NHS winter crisis looms

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?

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

Strange you should write that!

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

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

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.

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.

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.

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?

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

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

(Let them read links, indeed...)

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.

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.

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

Yup the counties and cities with the greatest need for publicly funded social care are those are of course the poorest boroughs. (More poverty = less ability to pay for your own care) The residents of those boroughs, are of course least able to pay the big council tax increases.
All for the Tory holy grail of keeping income tax down for those in upper income tax brackets. (Along with the hope that people will blame their (Labour) councils for the rises).
While spouting about how much she cares for the "just managing" Hunt and May are deliberately and viciously attacking the poorest.

Goodness things are bad up there DJ if you can't just turn up at A&E for an emergency.

I fell down the stairs, Anya, and sat on the landing for half an hour waiting for my son to come home - it was at his house, and I was there to take my granddaughter to a performance.
The pain had subsided a bit in that half hour, so I was hoping it wasn't broken, which is why we phoned the GP first.
Actually, it's worse now, because if a GP tells you to go to hospital it now has to go to a private committee who then decide whether you need to go to hospital.
You'd better hope this does not work up here, because if it does, it will be rolled out all over the country.

Do you remember the programme where GPs went round the country asking people about medical problems? One of the GPs on there was George Rae, from Tynemouth or Whitley Bay.
He had referred a patient to hospital because of a problem with her skin. It went to this committee, who turned it down. Rae complained and it took six months for the patient to see a skin specialist, when it was pronounced to be cancer. The patient had a much more extensive problem and operation than she would have needed if it hadn't been for this committee.

Talk about differences across the country

When GD1 was taken to GP running high temp. he rang up the Children's Ward at the local hospital and told them he was sending her for immediate admittance.

And yes, it was serious enough for her to need to stay in for two nights. Having said that a 7-year old had died the previous year after being seen by two local GPs and told there was nothing to worry about at A & E, so perhaps this was a wake up call.

It's supposedly a way to save money, Anya. Obviously we need to save more up here because we're all fat smokers who don't know what the NHS is for. Our GPs aren't capable of making resoned decisions, either. If they were, they wouldn't be up here!

Cynical? Me?

Referral by GPs to hospital is no longer in their hands. Even in acute cases in most places now they have to go via A&E or to an Assessment Unit prior to admission, including children. As dj says an ordinary hospital referral by GP has to be assessed by committee to see if in their opinion the patient's referral is appropriate or if they can be fobbed off advised on alternative treatment. Under the guise of efficiency it's a big money saving exercise.

If you phone for an ambulance here you have to wait for a nurse to do a triage assessment over the phone who then decides whether or not it is urgent.
Apparently a broken ankle is not urgent, so then you have to wait again for an ambulance.

This is to do with GP commissioning in England is it? Another one of Hunt's (we're not going to have a top down reorganisation) triumphs.
Fortunately in Wales we didn't have that and neither are we going to have more council tax rises to cover care. The Welsh government had a massive funding cut. Universities are all had a chunk cut from their budget, which will inevitably lead to redundancies. LAs have had cuts and there will be libraries closing etc etc etc. But the Welsh government has decided to protect health and social care.

Not just England, Northern Ireland as well. Wales and Scotland are devolved.

skwawkbox.org/2016/12/12/ni-portrait-in-miniature-of-tory-nhscare-predations/

It was planned as far back as 2010, by McKinsey.

skwawkbox.org/2016/10/31/proof-govts-nhs-desperate-measures-planned-since-at-least-2010/

It seemed a fairly sensible idea, except that I was in pain!
They try to ascertain if it is a stroke or heart attack in which case an ambulance would be sent urgently, or a first response paramedic.