NHS winter crisis looms

Great dj. "cynical calculated malevolence". Sums up this Government doesn't it?

www.taxresearch.org.uk/Blog/2016/12/12/suggesting-changes-to-council-tax-to-fund-social-care-is-cynical-calculating-malevolence/

This should be on PridesPurge in the cynical section, too.

Anya, my son rang the GP surgery, who said not to take me there, but to take me to either of the two hospitals. He rang the easiest to get to and park at, who told us that they did not have xray after 5 pm. It was 5 pm.
So we went to Durham hospital A&E, but as I said, we had phoned up first to find out where to go. Wouldn't have liked to go to Durham first, then find out that Shotley Bridge could have coped.

Well, I for one appreciate the summaries of your links daphnedill!

(Let them read links, indeed...)

I had to take my son to A&E a couple of months ago. He fell over and his knee was at an angle to the rest of his leg. Sure enough it was dislocated. I didn't bother with 111 or the GP.

The point I was making, dj, is that all CUH's advice is a bit useless if an elderly person, for example, falls or collapses unexpectedly, especially at the weekend or evening, because we don't have any of the community services, such as a minor injuries unit or out-of-hours GP service. The nearest pharmacy open on a Sunday is miles away (and impossible to reach by public transport because there are no buses) and it's only open until midday. If you ring the GP out of hours, you get switched automatically to 111.

The whole system is collapsing:

www.bbc.co.uk/news/uk-38286145

I did go to A&E with broken arms on my own volition. Did you not do the same DJ when you broke your wrist?

The only time I rang 111 (quite recently) I was informed there was a 'high volume of callers' and it might be some time before my call was answered and it invited me to call back later.

Isn't the first thing anyone thinks of to ring 111 to find out where you should go for any particular problem if you can't get through to your GP?
CUH teaching people to suck eggs? The only time I've ever been to A&E was when I was sent there by 111.

Closing community hospitals may fine if you have a good community nursing and social care system. However these have both been cut. The cuts that were implemented in the first 5 years of the Jeremy Hunt's reign over the NHS have been steadily bitting deeper. The reduction in number of beds has been as a result of direct pressure from his Department. People might not have joined the dots between their particular circumstances - the operation delayed three times or the reduction in the amount of social care that someone is allowed - to the bigger picture.
Large numbers of people who were previously oblivious are now noticing what is happening - the bigger picture is pretty terrifying. I am relieved that my DMIL is no longer with us because she dreaded another hospital admission and the experience for elderly, frail people, with multiple health conditions, must inevitably be deteriorating.

thatbags ,LABOUR closed A and E and cut services from Vale of Leven around 12 years ago,that was Ms Baillie and Lord McFall ,there was an initiative called Vision for the VAle that was SUPPOSED to make sure we kept all our other services but the health board are removing things by stealth.There has been no help from Shona Robison SNP health minister .The "free" prescriptions were nothing to do with services,it was announced that it was cheaper to give ALL prescriptions free than meanns test for them ,the admin cost was higher by a country mile

Strange you should write that!

The powers that be are building a new crematorium and the town cemetery is running out of space. :-(

Quietly fade away I think, then they'll (we'll) be less of a burden.

This has just been posted on Addenbrooke's website:

Help older people avoid hospital

09 December 2016
Cambridge University Hospitals (CUH) is urging communities and carers to help older people avoid the need to visit hospital.

Dr Stephen Wallis, consultant geriatrician at CUH, said: “We are seeing high numbers of older patients coming to hospital as an emergency when it may not be the best place for them to be managed.

“Currently, more than 12,000 over 75s are admitted each year on an emergency basis and being in hospital is not always the best option.”

For any non-emergencies, the public should not come to A&E, but should use alternatives, such as GPs, pharmacies, NHS 111 and minor injury units.

Dr Wallis added: “Communities can look out for their older peers by making sure they are warm, and that they have enough to eat and drink. They may also appreciate help with chores and shopping - particularly if they find it difficult to manage when it is icy outside.

“If people do need to come into hospital, we want to keep them active and help them get back home as soon as possible. Research shows that every ten days someone over 80 spends in bed ages their muscles by 10 years.

“Within the hospital we have set up a frailty flagship pathway which looks at how we care for older, frailer patients to reduce deconditioning and hospital complications, in order to promote independence and thereby reduce their length of stay.”

Addenbrookes is my nearest hospital, even though I live in Essex. There are a few problems with this:

1 West Essex doesn't have a minor injuries unit. The nearest one is in Hertfordshire and it's not open at weekends or evenings.
2 There are no 24/7 pharmacies.
3 GPs are at breaking point and there is no out of hours service for emergencies.
4 NHS 111 can take hours to respond and usually advises going to A&E to be on the safe side.

So what the hell are people supposed to do?

Let them read links, daphne. We're all intelligent enough, after all, as GillT says.

The community hospital I was talking about was the one where Simon Stevens started his career. When he took on his present job, he said it would never close.
A top NHS bod telling lies? Never.

This was originally reported in the Telegraph, but as it's behind a paywall, this is the link to a Huff Post article about the current STPs:

www.huffingtonpost.co.uk/2016/10/30/half-of-nhs-groups-plan-to-cut-beds-to-deal-with-financial-crisis_n_12725062.html

For those who don't like links, a quick summary:

Almost half of NHS authorities are planning to cut hospital beds while a third have proposals to close or downgrade accident and emergency departments.

More than half intended to close or downgrade community hospitals.

Almost as many (one in four) saying they intended to close inpatient paediatric departments.

Bearing mind that community hospitals take pressure off acute services and there was an article yesterday about the wait for paediatric emergency care, this is madness.

Children can't be blamed for taking themselves off to A&E when drunk or wasting GP time. People already in hospital can't be blamed for being too frail to go home.

Well said, GillT57.

The stories, true or otherwise, about people calling ambulances for a paracetemol or a tampon are a distraction from the real problems with the NHS, rather like the stories by the nastier side of the tabloid press about 'bogus' asylum seekers being housed and 'using up' all the social housing. The ageing of the population should not come as a shock to anyone who can interpret census data, or perhaps that is also down to plane loads of immigrant pensioners? I just get so bl**dy frustrated when most of us, intelligent people that we are, can see the problem,

It is not just about throwing cash at the NHS ( not that it is likely), it is about proper funding of social care to allow patients to be discharged safely to their own homes where they will receive the care and home nursing necessary. Care agencies will not accept local authority contracts, in fact many have withdrawn from massive multi million pound contracts, because it makes no financial sense to be paid £12.50 per hour by Cambridge Council ( for example) when the increased labour costs mean that each hour costs more than that. £7.20 an hour ( hardly a massive sum) plus paid 5.6 weeks holiday, plus travel expenses, plus training, plus administration, costs far, far, more than the invoiceable amount. Not rocket science is it?

I was being sarcastic, daphne.

I have just been reading the STP for my area. It seems we are lumped in with Northumberland, Newcastle and Sunderland now.
On the map there is Shotley Bridge hospital, but it never gets mentioned in the whole 100 pages of the STP.
Obviously they do intend to close it down, whatever they have said to us.

Yes, over the years many cottage hospitals and interim-care homes have been closed down - presumably to save money! At the time it must have seemed like a wonderful wheeze...

@granjura

I'm not denying it happens, but without robust evidence, nobody really knows how much it costs. We're certainly getting public health messages aplenty to visit our pharmacists, etc for minor injuries/illnesses. The trouble with that is that pharmacists are restricted in what they can sell. One of my dear children used to get regular eye infections and had to be prescribed antibiotic cream. I used to do all the right things (washing her eyes with cool boiled water), but the pharmacist always used to tell me to go to the GP. Headlines about wasting time might also get through to some.

I agree that people should take responsibility for their own health, but I have the impression that a 'blame game' is being used to hide underfunding. Yes, it does work both ways.

No, it's not 'our' fault, dj, but it's a fact that older people, not surprisingly, use up a huge chunk of NHS funding. The social care cuts are just making the situation worse. Everybody has to face up to the reality and a solution has to be found. It's not good enough to cut services to the bone, then expect those who can afford decent treatment to pay for it, while the rest rot.

I expect there have always been hypochondriacs and I'm not sure what can be done about them. I don't agree with charging for visits to GPs and A & E. I expect the stories we keep hearing about people wasting GP/A & E time are part of a public health message. However, I do worry about people who won't go to a doctor, because they don't want to waste time. Sometimes, they really are ill and they use any excuse not to face up to the reality that they could genuinely be ill. For others, even a small amount is a significant sum, especially if a long journey is involved. In any case, it's been shown that the admin costs are more than would be collected, unless quite a large amount were charged.

From the Nuffield Report, two findings are very significant:

1 Hospitals don't have much spare capacity, so have little flexibility during winter months.

2 Social care is being starved of funds. Essex County Council spends 25% less now on social care than it did five years ago. There is bound to be a knock on affect on the people being admitted to hospital and on the quality of life of those concerned.

Addenbrookes (in Cambridge) has a huge problem with bed blocking. Not only does it serve a wide catchment area with a high proportion of elderly, but many of them live in isolated communities. Private companies won't even take on the contracts to care for some of these people at home, because the travel time makes care packages unviable. I expect other areas have similar problems.

Meanwhile, our local 'cottage' hospital lies empty. It used to have low dependency beds for people who didn't need acute care, but weren't well enough to be at home. It's nuts!

as you well know, I am totally on your side on this and agree that the NHS is being deliberately run down in order to make the public accept privatisation. It's as clear as a bell.

However, there is plenty of evidence that since GPs generally do no do their own on call- more people do call the cover agency doctors for things that really do not require this. Same for A&E - for colds, minor sprains and the like - and with this- we can play a role in helping this winter.

Playing down the fact that some people have no respect for the system and the NHS staff- is not helping in the real battle. As I've said before re benefits, etc. The real problem is with those at the top who tax avoid and evade by billions and make money out of the demise of the country, be it selling vital utilities or privatising the NHS - totally. And yet- denying abuse at the other end does not help- even if it is proportionately tons less.

I have never wasted a GP or ambulances time, but know many do.We should always err on the side of caution though if a child is involved.

Good article, daphnedill - sets out the situation (as it was in 2014/15) very clearly.

And it is all our fault, as well.

www.onmedica.com/NewsArticle.aspx?id=1232e6b5-2c07-4a29-b8e9-09ca6ee93409

Baby boomers to blame. We didn't ask to be born then!