrations to me because they knew I could see what was going on.
After care cannot always be provided by family - if a patient needs someone to attend to them x 3/4 visits per day, a working family member just can't do it. And not all elderly patients have family within commuting distance either.
This is not a new problem is it? It's just highlighted at the moment because of the strikes (which, frightened though I am, I support).
Governments have had years to deal with the issue. They've talked - quite a bit... they've promised, a lot. Yet here we are because nothing's been done practically to solve the problem.
The whole system is failing - right from the offset, where patients can't get to see their GPs (and that is partly one of the reasons why people end up in A&E when timely intervention would have prevented it).
IMO the system is failing because the Tory 'small-state' economic model means that there is not the will to solve the problem... and as long as this government maintains its majority, it will continue to kick the can down the road and let the devil take the hindmost. The NHS is the victim of political ideology, and if you examine Tory ideology carefully, it basically means every-man-for-himself. That's my opinion, for what it is worth.

My feeling is that there are people going to A&E when they could visit a pharmacy or do more to help themselves. 4 years ago I was told by my GP to go to A&E because a blood test showed that my blood iron was dangerously low. They wanted to keep me in the hospital but I absolutely refused and insisted on having my treatment (blood and iron infusions) as an out patient. So at least I saved a bed for someone who truly needed it.

Ive heard of people going with a splinter in their finger or a bit of a sniffle or constipation.. Such things can be dealt with at home with over the counter medications and a bit of a google.

We believe its failing because we are being told it is constantly in the tory media .Its that old thing of tell everyone how bad it is so that when you say it has to be dismantled or sold we all breathe a sigh of relief.Of course it will then go on to make huge profits for the friends of government who are waiting in the wings to pounce and snap it up at mates rates!!
Isn't that exactly how it has worked with everything else thats been sold? Post office,rail etc etc .
I'm not saying its doing great but thats down to bad structuring by management ,lack of beds or not even a lack of beds but nowhere to move patiens to when they are recovering like the old convalescence homes .
My sister spent most of her first 7 years in hospital or a convalescent home where she had a bit of schooling and got well at a pace that was realistic.
Nowadays they think sick/just recovering people should be chucked out and left to fend for themselves.Its not realistic especially for many elderly who live alone .A sort of half way house is needed and that would free up beds for those in need .

Yes Growstuff it's time to reinvent the wheel.
Centralisation of services was seen as the magic solution once upon a time but eventually it's struck down by its own complexity. victim of its own success?

This extends to other sections of our society too
Local initiatives are being valued again.

Just been reading this:

www.bbc.co.uk/news/health-63894311

I have no idea how it works in practice, but it sounds like a good idea to me.

A & E is obviously not a good place to be, unless an acute hospital can offer essential treatment which is not available elsewhere.

Keeping people out of A & E has advantages for patients and would be cheaper for the NHS. It would mean that A & E would be better able to treat life-threatening emergencies.

Maybe I'm being incredibly naive, but it seems to me that investment in integrated community services and "cottage hospitals" is the way forward.

People have been coming up with these sort of ideas for years, but it seems there has been less funding in community services, so I don't accept the "emotional blackmail" about ambulance staff and nurses being the cause of old people finding it difficult to access ambulances. Governments have known about the issues (especially with an aging population) but have done very little.

Callistemon21

Urmstongran

Well I thank you too Calli!
It’s a complex issue.
I just wish any government (all stripes) would grasp the nettle.
Continuing as we are is untenable now.

Should it be a political football? Or should the NHS be immune from political ideology?

How can it be immune when allocation of resources is involved and there's a conflict between whether healthcare should be provided on the basis of clinical need or whether people should pay for themselves as individuals?

This is at the very heart of what politics is all about.

But it will always be a political issue because allocation of money is involved. Somebody has to be responsible for deciding how a country allocates its resources - unfortunately, there will always be a gap between what people want and what can be provided and somebody has to prioritise. People with different political views have different views about healthcare (especially at population level) and how it should be funded. Deciding whether a country should have "social" healthcare (ie based on clinical need rather than ability to pay as an individual) is a political issue.

Urmstongran

Well I thank you too Calli!
It’s a complex issue.
I just wish any government (all stripes) would grasp the nettle.
Continuing as we are is untenable now.

I agree Urmstongran, sorting out the NHS should be a non political issue, it is too big an issue for one term of a parliament, even if they are motivated to retain free at point of use health care which looks doubtful with the current Tories. I hope I interpreted what you posted as you meant and haven't put words in your mouth

People got angry. Why? Because the government encouraged them to be
We do have devolved healthcare here.

growstuff

Callistemon21

growstuff

It was a serious question. I have never been in an A & E where loads have people have come in shouting what's wrong with them. Most people come in, go to reception and then go and sit quietly, resigned to waiting. I don't think I've ever known what was wrong with anybody else.

Some people who were quite agitated were in A&E when we were there recently. They did go again and again to complain very vociferously to whoever would listen.
It was so overcrowded that anyone near reception could overhear what was being said, especially as people were repeatedly asked to speak up.

Others told other patients exactly what was wrong with them, how long they'd been waiting etc.

I would hazard a guess that you have never been in an A & E recently, growstuff.

You are correct. The last time I went for myself was about five years ago, when I was taken by ambulance after being found unconscious. Before that, I had a number of visits resulting from my children's various accidents.

So what's happened in the intervening five years?

People got angry. Why? Because the government encouraged them to be.

They have sown the wind and now we are all reaping the whirlwind.

Urmstongran

Well I thank you too Calli!
It’s a complex issue.
I just wish any government (all stripes) would grasp the nettle.
Continuing as we are is untenable now.

Should it be a political football? Or should the NHS be immune from political ideology?

Well I thank you too Calli!
It’s a complex issue.
I just wish any government (all stripes) would grasp the nettle.
Continuing as we are is untenable now.

HousePlantQueen

To put it bluntly (and crudely), most hospitals are constipated with more coming in at one end than is going out of the other.

Although - they're not actually getting in, they're stuck in A&E, MAU, SAU and in ambulances outside (if they get one).

HousePlantQueen

To put it bluntly (and crudely), most hospitals are constipated with more coming in at one end than is going out of the other.

👍👍👍

To put it bluntly (and crudely), most hospitals are constipated with more coming in at one end than is going out of the other.

henetha

I wish they would open some of the little local hospitals which are now standing empty (well, our local one is). Then bed blockers could go there.

Yes, henetha.
There has been much talk for years and no action.

Casdon

Callistemon21

I'm not saying it's all great everywhere, but it's not terrible everywhere either. It's not hell

If it's ok why does it need improvement? 🤔

Why do we think it's failing?

It’s multi faceted, but due to funding constraints the biggest problem is that there aren’t enough staff, and there are not enough beds in the system in acute hospitals, due to funding constraints. People are living longer and have complex healthcare needs, so there are more people needing acute healthcare. Patients are stuck at the front end in hospitals because there’s no capacity further in the system.

Patients are stuck at the front end in hospitals because there’s no capacity further in the system.

I keep saying the same, Casdon but you put it more succinctly

And get thanked.

Don't put off going to A&E, folks, if you really need to be there.

I know none of you are that stupid.

Nor are you probably the kind of people, as described by the overworked A&E doctor, who just want more co-codamol because you like it, or could have your cut finger attended to in Minor Injuries.

We haven't heard for a while now that there are people who read this but never post. I'm sure that there are lots of people like that. So when a thread is predominantly about how awful things are, we don't know if people are reading this and being, well, frankly, scared.

There was a recent thread where a poster said something along the lines of how they thought they needed to see a doctor, but they knew how busy things were, so they had put it off.