Current Affairs 2023

[Whynd1]

I have been reading about the dire state of the NHS,particularly a and e departments.
My dad who is 95 suffered a fall in his apartment a few days ago. His carer found him on the floor and rang for an ambulance, none available. Rang his gp who did not come out to him but diagnosed over the phone a broken hip. This was about 5pm.
I could not go to him as we have been suffering from covid, caught coming back from Iona.
So my brother made his way from Swindon.

The ambulance service said he was not a priority that was only for life threatening conditions. At mid night with help managed to stand and was put to bed. The paramedic came at 3am. He stayed for over an hour walking dad around to make sure he hadn't broken his hip etc. Luckily he was spared the wait outside the hospital in an ambulance.

Surely hospital trusts must do something about all the ambulances queued up outside to release staff etc. It all starts with social care. More investment is needed to move patients on from hospital.

Lindsey

Lindsey

[screwy]

We need to bring back the Convelecence hospitals. Here in our town we had a NHS hospital building for mental health patients, it has been replaced by a new state of the art centre on an older hospital site, the empty one is now being left to rot. Disgraceful.
No doubt they’ll do it up and shove bloody migrants in it.

[Mervyn and Trish]

You're right Lindsey, the bottle neck is social care and getting recovering patients out of hospital. And you're right too Mel. We have an excellent community hospital in our town that provides a minor injury service, district nurse clinics, out of hours GPs and blood tests. But it also has two wards that used to offer convalescent care that now stand empty while the acute hospital struggles.

When I had my major heart op I got out because nurse Trish was waiting at home.

Governments of both colours have promised better community care over rhe years and neither has delivered. Both parties are happy.to do nothing and blame the other.

If Rishi wants to make his mark sorting this one out is a priority.

[Stephen]

Our local Victorian community hospital is on a huge site and is being held together by a wing and a prayer with just a very small percentage of it used for services such as out-patient appointments, physio, X-rays and a stroke patient ward. The majority of the buildings at the rear of the hospital are just left empty and allowed to deteriorate. God knows what the maintenance and archaic heating costs must be.

The whole hospital site needs knocking down and a new up to date cost effective facility put in it's place. But of course the bureaucrats say part of the front facade is listed and access would be a problem, so that's knocked that on the head. Yet they soon allow new housing estates to suddenly appear all over the place without blinking an eye when it suits them.

As you say screwy, disgraceful.

[Stephen]

That's typical of GP's these days Lindsey not attending when they should. How they get away with it I don't know. If they got off their ar*es when on call and done they're job then a correct diagnosis could be given instead of second guessing over the phone and having the ambulance turn out unnecessarily.

[david63]

the bottle neck is social care and getting recovering patients out of hospital

Not all of it, some of the problems are created by NHS regulations.

Some years back when my mother was at home she fell and because of the position that she had fallen it needed ambulance staff to get her back up. The first to arrive was an advanced paramedic then the ambulance crew. Once she was up we were then informed that due to her age the current rules said that she had to go to A&E - even though the advanced paramedic said that there was nothing wrong and that there was no need to go to A&E.

If that is happening in just one scenario that I am aware of you can bet that there will be others.

The A&E problems are also being compounded by the breakdown with the GP service.

[Mervyn and Trish]

Yes you're right about the GP situation. The contract renegotiation under the Blair government was a disaster. More money for a reduced service commitment. Individual GPs are excellent but the structure is wrong now.

There is also a change in culture. Patients go to A&E for ridiculous things these days. The number of attendances directly related to alcohol consumption is also absurd.

[Stephen]

Yes you're right about the GP situation. The contract renegotiation under the Blair government was a disaster. More money for a reduced service commitment. Individual GPs are excellent but the structure is wrong now.

There is also a change in culture. Patients go to A&E for ridiculous things these days. The number of attendances directly related to alcohol consumption is also absurd.

That’s because they can’t get a GP appointment Merv so A&E is the next port of call. I’m not saying it’s right or wrong but what do you do when day after day you can’t get through to the surgery to make an appointment.

Like many others, I know all too well from my own experience when trying to get an appointment how difficult it is. On the phone bang on 8am when they open only to find yourself already 30+ in a queue.

[towny44]

Yes you're right about the GP situation. The contract renegotiation under the Blair government was a disaster. More money for a reduced service commitment. Individual GPs are excellent but the structure is wrong now.

There is also a change in culture. Patients go to A&E for ridiculous things these days. The number of attendances directly related to alcohol consumption is also absurd.

I do think this needs addressing, part of the triage process should be to send minor accident patients to their GP or their nearest minor injuries clinics.
As regards social care, I doubt this can be improved unless the salary structure is drastically improved, but of course any increase here would lead to demands from other nursing staff for their pay to increase to retain the original parity.

[Mervyn and Trish]

I don't entirely agree Stephen. Yes for sure in some cases, but many use A&E as their first port of call for things they wouldn't have even bothered their GP with 30 years ago. And as for the drunks, get pissed, fall over, go to A&E. No excuse. There are patients at our local A&E the staff don't even have to ask their names because they're there so often.

I'm not sure salary is the only factor in social care either. The overall cost of looking after someone on a community hospital ward for convalescence is far less than the cost of occupying a bed in an acute hospital.

But whatever the solution it needs sorting. We need OL's 30.year plan.

[Stephen]

Merv

but many use A&E as their first port of call for things they wouldn't have even bothered their GP with 30 years ago.

I think that's because these days we are told to be 'better safe than sorry' and get almost everything checked out by the medical profession. Whereas, as you say, 30 years ago it was almost a case of 'get on with it'.

[screwy]

I don’t believe that the NHS is a problem to be sorted just by the ruling party. This needs cross party working,all putting ideas and solutions forward without falling out, it is far too important to play party politics.

I know, if only. Something has to be done.

This is the biggest crisis in its history.

[CaroleF]

Mel, I couldn't agree with you more. No one party is going to sort things out. It's got to be a mixture of all the political parties to have any chance of doing anything. Part of the problem as people have said is that the smaller hospitals have gone under the idea that a huge hospital with all specialists is a better idea. Our local huge hospital is so big that anyone who isn't fit and healthy has a problem coping with the amount of walking. In our area we had a Naval Hospital, RNH Haslar, a fantastic hospital with brilliant nursing. It even had Cancer Care. What is it now, up market housing. All the service hospitals seem to have disappeared. Now anyone living in the Gosport area has a really long journey to get to the local hospital in Portsmouth and with only one road in and out of Gosport any ambulance, assuming there are any, can take a really long time to get to the local A&E department in Portsmouth. There needs to be Cross Party agreement to begin to get things sorted. If it means some sort of Insurance Scheme then that needs to be discussed. When the NHS was started it was never envisaged that it would have to cope with all the new developments there have been in the last 70 years. Is it realistic to expect the NHS to be free at the point of access. People pay N.I. contributions, it's not enough.

[Mervyn and Trish]

I agree 100% it needs all party agreement. The trouble is tthat at the next GE the main.parties will be blaming each other and agree on nothing.

I'm not averse to some sort of charging either. They have an interesting system in Sweden, I think it is, where it is largely state funded but with very small access charges. For example the equivalent of around £5 for a GP appointment, £15 for A&E. Affordable but sufficient to discourage missing appointments or turning up at A&E looking for a hangover cure. Or shopping department to department if they don't like the first answer.

I also think there are some things that should not be available fully funded by the NHS. Controversial I know but boob jobs, sex changes, vasectomy reversal for example.

[towny44]

I don't entirely agree Stephen. Yes for sure in some cases, but many use A&E as their first port of call for things they wouldn't have even bothered their GP with 30 years ago. And as for the drunks, get pissed, fall over, go to A&E. No excuse. There are patients at our local A&E the staff don't even have to ask their names because they're there so often.

I'm not sure salary is the only factor in social care either. The overall cost of looking after someone on a community hospital ward for convalescence is far less than the cost of occupying a bed in an acute hospital.

But whatever the solution it needs sorting. We need OL's 30.year plan.

I think it is salary levels for community carers that is the root cause of the current problem Merv. Since most carers are only paid the minimum wage level for a job that whilst basic in the skills required is extremely important and vital. The demand for care now comes mainly from elderly hospital patients, rather than from hort term convalescent needs, and it is the inability of the care system to provide regular prompt care packages that is the major cause of bed blocking, leading to ambulance delays and cancelled operations.

[Whynd1]

I did feel the gp should have come out.
Trouble is my father moved to this complex approx 6 years ago and is now out of his gp area.

If he had have come out as you say Stephen he could have saved the palrmedic a visit.

The whole system needs urgent reform. If more patients got to see a gp there would be shorter wait times in a and e.

Have to say though a few weeks ago whilst I was away for the weekend my husband had a dizzy spell while walking the dog and a neighbour kindly bought him and the dog home. Next day accessed the online gp system and was offered an immediate appointment, thought he might have had a slight stroke. Thankfully it was low blood pressure.


Lindsey

[david63]

I agree 100% it needs all party agreement.

I don't agree with a cross party approach. Yes the NHS needs a major overhaul but, in my opinion, it needs to be done outside of politics - in fact the first thing that needs to be done is to totally take the NHS out of politics and have some form of committee, like with the BOE, that take the day to day decisions along with a five/ten, or whatever, plan going forward. This would actually benefit all political parties as they would not be constantly being accused of mismanagement by the opposing parties.

[oldbluefox]

The whole system needs urgent reform.

This is the crux of the matter. The whole system needs reform.

• Nurse's working day hours
  Bursaries to attract nurses into the profession
  Does nursing need to be a wholly degree profession?
  Too many managers/admin staff?
  Eliminate waste and unnecessary spending
  Reinstate cottage hospitals and convalescence homes
  Improve the wages of care workers to reflect their value to the whole system
  A more robust triage system to deter time wasters and those who do not need to be in A&E. If it's not an accident or emergency they should be re-directed.

Of course if we want an up to date, efficient NHS we need to fund the whole system and we need to fund it across the board and not just in the major cities. It is unacceptable in the 21st century that some areas of the country are still managing on old, outdated equipment. It's not fair on the patients and it's not fair on the staff. But if we are to have a medical system on a par with our continental neighbours we need to pay more in our taxes to fund it. On this there should be a cross party agreement, whether by an elected committee it matters not but the NHS should not be a political football.

[Onelife]

A distressing situation all round and one where there are no easy fixes. I suppose at the end of the day it all boils down to money. The shortage of nurses/doctors and hospital staff have been creeping up on our NHS for years, add to this the medical advancements which have extended our life expectancy beyond that which was envisaged can only exacerbate the problem further.

Our hospitals are now being part used as nursing homes; therefore, as others have said, to move forward we need to see more convalescence facility’s. The short-term problem could be eased by utilising all the unused private care home beds of which there are hundreds if not thousands doted around the country…unused beds are money losers for these homes so I’m sure a fair negotiated price could be agreed to free up beds in hospitals. The bigger issue however is that most leaving hospitals for convalescence/care homes will need ongoing rehabilitation…alas physiotherapists and more qualified nurses (for more complex needs) are in short demand… this isn’t going to be an easy one to solve.

I agree with much of what Foxy has said…I also think they should bring back onsite subsidised nursing/doctor accommodation which would make the job more attractive for those considering this profession …. I also think hospital management could lighten the pressure on doctors and nurses by stop issuing new ways of doing things in their attempts to cut corners, which for the most only cause more confusion and disruption…this “let’s try this” style of senior management isn’t working and they would be much better off winding the clock back and just sticking with safe but basic nursing care until such time that things improve…and the only way this is going to happen is if we pay more in our taxes…the alternative will be private insurance and we will regret the day this happens for sure.

[david63]

by utilising all the unused private care home beds of which there are hundreds if not thousands doted around the country

That is not my experience (certainly pre Covid, but it may have changed). From my experience there is a waiting list of several weeks, if not months, to get into some care homes.

I suppose at the end of the day it all boils down to money. The shortage of nurses/doctors and hospital staff have been creeping up on our NHS for years, add to this the medical advancements which have extended our life expectancy beyond that which was envisaged can only exacerbate the problem further.

There is another approach and that is to scale back what is available on the NHS to what we, as country, are prepared to pay for. If we want an "all singing, all dancing state of the art" NHS then unpalatable decisions will have to be made as to how this will be funded - and it will require some degree of contribution from the end user - be that by direct payment, insurance or increased taxation. If we are not prepared to make this additional funding then the NHS will need to cut its cloth accordingly.

[Mervyn and Trish]

I'd agree with most that OL says except perhaps the bit about bringing back the nurse accommodation. I think that probably belonged to a past.era where nurses were almost universally young single women and I'm not sure how popular a return to those days would be. And I agree with David about the lack of nursing home beds. No surplus round our way for sure. But as I said before our town has two mothballed NHS convalescent wards. Get those staffed and open.

[Stephen]

I remember the nursing homes well

[barney]

Pre 2010 the NHS was in pretty good shape.
Minimal waits for anything.
It all changed after Cameron and austerity.

[Onelife]

Hi David /Sir Merv…we had dinner with our friends yesterday…she being a trouble shooter for underperforming private care homes. She covers a wide area with several care homes within her remit… she said there were bed spaces in everyone of them, 20 in one home.

https://careappointments.com/care-news/ ... filled-an-

[Onelife]

I'd agree with most that OL says except perhaps the bit about bringing back the nurse accommodation. I think that probably belonged to a past.era where nurses were almost universally young single women and I'm not sure how popular a return to those days would be. And I agree with David about the lack of nursing home beds. No surplus round our way for sure. But as I said before our town has two mothballed NHS convalescent wards. Get those staffed and open.

Sir Merv, I’m not sure why you should think encouraging young women or men into nursing by way of making it easy to be close to their place of work and living in subsidised accommodation would be a retrograde step. Nurses sh*t patterns often mean they are leaving late at night or early in the morning, the last thing they want to be doing is running to catch a bus after a long hard shift. The NHS need to be a far more attractive proposition if it is going to attract young people into the profession, I would have thought?.