Addressing the elephant in the room; people abusing NHS, health and social care.

After having twins by CS, massive bleed, second op to stop the bleeding, a 9pt blood transfusion, 24 hours in high dependency unit, then put on a 24 hour fast, at the end of the fast I asked for food and was told the kitchen was closed and the best they could offer was a packet of crisps from the vending machine - what a joke! Then they expected me to get up the next day with 40 stitches across my belly and no food in me for 48 hours to stand in a queue for my dinner. Care, they don’t know the meaning of the word and then they wondered why I couldn’t breast feed. Getting out of that shit hole they called a hospital was my biggest priority. There is no care.

Tbh, that was only part of the story. The woman was offered several options re accommodation, but turned them down. She is definitely one of the self entitled people that the OP is referencing. A&E is also hugely mis-used, a combination of decreasing GP services where you can’t get same day appointments, and that’s if you can even mange to get through to them on the phone, together with lack of education around the use of A&E. I think some people are so stupid, they really think A&E is an extension of a GP surgery.

Then you get cases like the EUPD wheelchair user who was refused by so many care facilities, who then refused the only place that agreed to take her, then spent years in a hospital bed until she was finally evicted under a police escort

It is absolutely true, it has happened for years and patients sometimes die before the ambulance arrives to rush them back to hospital.

Well I was in hospital a couple of times last autumn. I went home after being released but on both occasions I spent a week more or less in bed and watching telly thereafter (whilst recovering from surgery it was 3 weeks). I'm not really shocked that people fresh out of hospital need bed rest.

It's more complex than that. I've also witnessed people coming into an acute setting from their home and then needing nursing care. Rather than allow mummy/daddy/uncle/auntie some time in a nursing home they are whisked away by their nearest and dearest back to their own home so the family home/inheritance doesn't get sold to pay for care. These cases often end up in and out of hospitals frequently and sometimes the consultant geriatrician has to become the patient's guardian in order to get the care they need. I'm glad your colleagues talk to your patients rather than simply being task oriented professionals

I don’t know whether this exists anywhere, but I think there need to be intermediate facilities possibly jointly run by the NHS and social care for people who need lighter-touch medical support (but still some) but the predominant need is for social care.

I would blame the lack of funding for social care rather than the NHS.

I know someone who was bed blocking until a consultant decided to make the NHS and social services do something so the person is no longer considered a bed blocker.

This person has was repeatedly discharged from hospital when still unwell.

Some of the people I've known have been much younger. This is why I asked my family and friends who work in the NHS in different clinical roles and also live in different communities where they engage with their neighbours for their experiences.

Not everyone on levothyroxine uses all those services. I’ve been on it for nearly 25 years, never had an endocrinology appointment (well, not for that) or had any dealings with radiology. I have an annual blood test, doctor texts me to say levels look ok, and that’s it. So medication, phlebotomy and blood-related service and about 2 minutes of GP time.

And what when appropriate places are sourced and the patient refuses because it's not their dream?

Odd that myself and my SILs have seen it with our own eyes.

But then we are all liars. I am used to being called a liar and being gaslighted when I catch people in officialdom doing things wrong there as other people I know well either get them backtracking or compromise agreements.

That's complete tripe though. It's a very cheap medication... Even in high dose.

I think this is interesting, which bits specifically?

I would have thought the NHS’s colossally inefficient administration is far more of an elephant in the room than this.

I think we need to have a National conversation about what we expect the NHS to deliver. All social care for everyone including hospital beds (or even just beds) and carers I think will be difficult to provide for all, without a major increase in funding.

There are massive improvements in care with complex new treatments. Genetic testing and immunotherapies. Screening and now, God help us, Euthanasia. These things will cost huge amounts.

I think the NHS staff are exhausted with more and more change, which usually means more administration taken on by clinical workers.

We should empower workers with boundaries in the NHS. Those services that pride themselves on being good don't really know what they can safely say no to. Eg. Second opinion on the NHS, great idea, but 4th opinions? Transport for everyone that needs it, great idea, but for an escort too? Sure, in an ideal world you can have everything, but it's not an ideal world. I do think people expect a champagne service on beer money.

Is anyone actually explaining how the rehabilitation centre works or do you just expect them to understand it?

I did also work in a rehabilitation unit for a period of time, and I do understand some of what OP means.

In our particular place, people often came from hospital with dysregulated body clocks, and supporting them to reorient to day and night was important. It did feel a bit like a boot camp at times, but lying in bed all day wouldn't have been encouraged.

It was an expensive service, so if residents weren't following the therapeutic programme, then they could lose the funding to be there.

People who are "medically fit for discharge", may not be very well at all

There is nothing medically that the hospital staff can do further for them and the hospital can be a dangerous place for people with compromised immune systems

The challenge comes when someone who needs rest and rehabilitation or hospice care and who is medically fit for discharge needs to leave

That's where social workers, occupational therapists and the discharge teams come in

To prevent an 'unsafe' or 'failed' discharge, they are the ones who have to find respite/hospice/step down places/new homes/rehabilitation or who have to find all the equipment a patient would need to be discharged safely to their own homes

From what I can gather, the woman evicted from the hospital had physical and mental health issues which meant she needed to be in a social care environment, and the previous care home was not able to have her back again. Someone like that cannot advocate for themselves and find their own care home, they need officials to do it for them. Yet here you are saying she has been abusing the NHS and the very social care system that let her down so badly.

Do you have any actual genuine evidence you can offer which supports your elephant in the room hypothesis, or are you just here to be goady?

This is not true

Try as I might, I can't find this costing anywhere. I also wonder if this is correct it must include the costs of monitoring the drug, ie blood tests and appointments.

The Levothyroxine may cost that much, but factor in the cost of the regular check ups, doctors, nurses, Endocrinology Outpatient appointments, phlebotomists, biomedical scientists, laboratory aides, radiology staff to monitor the thyroid and all the admin staff who make this happen and it costs way more than €7.50

I think this is way way WAY down on the list of issues that are having a majority negative affect on the NHS.