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

The number of district nurses in England fell by 43 per cent in ten years between 2009 and 2019, with 7,055 reported in September 2009 compared to 4,031 in January 2019 - and that was despite increased demand.

www.hsj.co.uk/community-nursing-will-blow-as-discharge-threshold-is-reduced/7027384.article#:~:text=The%20number%20of%20district%20nurses,to%204%2C031%20in%20January%202019.

Yes, there does need to be a change of strategy because it would involve reallocation of funding.

PS. There also needs to be a change towards funding mental health better.

Casdon I disagree with you that the situation isn't replicated. I know other areas where it's exactly the same. One of my sisters was a district nurse for years and latterly the manager of a big area in England. She was made redundant when the system was reorganised - as was the system in many other areas. That's how I have some insider knowledge of structural changes. She was offered another job, but the emphasis had changed to social care not nursing and she would have taken a drop in salary. The service was soon outsourced to a private company. My sister took the huge redundancy package instead.

As I wrote above, my mother needed nursing care in the weeks before she died. We knew exactly what was available - but there wasn't anything! Goodness knows how many phone calls my sister made, but got nowhere - and she did know what she was doing and still had contacts. My two sisters could cover most of my mother's needs, but they weren't allowed to do some of the serious stuff, which is why we ended up paying for a private nurse. It was expensive and there are many people who couldn't/wouldn't have paid. The alternative would have been for my mother to take up a hospital bed, which would have cost the NHS more, in addition to making my mother's last few weeks thoroughly miserable.

So please stop trying to lecture me about community care and systems and what you think is available.

growstuff

Exactly! I didn't need social care! I needed nursing care! That's precisely the point I've been making. There weren't any district nurses. Funding for them has been cut, even in the context of general cuts to services - that's why I think there does need to be a change in strategy/direction.

I didn't need to take up any bed in an institution either. I was far happier to be in my own bed, but I did need nursing care for a few days. I was discharged the same day as my op, but that only happened because I had somebody who could drive me to hospital every day for the next week. If I hadn't have had that, I would have had to stay in hospital and been a "bed blocker" and would have cost the NHS far more - and I'm not the only one in that situation by any means.

Does there need to be a change in strategy/ direction for there to be more district nurses in your local team so that they are able to provide the level of nursing care required? I’d say no, there just need to be more district nurses so they can fulfil the requirements. I don’t think your local issues are necessarily replicated throughout England, because local choices are made about which services are prioritised.

DH got daily visits from District Nurses not that long ago.

Exactly! I didn't need social care! I needed nursing care! That's precisely the point I've been making. There weren't any district nurses. Funding for them has been cut, even in the context of general cuts to services - that's why I think there does need to be a change in strategy/direction.

I didn't need to take up any bed in an institution either. I was far happier to be in my own bed, but I did need nursing care for a few days. I was discharged the same day as my op, but that only happened because I had somebody who could drive me to hospital every day for the next week. If I hadn't have had that, I would have had to stay in hospital and been a "bed blocker" and would have cost the NHS far more - and I'm not the only one in that situation by any means.

growstuff

Callistemon21

It wouldn't have been appropriate for me when I came out of hospital the same day as my op. As it was, I had to go to the breast unit nearly every day to get checked out

A District Nurse came daily to me years ago after a 36 hour discharge.
I believe they will do now too, unless a patient can somehow get themselves to the GP surgery.
Even so, a fortnight of convalescence with nursing treatment, physiotherapy etc would be beneficial.

Maybe things are different in Wales
My relative had three weeks in a cottage hospital after surgery in England.

I was told there were no district nurses available. I wasn't supposed to drive, so my partner took me to the hospital most days to have the dressings checked and to monitor my recovery. I needed nursing, not social care.

District Nurses don't do social care.
They come daily for nursing care, checking wounds, changing dressings until it is deemed no longer necessary.

Convalescent home are a good interim for older people who don't need medical intervention from doctors, may need some nursing care and need to get stronger so that they can go home.

Casdon Even the different regions of England operate differently. I checked my own county. There is a rapid response team operating in the south of the county, but it's separate from the NHS and run by a group of GPs and trusts. If somebody rings 111 or 999, the call handler decides whether it's more appropriate to call rapid response or an ambulance. The CCG (now ICBs) commission the service. However, my area is run by a different ICB and doesn't commission anything similar. It's an ambulance or nothing.

Callistemon21

^It wouldn't have been appropriate for me when I came out of hospital the same day as my op. As it was, I had to go to the breast unit nearly every day to get checked out^

A District Nurse came daily to me years ago after a 36 hour discharge.
I believe they will do now too, unless a patient can somehow get themselves to the GP surgery.
Even so, a fortnight of convalescence with nursing treatment, physiotherapy etc would be beneficial.

Maybe things are different in Wales
My relative had three weeks in a cottage hospital after surgery in England.

I was told there were no district nurses available. I wasn't supposed to drive, so my partner took me to the hospital most days to have the dressings checked and to monitor my recovery. I needed nursing, not social care.

Callistemon21

^I also witnessed it with my mother in the months before she died. She didn't need in-patient hospital care, which would in any case have distressed her, but she did need nursing care - not social care^

So a period of convalescence with nursing and physiotherapy care would have been beneficial for her.

Not convalescence. She was dying. However, she needed more than social care. She needed somebody to manage her syringe driver, oxygen and catheter. There was nothing wrong with her mind, but she was distressed about staying in any kind of institution. My sisters are both qualified nurses, so they were able to meet her needs, such as keeping her mouth moist, providing some basic nutrition and preventing bedsores, but weren't insured for certain procedures or drugs. We paid for a private nurse to come in every day during her last few weeks. The alternative would have been for her to stay in hospital, where nothing more could have been done beyond what was already being provided. In the end, she died in her own bed, which is what she had wanted.

Gramrretto, we have hospice at home. It’s worked well for friends. Sadly, my husband was too I’ll to come home

When DH was dying, 2 year ago he had "Hospital at Home" . This meant daily visits from the DN team, Social Services providing a bed and reclining chair and the doctor calling frequently, often with a student doctor. I must say we felt well cared for.

Maybe our system in Scotland is not broken yet.

In 1986, I was a sw manager. 4pm Friday, I was involved in a ‘discussion’ with the consultant whose staff nurse instructed our duty officer to get services in the home of an 84 year old who’d had a double mastectomy the previous day. She lived alone with no family or friends to support her. The consultant described her as ‘a bed blocker, needing social not nursing care’.
My belief was she needed nursing care and we would assess then if appropriate arrange care at home or in one of our residential placements as an interim measure. My memory of thus ‘discussion’ is of it beginning with staff nurse - duty social worker and escalating to the consultant ringing me and shouting at me.

She stayed in hospital. We assessed and made appropriate arrangements. It could have been a sensible referral prior to her surgery.

I think it varies from area to area. My dad fell on Tuesday morning, fracturing a hip. Checked out by nurse from his sheltered housing complex. She sent for an ambulance (she didn't know it was a fracture at the time) they came approximately 4 hours later. In hospital, tests, x-ray etc and in a bed by 8pm. Next morning had surgery, it will be a while before he can go home, but excellent care and kindness. I'm a big fan of the NHS, but accept that there are serious shortcomings at the moment. Not the fault of any of the staff. I hope its there for me when I'm 96 like my dad!

I also witnessed it with my mother in the months before she died. She didn't need in-patient hospital care, which would in any case have distressed her, but she did need nursing care - not social care

So a period of convalescence with nursing and physiotherapy care would have been beneficial for her.

It wouldn't have been appropriate for me when I came out of hospital the same day as my op. As it was, I had to go to the breast unit nearly every day to get checked out

A District Nurse came daily to me years ago after a 36 hour discharge.
I believe they will do now too, unless a patient can somehow get themselves to the GP surgery.
Even so, a fortnight of convalescence with nursing treatment, physiotherapy etc would be beneficial.

Maybe things are different in Wales
My relative had three weeks in a cottage hospital after surgery in England.

Reading your posts growstuff, I do think services in the community run slightly differently in Wales. The District Nursing teams are part of the integrated care teams. People who need nursing care at home only, eg post operatively, are looked after solely by the DNs. If you are post operative and need care as well as nursing input, that is picked up by the integrated team - the care co-ordination is done by a professional from whichever service has the most input. There is a rapid response nursing service as part of the DN service in the community as well, operating for those people who are already known to services, and they work in conjunction with the hospital front end rapid response team - in some areas they are the same team.
There are however many people who don’t need nursing care, but do need support packages, occupational therapy, dementia care etc. living at home. If somebody who isn’t involved with any of the services falls at home, then the ambulance service is used and the person is assessed at the hospital, to be turned around if they don’t need admission after examination and assessment.

One of the structural changes was actually running down district nursing in England and transferring it from the NHS to local authorities.

I do have a little insider knowledge of how it worked because I know somebody who was the Community Nursing District Manager for an area of England.

There's a difference between nursing and caring roles and many people at home do need nursing care. The alternative is unnecessary hospital stays. That's why I'm saying we need to undo the previous restructuring, which hasn't worked.

Callistemon21

^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.

It wouldn't have been appropriate for me when I came out of hospital the same day as my op. As it was, I had to go to the breast unit nearly every day to get checked out.

I also witnessed it with my mother in the months before she died. She didn't need in-patient hospital care, which would in any case have distressed her, but she did need nursing care - not social care.

Maybe things are different in Wales.

People who leave hospital with dressings still in place do need nursing care. They also need nursing care to check vital signs.

Casdon I'm not talking about care packages. I'm talking about having a community nursing team, who could respond on an "ad hoc" basis for people who have falls or have recently come out of hospital, but need help on a temporary basis. An individual "package" wouldn't be appropriate, although a community nursing team might recommend one. That kind of thinking would need some restructuring.

Having relatives in all three armed services, as well as a daughter who’s a paramedic I suppose I see both sides of the argument.
My daughter voted for action short of a strike as she (I believe rightly) felt that morally, the service should not be withheld. She just wants to do what she trained to do, not sit for 9+ hours outside an A&E, unable to finish her 12 hour shift on time, often without a break.
The military are at breaking point, having backfilled every home and away crisis for years, and are now under-recruited. Training is ongoing for potential conflict in Eastern Europe as well as everything else (the UK public really has little idea of the worldwide commitment being enacted) and now they’re expected, whilst unable to ever strike, to do the jobs of those wanting much bigger paypackets whilst being expected to forgo Christmas themselves.

DaisyAnne

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.

There have been more changes to the NHS since 1948 than any other public service, and structural change happens with every government, with services reconfigured in ever more confusing combinations. In my time in the NHS we had Hospital Management Committees for hospitals, and primary care and social services as a separate body, then we had sectors with community separate from social services but on a large geographical footprint, with primary care separated out from community, then we had combined mental health and community services, with hospitals managed by Trusts. Now we have integrated health and social care but managed by two bodies through local government and the NHS. Honestly, structural change is not the answer when services are so depleted, it just causes more disruption and uncertainty, good people leave, and services get worse in the short term.

Funding of services is a different issue to restructuring, which is about organising the ducks in the line in different ways.

I know everybody has different views about funding, I personally think all elements of the NHS should be free at the point of delivery, and increased revenue should be raised through taxation.

growstuff

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’m confused growstuff, because I mentioned home care packages as well as care homes - I wasn’t implying that everybody who needed care should go into a care home. What Callistemon21 said is also right, if a home care package is right for the future but not immediately, and the person no longer needs to be in hospital they should temporarily be placed in a rehabilitation type care facility, not another hospital. Community hospitals provide care for people who still need nursing care and medical input. More resources are certainly needed in the community, but for the majority, it’s not nursing care that’s needed but reablement and care support.

We have front end rapid response in A&E departments already in Wales, and they do provide a valuable service in keeping older people out of hospital, but to be successful the team needs immediate support at home to be available so people can safely return home and have the intervention and support they need. Access to the home support is the biggest problem, due to a lack of staff.

Yes. We all need to be extra careful during the strikes. But we also need to remember the Tory government got us into this perfect storm of strikes and vote accordingly when the time comes.