To think a bit of joined-up thinking might save the NHS some money?(30 Posts)
DM is 87, has had very severe osteoporosis and osteoarthritis for the last 15 years. This year alone she has had 4 falls, 3 of them involving paramedic call outs and yesterday's one - see below.
We spent 8 hours yesterday in two separate A&E departments with a possible skull fracture (sent from 1st to 2nd for poss CT/xray etc).
Luckily, no skull fracture but very shaken up and bruised old lady.
At 10.30 last night as we were being discharged, the nurse said "oh, have you ever been referred to the Balance Clinic?" No we said, we've heard of it, is it a new initiative? No its not a new initiative, it's been going for many years, it's designed to help people with poor balance cope better - skills, learning to move better etc - and also provides things like hip protectors so that if you do fall you are less likely to fracture a hip.
Is it unreasonable to think that someone over the last 15 years - like the GP practice for example, or the Intermediate Care Team who she was under for 6 weeks following a fall in August this year and in previous years - should have know this service existed and pointed her towards it??
It could potentially have saved lots and lots of dosh.
YANBU. Unfortunately this is pretty typical for care of the elderly, in my experience. I sometimes think some HCPs think elderly people are not worth bothering with, as they are just old, and what can you expect. I hope your DM recovers well.
Falls clinic - quite possibly
Balance clinic - only if she has balance problems (dizziness, unstable blood pressure , middle ear problems )
Sounds like she has mechanical fall issues due to bone related disease so wouldn't be a candidate for balance clinic
I think it's easy to not really understand how certain speciality clinics work and presume someone is negligent. Doesn't sound she would be a candidate for balance clinic
And speaking with respect here. Re: nurse - it is not her remit to know the criteria for referral for balance clinic. She was probably just trying to be helpful but may have confused you.
The intermediate care team would have a good idea whether your mum would benefit from a falls clinic. Not everyone is candidate and useful if people have multiple reasons for falls which need unpicking (i.e. several illnesses ) . If osteoporosis and arthritis is it usually not a medical conundrum and therefore doesn't need a falls clinic, if that makes sense
There is not good evidence about hip protectors - research is conflicting about benefit vs harm.
thank you acornfed that is actually interesting and really helpful, and maybe the Balance Clinic is not right for her, because it is mechanical rather than related to other health-issues.
It was all very stressful yesterday... but I also agree with leopard about the general fobbing off of the elderly - direct experience of that one led to DM being hospitalised with pneumonia and 3 new spinal breaks and a fortnight's admission.
So it's really hard, as the next of kin/advocate/daughter to actually know what to believe or where to turn next. Maybe a return to the old GP system where you had a doctor who knew you, knew your history, knew your social support network etc. One can dream!! It's probably cheaper than getting paramedics out over and over though.
Totally agree with acornfed - don’t think your mum would meet the referral criteria for our falls clinic. That said I do feel for you OP if your mum’s GP isn’t much cop get to know her local community health provider. Is she under the care of a district nursing team or community matron? They are ace at signposting to services and generally have more time to spend with patients and families than GPS do.
My DM was referred to the 'falls' service after a hospital admission following a fall. There was a 3 month wait - by the time the referral came through she was back in hospital following another fall - she never came home .
so sorry bigbluebus.
sparkle I will look into those options. she's not at the stage of needing personal care, which I think cuts her off from lots of stuff, but we are going to need to do something. sigh.
YEP agree totally.
DH has a rather nasty little growth on his leg (behind his left knee.) He saw the doctor in May, who said she will 'refer him' to a specialist. He then got a letter 2 months later from a private clinic (although NHS will pay the £300 odd bill for the consultation/diagnosis,) asking him to ring to make an appointment. He rang them (mid July,) and got an appointment for 2 months later (mid Sept.... 4 months after he first saw the doctor.)
So 15th Sept we drive a 60 mile round trip to this clinic, using £15 of petrol, and my DH had to use a half day's leave from work, and went to the consultation that cost the NHS £300 quid. He was called in and spent 3 minutes in there, just for the 'expert' to say it's a certain type of cyst, and needs to go back to your GP to be put on the list to get it removed.
It then took him a MONTH to get a GP appointment (which was 2 weeks ago,) just for the doctor to put him on the list, where he will wait 4-5 months. Meanwhile, he is in pain and discomfort with this cyst.
Why the original GP could not have diagnosed that it was a cyst himself, we have no idea. 5 months wasted, half a days leave, £15 of petrol, and £300 NHS money.
Hindsight is a wonderful thing.
By your own admission it was a nasty growth - clearly needed a specialist to rule out cancer by the sounds of it.
Referred back to GP for further management . Entirely 100% appropriate
Ps hip protectors are not clinically indicated to help reduce hip fractures
I work for falls team (ot) and we get most of our referrals from fracture clinic and ambulance service.
Hospitals are too hot. Turn the heating down a degree or two and save money.
Oh and if your mum had ict in the summer and was seen by ot then honestly she probably was assessed on their visits. Sometimes it can feel very informal so doesn’t feel like an assessment. This has the benefit of not being frightening but the disadvantage that she may feel she has missed out.
And to the poster thinking hcps feel elderly people aren’t worth bothering with.
Sorry if this is reading as being snippy but after a day of very tricky patients I think I’m a bit prickly!
I recently cost the NHS a good few tens of thousands. They actually encouraged me to bed block for weeks instead fitting in an emergency surgery. Do you know how much I would've cost them if they had a dedicated team for gallbladder removals to do same/next day surgery? Less than £2k.
Now X that number by about 40% of women between the ages of 21 and 80 over the next 20 or so years.
The NHS isn't failing from lack of funds in a lot of areas. It's failing from shitty management in most areas.
Yanbu. I read some government research papers at my work 5 years ago and at that time the average cost incurred overall by an elderly patient being hospitalised for a fractured hip was £27k! (In Scotland). They should definitely be doing more joined-up, preventative work. I hope your gran makes a good recovery.
I read the other day that every time politicians say they will raise taxes they then lose in elections.
How do people think the NHS can provide better care? More elderly patients, more expensive drugs, more illness ... it becomes fire fighting.
"The former head of a surgery’s patient participation group has questioned whether the operator is putting profit before patients after the death of his father from cancer.
Nicholas Challen, former head of Church Lane Surgery’s PPG, has blasted operators Virgin Care in an official complaint to NHS England.
Since Virgin took over the contract at the surgery in June 2016 Mr Challen says the service has gone from “crisis to crisis” and care is getting worse.
He said: “In my view Virgin are running the surgery as a standalone profit centre, and cutting corners to make the numbers work rather than a public service, fit for purpose.
"I do not blame the staff at Braintree level. They are under a lot of pressure, and not being supported adequately from their head office, which includes adequate training, staff retention and recruitment.”
Donald Challen was first visited by a doctor from the surgery on Saturday, October 14, when he was diagnosed with an infection and prescribed antibiotics.
Two days later after no signs of improvement, Mr Challen called the surgery and asked for a home visit as his 84-year-old mother Patricia was struggling to cope.
He says he told staff several times he thought my father was at the end of his life.
A doctor attended and an appointment with the district nurse was booked.
On Wednesday 18 the district nurse attended for what had been booked as a diabetes assessment.
In despair Mr Challen called the emergency services.
His father was diagnosed with terminal cancer at Broomfield Hospital on October 19 and passed away on October 28 with the family choosing palliative care.
Mr Challen said: “I was chair of the PPG for three years, stepping down in September.
"In that time I have seen the surgery lurch from crisis to crisis, and under Virgin’s stewardship, it is getting worse.
"The reputation of the surgery is extremely low and Virgin must be held accountable and resolve the crisis they have created.”
Virgin Care has defended its record at Braintree’s largest doctor’s surgery.
Asked by The Times whether the standard of care at Church Lane Surgery was good enough, a spokesman for Virgin Care said: “As an experienced provider of GP services for more than ten years, we have very strong policies and procedures in place in line with national best practice.
“Since taking on the surgery a year ago we’ve been implementing a transformation plan which has significantly improved the practice, moved to new purpose-built premises and added additional clinics and appointments as well as increasing staffing - 81 per cent of patients rating the service this year say they would recommend it.
“Recruitment of GPs is challenging across the country but our recruitment campaigns have allowed us to recruit a number of GPs for our Essex services since we took them on last year and we continue to work hard to appoint permanent GPs for the surgery as soon as possible.”
NHS England confirmed they are investigating Mr Challen’s complaint."
A lot of the issues in that article aren't the surgery but the wider community led services. HCPs don't want to do the grunt work any more they don't want to see people in their homes they see the elderly as an inconvenience and woe betide you're of working age and disabled then you're totally screwed over.
I have severe musculoskeletal issues. The waiting times in my area to see specialists and physios is huge and I've been told by more than one clinician that the expectation is my age group should go private to free up space for the elderly. I have needed surgery in the past, again bumped off the list for an elderly patient.
I'm not being ageist but surely specialist geriatric clinics or hospitals are needed seeing as they take up so many of the resources especially in orthopaedics and cardiology/vascular issues. Surely someone my age they can operate on and send home without a care package in a day or 2 and get us back to work so why do we have to wait the longest?
With regards @helenadove article - most of the complaint isn't a surgery issue it's a ccg community one
There are problems with the surgery as well Comments on the fb page of said paper like a GP not being able to finish a patients med review in the allotted time
So patient told to ring up and book another appointment to finish med review and struggles to get one.
Oh wow! Most GP's would have just run over the time - mine does frequently.
Er.. there are designated geriatric clinics!!
Also to the poster about same day : next day gallbladder ops- where is the staff and theatre space coming from for that service in a grossly underfunded and debt ridden hospital trust? There is just not enough money in that pot
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