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?

The issue is there are NO staff. I hear people on here saying we have to provide as we are negligent. There are NO staff. I could assign one of my staff to 1:1 but that would mean other patients could die, sepsis patients requiring monitoring/antibiotics high flow oxygen patients deteriorating, on optiflow/epidural/chest drains, including post op patients.
What can we do? I live in fear of missing something and causing distress or worse to a patient. I have these same arguments over and over with site managers/matrons. We are just told 'baywatch' do the best you can.

I recently cared for an elderly man with dementia, post op so was more confused, he liked to wander, was risk of absconding and falling, he was under a DOLS RMN not warranted and no 1:1 available. The only action I could take was to let him walk around in the bay with me whilst I took obs and gave out drugs. I had no solution. Nobody wants to work in the NHS. I am not sure I can.

It is devestating to see the level of care we are giving, something has to give, often it's getting patients washed or to the toilet or spending time with a patient who has just be given bad news. When we get end of life patients it's even worse, often on hourly drugs, family understandably need lots of our time, I feel broken, I didn't come into nursing to do this. We are fire fighting at best.

I am so sorry for the poor care, sorry that it could be the same for my family too. I want to leave, but I want to make a difference, I feel I have to stay. I am a very experienced nurse, we are loosing these types of nurses all the time. We have lovely newly qualified/overseas and nursing associates but, we are letting them down. Virtually no supernumerary time, I feel I am there to prevent mistakes not mentor anymore. I don't have the time. I was up at 5am today to sign off 2 of my students, this has to be done, I don't get time at work and I am acutely aware they are our future.
Honestly, we are just about holding the NHS together, covid is increasing I can see us going back to masks and reduced visiting at work again.

Sorry for the rant I hope you find it useful to have an insight. It does not solve your problems and it is just the tip of the iceberg.
I have no advice, as I am that sister that would be trying to get a 1:1 but I know it never happens.

Yes. We had a patients family do this.
They certainly wouldn't pay for it, pretty common but tip of the iceberg in thr types of things dementia patients can get up too. But you can definitely do it. It'll make it easier for him and staff.

In my hospital we have a contract with a sort of private security for hospital settings company. The staff members are a sort of cross between a security guard with health training and a specialling HCA - they are employed to watch the patient and stop them from coming to harm / pulling tubes out / follow them round the ward and then the nursing staff come and do the same jobs they would do with any patient. They never seem to struggle finding staff as I think they get paid a lot by the hour and don't have to do the 'care' element of nursing.

Glad to see from latter posts that there may be some options available to the op, I do hope you are finding a way through💐.
On the subject of private enterprise not proving itself angelic just look at the way Philip Green was able to asset strip BHS and leave its workforce and their pensions under water. It’s abhorrent. That’s what would happen if we let them privatise them NHS.

I think it's unlikely you will either find someone or it be allowed to be honest. And with covid going how it is, things are only going to get stricter in terms of visiting imo. There are other things that may help. Does he have a falls sensor mat? Is he on a low bed? If he normally walks with a frame or a stick, is that nearby? Have you seen those fidget / twiddle muffs? They may help. Does playing familiar music or an audio book help settle him? Does he have a chair that is suitable for him (this may be need to be a recliner)? Is he eating anything? Could you put his likes and dislikes on a piece of paper above his bed. Try and be there over mealtimes so you can help then. Bring in day clothes that he can wear during the day and PJ's at night to assist in orientating him. It's really tough.

The lack of forward thinking in my trust is absolutely mind boggling. They must have spent millions on projects that have been abandoned after a few years. And don't get me started on the helipad that we should have on site, as we are an MTC. We had one. They built on it.

We only get 1:1 with the mental health admissions that are considered high risk. It used to be staffed by CSW's. But they were getting mutinous and leaving, so we have Agency RMN's to 1:1. We will rearrange staffing if a patient is very sick. But it's paediatrics so slightly different.

Does he have bandages over his Cannula's? That usually stops toddlers pulling them out so might work with an adult.

This sounds like chroma? Honestly the ones I have met are paid NMW toys waste of resources unless a patient is extremely unsettled because they don't have to do personal cares!

Thank you all so much for your input. Rupertpenrysmistress please don’t apologise for ranting. Your words echo those of the PALS woman, the matron, the junior doctor and all the nurses I have spoken to. The pressure you are all under is truly horrendous. I made it very clear when I went to PALS that this was not a complaint against individual staff but against the system that allows an 87 year old man to be unsafe.
Things have improved slightly in that one patient has left the bay my dad is in so they aren’t quite as busy. We have worked out a rota for daytime hours this weekend and last night he was watched as much as possible ( but he still pulled out his cannula - they bandage it, but he still managed to get it off). Today a nurse asked me if we would be here all day and when I said yes, she said they’d give him his IV fluids during the day so we could watch him. The fluids seemed to have calmed him down and made him a bit more lucid, unsurprisingly!
We have hired a carer to sit with him next week in the hours we cannot do and have managed to cover each day from 10-7 in that way.

Your dad is lucky to have you OP. What you have managed to arrange is amazing and I'm sure the staff on the ward are extremely grateful. It shouldn't have to be like this, we all know this, but what you have managed to set up is truly humbling. I hope your dad recovers soon.

Hairyfairy thank you. The IV fluids all day yesterday made a huge difference to Dad's calmness and lucidity ( unsurprisingly!) He is still very confused but responding more appropriately than he was. The regular mouth care and oral trials of sips of water have been going well, with no choking. By yesterday afternoon he'd stopped trying to pull out his cannula. Tomorrow the SLTs will assess his swallowing again and a teams meeting will be held to discuss whether they reinsert the NG tube or institute 'feeding at risk' - giving him small amounts of food with the understanding that he may aspirate it, which is likely to cause another infection, but will be beneficial to quality of life. We will be invited to the best interests meeting to discuss this ( we have POA). And this is the crux of the whole thing: if the delirium continues to improve then there will be more chance of recovery because he will be calmer and understand the implications of pulling out tubes etc. This will only happen if he is appropriately treated with IV fluids, mouth care etc. This can only happen if we are there to supervise. If he didn't have family I honestly think he wouldn't have a chance.