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Very little discussion on the lack of non-covid NHS

(116 Posts)
sunshinedaisyfatrat Sat 11-Apr-20 12:23:51

Last night was the first time I saw a news bit from a paediatric consultant saying they were gravelly worried about the lack of children presenting to hospital etc. We've all heard that outpatients have been cancelled, no ENT, no dentistry, rehab stopped, operations stopped, chemo halted, lack of face to face GP appointments etc but very little reported on regarding the long term effects of this. Hospitals are having few strokes / heart attacks presenting etc. If you have covid and a stroke you get placed on a covid ward and receive no stroke care. It's just awful. Poor nursing staff can't be jack of all trades and know the intricacies of all client group needs at all times.

In my hospital all of the above have stopped bar high emergencies which could result in an admission. We don't even have an outpatient / ENT / paeds department now because it's been repurposed as the covid entrance / assessment area. Lots of people being redeployed but some are still only in the process of shutting it all down and going through redeployment training. This is in place for the long haul and not just the 12 weeks.

How will the NHS ever go back and pick up the work it was doing? All of the above was stopped to ensure covid patient numbers are kept just under the capacity threshold but that won't go away as long as covid is around and cases still occur. Particularly so when lockdown is lifted. Face to face appointment still won't go ahead as transmitting is still a risk and aerosol generating procedures will still be a risk.

Sorry, very rambly, just surprised there hasn't been more reporting / stories / concerns about this whole side of the pandemic.

OP’s posts: |
Goandplay Sat 11-Apr-20 12:26:47

When you say longer than 12 weeks do you see this being semi permanent?

Reginabambina Sat 11-Apr-20 12:27:49

To be honest I find this more concerning than the virus itself. I have a few old friends who went into medicine in a country that hasn’t experienced a large outbreak, even there they’re at risk of staff shortages (due to doctors and nurses isolating with symptoms). The long term effects of the current situation in the U.K. is very concerning. What’s going to happen to all the people who’ve been told to wait even longer for their care? How long will it take to clear the backlog?

sunshinedaisyfatrat Sat 11-Apr-20 12:36:11

@Goandplay I don't really know as we aren't being told anything from above. But it certainly doesn't feel like it's only going to be for another 9 weeks and then we will start reversing the changes back to normal. Some people in my team aren't even having their redeployment training for another few weeks. Some have been told to expect to be redeployed for 6 months plus etc. For every person not doing their job is a caseload waiting.

The aerosol generated procedures side will always be a risk until covid is gone surely? So no dentistry, ENT, endoscopy, keyhole work etc. Or what is done carries a huge transmission risk, mass PPE and deep cleaning in between appointments etc. Not very workable for non emergencies.

OP’s posts: |
sunshinedaisyfatrat Sat 11-Apr-20 12:37:23

@Reginabambina quite. We already operate an 18 week wait which is regularly breached. I'd fully expect this being taken away and there is no cap on the wait for non life threatening treatment.

OP’s posts: |
CrunchyCarrot Sat 11-Apr-20 12:39:53

Read this very sobering article written by a GP in Pulse magazine:

www.pulsetoday.co.uk/views/blogs/who-has-the-right-to-decide-who-lives-or-dies/20040524.article

bambinis Mon 13-Apr-20 16:54:45

I've just been reading threads on people's cancer treatment being stopped and the one where literally everyone's pretty serious appointments have been cancelled. I mean, if we're expecting more peaks and lockdowns for the next 12-18 months presumably, there will be no standard healthcare for all that time. People keep saying lockdown is to increase capacity in the NHS but a big part in that is cancelling everything else as well!

RubyDreamsOfRainbows Mon 13-Apr-20 16:59:46

Yep, my friends who work in hospitals (I'm in a community healthcare role) say their wards are empty of the usual heart attacks/strokes. They must still be happening but we think people are afraid to present because they don't want to risk corona 🙁

JemNadies Mon 13-Apr-20 17:02:52

Message withdrawn at poster's request.

Fivefourthree Mon 13-Apr-20 17:03:21

My DH was only saying earlier he'd prefer to die of a heart attack at home than risk going to hospital.
It's certainly a very difficult situation.

Topseyt Mon 13-Apr-20 17:11:06

I must say that this worries me a lot.

I have a couple of issues myself (not too urgent yet, fortunately) that I wanted to get advice on, but no chance now.

People have had some urgent appointments and surgery cancelled. My own elderly parents have serious medical conditions needing regular checkups and appointments. My mother has crumbling joints due to osteoporosis, my Dad has a blood disorder and significant COPD. The only help they get is the occasional telephone call if they need advice or a new prescription.

My youngest DD (she is 17) has clinical depression, anxiety and anorexia nervosa, which are controlled at the moment, but what the hell do we do when the next flare up happens?

It does seem that Covid 19 is the only problem anyone is allowed to have at the moment and I am convinced that it must be causing major issues already even though they are not currently being reported.

Laniakea Mon 13-Apr-20 17:12:16

I am much more worried about this than the virus.

I've had a haematology appointment cancelled, gynae indefinitely postponed & physio after a procedure abandoned. If the service ever starts up again I'll have start from the beginning & repeat the procedure. My son has had his OT & SALT cancelled - this is a disaster. DH had an urgent ENT appointment from March moved to June & video appointment not in person. Lets hope he doesn't have cancer.

Best way to 'save' the NHS is not to treat sick people!

bambinis Mon 13-Apr-20 17:23:04

And it's not going to be 'in the short term' is it? It'll be for as long as covid is around. I'm amazed the media hasn't picked this up and isn't writing stories on it!

ViveLEntenteCordiale Mon 13-Apr-20 17:36:16

CrunchyCarrot that is such a well written article. I'm really glad doctors are talking about it because when everything ground to a halt I spent a week panicking about my growing list of cancelled appointments.

I'm in a country with a better funded health service but the same thing is happening here too. I'm in that list of people further down the article - I haven't been denied life-saving care but I have chronic conditions and almost all medical support has disappeared. Even though my small local hospital is not taking Coronavirus patients (because they are all being cared for in the larger facilities), services have been radically cut. I spoke to one of my specialists last week and he agrees it's terrible that treatment isn't available, but because it's government ordered the doctors can't do anything.

buttcrackmcheese Mon 13-Apr-20 17:43:37

My sister works in a hospital and says the wards are half empty apart from the covid ones. It is a worry that people are too afraid to go to A&E etc if they really need to. Also I read on a local newspaper Facebook people slagging others off for going to a&e so that might put people off too.

OldQueen1969 Mon 13-Apr-20 17:48:27

This is a very interesting subject to me.

My current situation is this:

My 76 year old DM was diagnosed with stage 4 ovarian / omentum / peritoneal cancer just under two and a half years ago. In the first few months she had chemotherapy with a view to shrinking the tumours, which severely negatively impacted her quality of life, but did buy her some time. Last summer when scans revealed her tumours were growing again, she was persuaded to try another round with fewer sessions and reduced medications - she had one session and the side effects were so bad she ended up hospitalised for a week. She then rallied a little, and declined further treatment.

In February she was discharged from her consultant and moved to palliative care. At that appointment it was said that her increase in abdomen size was tumours rather than fluid. Within weeks she ended up needing to have between 9 and 1 litres of fluid drained from her abdomen and now has a drain that district nurses perform every other day.

Last week she had become so unsteady with oedema in her legs and peripheral neuropathy in her feet that it became obvious she could no longer live alone shielding with me going to her flat every day to give personal care and shopping etc - in addition she has such low sodium that her GP ordered blood tests and then had her admitted ten days ago for a saline drip etc to help. On that day she phoned her Macmillan contact to say she no longer felt safe at home and was at risk from falls, as well as telling her GP the same. The secretary of the Macmillan unit said that after consulting with the team, it was not allowed for her to move to our home where she would have a bedroom and ensuite, because of lockdown rules. They also said there were no hospice beds available because they have been shut down due to staff shortages and Covid pressure, although in our fairly large county I believe deaths are at about 50 (ish) and cases in the low hundreds - less than 300 last time I looked. No alternative suggestions were made as to how to manage the situation - I could not move into her one bedroom flat with her and share a bathroom in a shielding situation and my DP would have had to start going out to deliver shopping and prescriptions etc - another added risk on top of the journeys I had already been making (masked, gloved etc).

Fortunately her being admitted to hospital meant that the OTs had to risk assess her living situation. She was in for 24 hours and the consultant couldn't wait to get rid of her and implied that her admission had been over zealous despite her GPs opinion. He also said that IV treatment for low sodium could not be administered at home only in tablet form. The reason why this is important is that the low sodium is making her week, dizzy, and unable to eat anything other than eggs and one particular yoghurt because everything tastes disgustingly sweet and makes her nauseous and sometimes sick. This has been shrugged off somewhat as "just one of those unfortunate things". And she doesn't have thrush (another investigation done). So her nutrition has fallen massively, she is getting weaker by the day, and had had a couple fo falles while alone.

Now I KNOW she's dying. But she's a fighter. She is proud. She is absolutely against bothering doctors unless it's urgent - so when she is sobbing to a GP it's serious.

So ten days ago, in a 24 hour period we moved her electric bed and recliner to our annexe, bleached everything to within an inch of its life and she was discharged to us.

Macmillan nurse has since said this is fine , so I don't know what the secretary was smoking - but she certainly gave my DM the message that all that mattered was Covid. The things that are affecting her dealt with in a 50 / 50 manner, with an element of "hot potato".

Today's District Nurse was so awesome I cried when I buttonholed her outside to ask if her legs leaking plus all the other mounting issues were a sign of real decline. She is referring for a hospital bed, OTs to assess for other equipment, nutrition advice etc etc..... which Macmillan have been very slow to get involved with - if one can get through. before lockdown she was assured of Macmillan attention and visits at least once a week - since lockdown it's been increasingly difficult to get through.

Sorry this has turned into such a ramble. I think the point I have been trying to make is that it seems that lockdown rules are over-looking that if resources aren't there to provide professional care and family are willing to step up, the "Covid - rules" cry is going to leave people in limbo and a precarious situation. For days my heart was in my mouth thinking that some authority would come and take her due to risk - which as I have been doing everything I can with the rules to keep DM safe was no more than her being in hospital overnight, nor the day when she went to have her drain fitted.

Two of my friends have had their chemo suspended and are in their 20s and 50s so by no means at the end of the line if you get my drift.

So by the law of averages, if I know 3 people in this sort of situation, most people must know 1 or 2 - and if you start doing the maths I'm terrified at the potential for non-Covid harm and deaths.

Ages ago I said on a thread that a list of NHS non-Covid services and contact details should have been issued. We all know what to do if we have CV symptoms, but for everything else (bar 999 style emergencies) it is much less clear and can lead to multiple telephone calls before the right advice can be given when the usual routes are changed. I'm a bit baffled why entire hospitals have been cleared and are "quiet" (fully understanding the peak scenario) yet people are suffering and being denied things which would take pressure off the NHS by dealing with them now rather than when more significant and costly intervention will be necessary.

The staff we have been dealing with are lovely and I am very grateful to them - but it's obvious that Covid is the only real priority according to policy right now, which is impacting them too.

Something has gone very very wrong with all this.

JustDanceAddict Mon 13-Apr-20 17:50:20

I find this very concerning, Esp if you’re due to have tests or treatments. Surely when the curve starts to flatten they can reinstate a semi-normal nhs.

SquishySquirmy Mon 13-Apr-20 17:58:49

I've been thinking a lot about people who live alone (young and old) and the effect lockdown will have on the identification of ill health not just by medical professionals but by friends, relatives, colleagues etc. Previously some heart attacks, strokes etc occurred while the victim was at home. But some signs also started while at work or socialising.
Now pretty much all health emergencies will occur in the home. Which means less chance of a colleague saying "Bob, you need to get that checked out" or of someone phoning an ambulance on behalf of someone else.
So when does someone's absence become noticed?
When dh used to work away when DC were small I used to worry what would happen if I fell down the stairs etc. But at least their absence from nursery would have been spotted... What would happen to someone now if they are the only adult in the house and they cannot phone for help themselves?

Purplewithred Mon 13-Apr-20 18:03:11

@OldQueen1969 please can you report this to your local Healthwatch and/or the CQC who are on the lookout for experiences like yours. It’s horrifying that the services are so badly integrated and that your DM was subjected to such unsafe decision making. I wish you all the very best with caring for your mum.

OldQueen1969 Mon 13-Apr-20 18:04:21

@SquishySquirmy

This is a very good point for people without an extensive support network. I was helping an elderly gentleman for the last two years who I got to know through my shop with unmedicated mental health problems. My shop is shut and his only network was people like me as his engagement with professionals is fuelled by paranoia and sporadic at best. Because I have been solely focused on DM and her issues, I haven't been able to do anything about him and am praying his CMHT are following up as he is definitely vulnerable. I feel so guilty.

nicerainyweather Mon 13-Apr-20 18:11:42

.

OldQueen1969 Mon 13-Apr-20 18:12:01

@Purplewithred

I am indeed considering some follow up in the future but of course in the current unprecedented situation and given that things are now under control and my Mum probably has weeks (ouch to typing that even though I should be prepared) left, I am not sure where to start. The problem is obviously systemic and not with individuals within the NHS doing their best - but yes, in order to make sure improvements are made in the future I will be giving feedback to the appropriate bodies at some point. Thank you flowers.

My paranoia about being called out on technically breaking the rules has been massive - only a few close friends know what has happened and I daren't mention it on social media for fear of an outcry. We and my DM are willing to take the risks and responsibility - she already has a DNR and knows she is low priority for intervention and has accepted that - but until the end comes we have no idea what to expect.

bambinis Mon 13-Apr-20 18:13:00

@JustDanceAddict I don't think it will. The NHS has created capacity to deal with greater numbers once the lockdown lifts. That capacity comes from doing nothing else. They can't risk doing anything else in case it takes precious beds for covid patients. Also, face to face work increases transmission and many treatments are high risk so just won't be done anymore.

HarrietM87 Mon 13-Apr-20 18:13:13

I know my situation isn’t half as bad as others, but I went to A&E today (on midwife’s advice) after a night of heavy bleeding and pain. I’m 10 weeks pregnant and have had 4 previous miscarriages. A&E was totally deserted and drs were literally sitting around chatting outside the curtained booth I was in - they were saying they had nothing to do. They examined me but refused to scan me to confirm a miscarriage because “reassurance scans” are non-essential. I am on medication in this pregnancy which suppresses my immune system and so it would be massively helpful if I could stop taking that (assuming the baby has died) in the current environment!

I appreciate some services have to be cut but I just feel my care was so poor. I am really suffering physically and mentally and they just sent me home to wait for worse pain/bleeding or my 12 week scan (which isn’t happening until almost 14 weeks, also due to cuts in services). A scan would have taken minutes. I’m working full time from home and don’t know if I should have time off or not or what I can even tell them (they don’t know I’m pregnant). Just feel miserable and let down.

OldQueen1969 Mon 13-Apr-20 18:19:53

@HarrietM87

I am so sorry - that sounds utterly unreasonable and my heart goes out to you x I don't know what to say but offer you a hug x

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