It is possible to pay for 1:1 care in an NHS ward?

[LaBelleSauvage123]

Posting here for traffic but have posted before about the situation on Elderly Parents. My 87 year old father is on a dementia ward following two weeks in ICU. Having been independent before the accident with only mild memory loss he is now severely confused ( the doctors say he has delirium which is common after a major trauma especially in the elderly). As a result he keeps pulling out his tubes and yesterday fell out of bed when I left the ward to go to the loo. The ward is understaffed - everyone we’ve seen says he needs 1:1 nursing but they just can’t get it - no staff available. We are here as much as possible but can’t be here all the time. He has private medical insurance but it doesn’t cover 1:1. The ward sister has said that if we can get someone in privately she would have no issue. So does anyone know if you can hire agency nurses to work privately in an NHS ward?

Hopefully some one has some relevant advice for you.

But a few years ago I read that independent midwives were banned from entering hospitals (professionally), when they used to be hired for one to one support. Reading between the lines it was to avoid issues/disagreements around hierarchy (and presumably liability). I would imagine similar could be the case here, although maybe not if the sister said it was fine.

You can certainly hire private self employed carers to come and sit with your dad and stop him pulling the tubes out. This is something I would definately do as a self employed carer. You don't need a nurse.

Expect to pay in the region of £22 an hour.

i would hire a ‘carer’ to sit by his bedside while you are unable to be.

If you can employ a carer you may have to check if they are insured, trained in dementia and have dbs checks to help him on the ward and would he need someone 24.7.

You have to check those things anyway @BlanketsBanned regardless of whether the carer was working at the hospital or in his home.

Independent carers may be very limited as to what they can do in the hospital. They may be fully trained to look after someone in the community and use equipment, but unless trained on hospital equipment they can't use it in hospital.

When my dad was very Ill, on end of life care, he was basically unconscious but would occasionally wake a bit and try and pull out iv and bladder catheters. We tried to get a night sitter but on questioning we were told that they were not allowed to restrain him from pulling out tubes etc . Much crying down phone from me as I was so bloody tired but basically that was it. So we just carried on doing it between dh and I.
So just check what they will or won't do is what I'm saying

I work in a hospital and staff have to be provided by the hospital if a patient is deemed to need a 1-1. I would be contacting your dads social worker the ward manager and pals. They can always get an agency carer in even if the ward is short staffed

I agree with this. If he has been medically deemed requiring 1:1 care or "special observation" the trust will pay for an agency special obs carer. I would push this given the falls etc recently. It would give you peace of mind.

I have never come across this,.although, I know that carers who come In with a patient from a nursing home, can, alternate sitting with the patient but they are not really able to do anything else, as they will not be insured.

I agree try PALS they might be able to add weight to your voice, trusts would rather quash complaints early. I will say though, our trust cannot even staff the ward, no bank, no agency. I hope your dad improves soon.

I’ve been to PALS and lodged a complaint but the woman there basically told me that there was nothing she could do other than log it. The matron came to talk to me today and said she’d applied for 1:1 but told me that they were very unlikely to get it. She said something like, if 1:1 is needed for ‘control and restraint’ then they can get agency staff in, but if not they have to staff it from the hospital. So a man in the ward who wanders about ( and I guess can be ‘difficult’ though I haven’t seen this) has constant 1:1. I am furious as I believe it’s a safeguarding issue but feel as if I’m getting nowhere. For tomorrow and Sunday we have a rota of family going in for two hours each to watch him and do his mouth care routine but next week we’re all back at work so I don’t know what will happen.

I’m so very very sorry. We had this issue with my step father - as far as I’m concerned it was euthanasia via nhs - no one had the time to do their job properly and we were not allowed to stay beyond visiting hours. We had the money to pay for extra but we were not allowed to bring anyone in. It’s diabolical. My mother now point blank refuses to go near a hospital. To be honest I’m with her.

Sorry to be the bearer of bad news but I have had clients with specified requirement for 1:1 in their local authority/NHS CHC funded care plan or DoLS and it’s still not provided in a hospital setting. It’s certainly not something you can just request and expect to be honoured. If you can pay for a sitting service, just to be there and flag up any issues, I would.

Actually, I’m fired up enough to change my wording on my previous post. It’s not just diabolical, it’s criminal. It’s an absolute disgrace and the mandarins in charge should be held accountable. There are many brilliant people in our health service but as I’ve said on other threads the system is broken. It needs a total overhaul.

@Blinkingbatshit Overhaul how ? That must be one of the most overused words on MN. Private insurance type schemes won't magic up 1000s of nurses or doctors.

If he requires enhanced care the ward have a duty to book a member of staff to monitor him.

I have seen 1.1 nursing for patients on a section or specialling as we call it, but for patients who wander and at risk of fall its rare, they often special a bay rather than one patient, telling someone to stay in bed, not letting them get up is a form of restraint. Teying to control and restrain someone can make it worse. The ward staff would have to carry out a risk assessment , the doctors need to decide what IV , oxygen, catheter treatment is essential if he has tubes in, is he on any medication to help him relax, does he have a lo bed and falls mats. It sounds very difficult and frustrating, domthe doctors think he will settle soon, its common to have post itu delirium.

Hi @Assanctamonioysastheycome , no I’m not talking about privatisation. But there is huge wastage in the system - both bureaucratically and financially. How come pharma companies make the nhs pay mega bucks (& get away with it) for paracetamol yet you can get over the counter for a fraction of the price? How come they’re spending £££ on reprinting leaflets to erase the word woman from everything? How come civil servants who are in the ‘top jobs’ are being paid well, well over 100k pa when they’re not effecting ANY useful change, and now we’ve made ourselves so incredibly unattractive a prospect to Europeans they need to be looking to recruit staff from further afield - Philippines etc as we are just not getting them from grass roots here.

@Blinkingbatshit absolutely agree !

There is massive financial waste in the NHS and we have been recruiting doctors and nurses from overseas for decades, none of this is new. ITU struggle to nurse patients 1.1 now so the chance of funding and finding someone extra for the general wards is pretty much zilch.

@Blinkingbatshit you are so right .The NHS is not underfunded, millions upon millions are thrown at it but they keep on employing more managers on huge salaries. Have swathes of employees that do very little work and are virtually impossible to get rid of. They need to bring in some top brains from the private sector to get rid of the waste and start managing it properly

Yes I pay a carer to essentially sit there and supervise and entertain. They can do basic medical tasks that we usually do at home, personal care, tube feed, washing etc, Can stop absconding and lines being pulled out. However can't touch anything belonging to the hospital (syringe drivers etc). Can't use any money to pay for it that has the merest whiff of NHS funding so continuing healthcare funds can't be used etc but social care money can.

I am a nurse in mental health and have had this discussion with general wards before that they don’t have the staff and can’t do 1;1. We have no choice in mental health, we would be negligent if we didn’t provide 1;1 if required, be it for falls risk, self harm or risk to others! Saying we can’t simply would not be an option. As you say it would be a safeguarding issue and if your dad were to fall and injure himself which is entirely possible and very often the reason we use 1;1, the ward would be culpable.

Staffing is a nightmare in mental health but we have to do it. And our first 1:1 comes out of our basic staffing numbers so we don’t get the choice of extra staff. I get that it is tricky for general wards to source mental health trained staff but agency RMN’s often like it because it can be an ‘easy’ job, just working with one patient.

I hope a solution is found.

No way would a general ward employ an rmn to sit with a confused patient, they would only be employed if a patient were sectioned and waiting for a transfer to a mh unit and even then you might be lucky to get a mh hca. A favourite expression on general wards is risk assessment and that you cannot fully prevent falls. I dont think any ward would allow a carer to deal wirh a tube feed either, employed hca won't do that. .

@Georgeskitchen would that be the same private sector that required government bail outs in 2008? Or like Carillion who went bust in 2018? Or who took hundreds of millions of pounds from govt during covid and didn't deliver on their contracts?

There's problems in both the public and private sector. One is not better than the other. The idea that if only the NHS took some CEOs from the private sector it would be magical transformed is ludicrous.

Perhaps the top brains from the private sector might like to look at how private hospitals can build and staff their own emergency admissions unit, fully train and staff itu and rhink of ways they can safely look after patients so that any complications are not shipped back to the nhs to deal with.