Once more, the media is full of stories on straining AandE admission rates and other service level issues within the NHS.
It is clear from earlier blog entries that I
have had to spend an awful lot of time under the care of the NHS in
recent years due to a broken spine. My treatment has necessarily involved a lot of time waiting around for clinic and GP appointments which has meant a lot of eavesdropping from boredom. The following observations are the result.
I think that some of the problems stem from too much
choice without sufficient information upon which to base a decision or,
at least, to assess if what you're being told seems a reasonable course
of action. I feel fairly sure I'd know when to call an ambulance but not
that I'd know when I need help that falls short of that but is more
urgent than a regular GP appointment for example. 111 is meant to plug
this knowledge gap but the phones are answered by unskilled staff which
means one usually has to wait for a call back from a medical
professional. I've rarely been told if I am talking to the cleaner, a
nurse, or a doctor so have had no idea how much reliance I can put on the advice received. I hold a Life Sciences degree so if I don't feel like I always understand the logic, what are the chances those without will make the right choice on if and where to seek treatment?
The number of missed appointments per week that my GP
details is truly horrific. I find it an odd contradiction that my NHS dentist fines for missed appointments but my NHS GP doesn't or can't.
I don't support charging as
the poorest would be excluded from health care with all the associated knock-on issues related to disease control and life-span as happened pre NHS. However, I do feel it might make all of us think a bit more before charging off
to AandE, wasting drugs by not finishing the course, demanding
inappropriate antibiotics etc if we were told how much our treatment
cost. For example, having the true prescription cost printed on the receipt that
came with our drugs, be told the average cost of a 10 minute GP appointment, having
the cost of our blood test printed on the results, etc.
On the subject of presciptions, 88% of prescription items are dispensed free of charge. I can't help wondering if the NHS would actually get more money of we dropped all exemptions yet lowered the cost of each item bought via prescription. It might even result in fewer courses not being finished given that people tend to value more that which they've spent hard cash on.
Of course, there will always be stubborn time wasters but I know
many of us are simply too helpless at the time we need medical help to be expected to think
for ourselves; good instruction is key. I finally had succesful fusion
surgery on my spine but the post surgical support was none existent at first. The impact of which was covered in an earlier blog entry which I've repeated below for ease of reference.
The biggest elephant in the room however is the issue of having somewhere suitable for the elderly and those with cognitive issues to be homed between ending their need for hospital care and being able to care for themselves at home. Social support has been cut to the bone, partly for financial reasons, and partly due to a buffalo like charge toward the golden land of being taken care of in one's own home. Yes, it is desireable, but is it always appropriate? There needs to be more synergy between the NHS, Social Care, and Housing. This subject was covered in more detail by bdonline.co.uk in an article by Pamela Buxton dated 22/July/2013, Eldery Demand Better Homes. Please note that you will need to do a web search for it (e.g. using the key words "housing for the elderly bdonline") as linking takes you to a subsciption form.
...ooOoo...
I
was a re-admitted via AandE (hours) and CDU (two days) this year
as a result of my spinal fusion surgery having some unexpected issues. I
had had an adverse reaction to codeine whilst in Orthopedics and larger
incisions than predicted, one of which kept bleeding for four weeks. I
live alone so had no support and was not really in any fit mental state
to care for myself when first discharged due to the impact of the
surgery and codeine.
You'll
find it surprising but I assign no blame to Orthopedics who were so
busy caring for a bay of Alzheimer's' patients that my bay's assigned
nursing staff had no time or space mentally to consider whether someone
who'd not had a standard experience of fusion surgery should undergo a
standard discharge procedure. I was discharged with nothing more than a
slip of paper with the ward number printed on it in case of concerns.
My
second discharge from an ENT ward was handled much better. The ward
sister had arranged appointments at my GP's to having my dressings
changed and checked, had re-filled my meds and issued me with spare
dressings and pads to cover anything I sat or lay down upon. She was
able to identify and address my needs as she was allowed the time to do
so.
That
said, I still ended up back in AandE twice more in the early
hours of the morning due to needing a flooded dressing changed at a time
of day when there was no other service available. Another night saw a
pair of district nurses being sent to be from another town by my GP's
out of hours service for the same reason.
My GP's practise nurses gave me some great tips later on how to handle the bleeding:
- stuff an absorbent pad down the back of my briefs
- tape inco-pads to my lower bed sheet,
- put another dressing over the top of the existing one if it leaks at an inconvenient time of day
- make use of the drop in centre in the Broad St Mall at times when the surgery is shut where possible
It's
just a pity I wasn't given these before being discharged the first time
as it would probably have saved at least two of my three trips to
AandE, and, perhaps, the district nurse visit.
I spent a total of twelve days in the RBH. The average for my procedure is 1-2.
I'd
just like to take this opportunity to say how impressed I was by all
the staff of Orthopedics, AandE, and Dorrell Ward. I just hope the
'powers' start listening to them over what they say they need to do
their jobs more effectively and safely.
