Catastrophic state of the ambulance service: what's behind it?

[tulips27]

Seeing the shocking and upsetting thread where the OP has been waiting for over 24 hours for an ambulance for her relative who has a broken hip I want to ask what has cause this state of affairs? How can this be possible in our country? Can anyone offer any insight?

(Link to the thread for those who have not seen it: www.mumsnet.com/talk/am_i_being_unreasonable/4701431-i-know-iabu-blatantly-using-this-for-traffic-emergency-situation-no-ambulance-still-and-need-advice )

It's the knock on effect.
Doris (87) with a fractured hip.
She gets it fixed, transfers to a step down/rehab for physio.
During that time it's decided (eventually, these things take ages) that Doris needs a package of care.
It's taking several months for domiciliary care providers to pick up new cases due to capacity issues and it's unsafe to send her home.
So she's stuck in a hospital bed. At risk of further falls and infection.
We have around 200 'Doris's in my health board alone, in hospital beds they don't need. But literally have nowhere else to go. And this is just a straightforward case without the need for capacity issues, family arguments etc...
So when William falls there is literally no room at the inn because there is No movement throughout the hospital.
He is kept either on the floor where he fell or on the back of a truck waiting outside ED.

And do what with them exactly? Many of those waiting are waiting because they need a hefty social care package or care home or nursing home pand probably an ambulance transport to safely get them to said place. And probably all the associated equipment to make sure they can safely have care at home.

And who would be paying all these families to not go to work so they can be reluctant carers for their family member? I'm pretty sure the families that can do it to get their relative out do so.

Define eyewatering...

Eyewatering compared to what? Have you looked to see what it costs compared to other countries? Have you looked to see how rich the UK is compared to other countries? Those two things are way out of kilter.

6th richest country, 28th highest healthcare spending. That's the issue. We spend the 2nd least per person in the G7. That is a political choice not a necessity, we could afford to spend more, but we vote, and choose not to.

www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29

Unneeded ambulances are not causing this, it's the backlog and queues. Yes it's a waste of time to go to somebody with a cold, but the crew can be signed off that job within 30 mins and ready for somebody else. Waiting 8 hours in front of a hospital, how many jobs could they have done in that time?

It’s not that simple. My MIL was bed blocking recently. We weren’t unwilling to come
and collect her - we wanted to get her home. Unfortunately for her to be at home safely she needed a care package involving people who know how to safely transfer etc. we are paying for the package privately so it wasn’t even funding. It just took time to get it approved and sorted.

I don’t think people are bed blocking because their family have washed their hands of them.

www.walesonline.co.uk/news/wales-news/face-93-year-old-left-25794072.amp

Two weeks ago we waited 2 hours for an ambulance for my mum when we didn't know if she had had a heart attack or a stroke, yesterday exh waited 4 hours for an ambulance for exfil who was found unconscious & unresponsive. In neither case did the call handler stay on the line to instruct if the patient needed CPR until the ambulance arrived as they usually would have done. This government needs holding to account, everyone who has a case like this should be contacting their MP to get them to bring it up in Parliament, it's the only way to get anything done & if anyone dies then take the case to the media.

@Iliketeaagain Maybe view the child-elderly parent responsibility in the same way as we view the parent-child one now? As in, in an emergency you can leave work to get both your child and your elderly parent from hospital.

A child can be picked up

Most adults can't lift their parents into a car

As PP have said it’s all about patient flow. You can’t get people into the hospital until you get people out the other end.

austerity/brexit/covid have destroyed social care. Local authorities have been cut & cut & cut - they’ve no money to spend on fixing it. The government announced 500 million or similar in November to help with social care Winter pressures but divided up amongst every local authority it’s a few hundred thousand. My local authority got around £700,000 but it makes no difference. Most dom care providers don’t have any staff capacity & they can’t afford to recruit ppl on a higher wage because we’d have to put everyone’s wages up and 700,000 isn’t going to cover that for more than a few month.

the government doesn’t give a toss about social care (Tbf very few governments do) and to fix it will take years, a lot of money and difficult conversations with the public which a government like this one which governs by slogan isn’t interested in having.

In my local area, the social care sector is collapsing. And has been worse and worse since covid.
Care staff are paid minimum wage and expected to deal with ALOT. Abuse from patients, long hours, burn out, stress, no occupational sick pay. Care staff are burnt out and leaving.
Domiciliary care is suffering the impact of the fuel price hikes, most carers either don't get paid mileage or get paid about 25p per mile which isn't enough. They are overworked and underpaid and don't have enough time to provide proper care. Many leave.

Hospitals can't discharge vulnerable patients who need care without a care package in place. If there's nowhere for them to go, they can't be discharged.
Social services will argue over care packages (eg saying they'll fund a twice daily poc, but the patient needs a 4 X pic). If the family and the funding disagree this makes the process longer.

So these patients stay in hospital.
They stay in wards.
Anyone then admitted to a&e and needing a bed in that ward can't progress beyond a&e because there isn't the space.
Which then leads to no beds in a&e, so people in ambulances can't even get in the door.
Ambulances then can't attend emergency calls.
It's decimating the health service where I live.

agree it’s no flow in the hospitals. I’ve had the misfortune to be in our local a&e twice in the last week.

First time waiting times were up to 48 hours. We actually got seen quite quickly but after a blood test had to wait 8 hours for the results as “the system” crashed. Nobody in the hospital was getting results of blood tests and obviously a large number of people in a&e can’t be discharged until results are back. No beds available in the hospital for people who needed to be admitted and ambulances stacking up.

second time was better as the blood results system was up and running so we were in and out in six hours. Average wait times were still about 12 hours though. I heard a nurse saying they had 50 people waiting for beds and no beds available.

and yes, the beds aren’t available down to a large part due to bed blocking because of lack of social care/lack of care home places. It’s time the government funded state run not for profit care homes….though God knows how they’d manage to staff them as there just aren’t enough care workers now.

The idea that it's all caused by plonkers going to A&E for a minor ailment is naive. It's not that people DON'T do this (we know they do), it's just that it pales into comparison next to the massive societal and political issues facing the NHS.

We have an increasingly old, increasingly fat, increasingly inactive, and therefore increasingly unhealthy population.

Against this backdrop of people needing more medical care, we have a dwindling pipeline of doctors and nurses in training. We have a serious lack of accessible primary care (GPs). We have a serious lack of cottage hospitals and minor injuries units. This means a) that when people eventually get to a doctor, the problem has been exacerbated and is more serious and more care is needed, and b) people are forced to A&E for non-A&E ailments, because there is no other care.

We have lost a good number of hospitals over the last decade.

There has been a failure to invest in social care. This means hospitals can't discharge patients, and it also means, as above, that if people are unwell or need attention it is not always picked up on early, and therefore when they actually get care the care that is needed is more intense.

A lot (although not all) of the last three points can be summarised as "12 years of Conservative cuts". But the essential point is that demand is growing but the service is being cut.

The old lady my mum helps looks after, in her 80s, allowed herself to become so completely infirm and immobile to the point that she cannot get off the floor if she finds herself on it. What does she do? Pulls her emergency cord which then triggers a call to the paramedics as she needs a hoist to get her up.

An ambulance nearly every day because the stubborn old bird refuses to use her day bed, slips out of her chair and can't get off the floor. How much does that cost the NHS? And how much is it replicated across the country? Obscene.

A repeated message through this thread is that social care is not adequate and it's stopping people from being discharged and causing backlogs in A&E.

How could it be funded better and by how much? Can this country afford it?

What has caused it?

Dickeheads who voted Conservative.

This country could afford it

It does mean more taxation

One way would be to legalise drugs and raise taxes like we do on alcohol already

Also solves a lot of other social problems

The solution: perhaps portacabins, to eventually be replaced by proper extensions on hospitals, to house all the people waiting to be assessed or discharged into care, (people who just need basic care) and staffed by either volunteers or hired carers. This would free up hospital beds and help ease the problem of ambulances having to sit outside the hospital for hours waiting for their patient to be accepted into the hospital.

"Bed blockers' is a vile term - disgusting and dehumanising. These are (mainly) older people who have contributed to society all their lives, and who have every right to expect society to support them, now that they are frail.

In my village until last year there were two large care homes run by the same company. When the insistence on covid jabs became a thing so many left, many Polish care workers went back to Poland due to a combination of brexit and covid and not returned and now more people are leaving due to pay not keeping up with other sectors such as retail. So they couldn’t find enough staff to keep both homes open and closed one, the council had to find spaces in other homes for the 20 residents.

how much is this being repeated around the country ?

care homes say they can’t pay staff better due to how much funding they get from councils. I guess their costs have gone up as well, energy costs, food costs, equipment.

@tulips27

Quote (improving care work) "That's a very tough ask, isn't it? The way I see it as an outsider is that it is emotionally and physically demanding labour, long shifts and antisocial hours and all for minimum wage. Hats off to anyone who chooses it."

Several times I have said on mumsnet threads how employers always expect carers to be available at all hours of the day and night, every day of the week - rolling rotas etc and how some people might be available for mornings or evenings or weekends, around their partners work for example for childcare. People that work in care recruitment have replied each time that it's not possible to take any account of an employees preferences for hours. They all need to be available all the time - employers don't seem willing to even try and improve terms and conditions let alone pay. Retail and hospitality are 7 day services and sometimes 24 hours and seem to be able to offer people regular fixed hours. I think the poor terms and conditions are part of a culture of treating carers badly.

It strikes me that in private residential care shifts running understaffed probably increases profits. If a shift runs one person down the employer probably saves £100 and has an excuse why care is the absolute minimum/lacking and no extra activities. The residents are still paying the same as a fully staffed home. Care shouldn't be for private profit.

It would mean the government having to have uncomfortable conversations @tulips27

one of the main problems is that the government focuses what limited time it spends thinking about social care on the “how can we stop ppl selling their home to pay for care” but this ignores the fact that the vast vast majority of older people do not go into care homes. Of the 11 million people over 65 in the UK, less than 500,000 go into a care homes. The majority are supported to stay at home by family and/or domiciliary care. So what little thinking there is focused on the small minority who go into care homes rather than the majority who stay at home

it skews all the thinking about how social care is funded

This.

There was an A&E consultant interviewed on the News the other night, and she described the how desperate the situation is. And was very clear that investment in social care was very much needed to resolve the problems currently being faced. We can’t get people into ambulances because the ambulances are stuck sitting outside hospitals, unable to get patients into hospital because patients who are ready to be discharged are still in the hospital, so no beds for those who are arriving!

My elderly DF went into a nursing home last week, having been in hospital twice ( one hospital for medical care, then soon sent to another hospital for physio which was quickly realised was of no benefit as problem is dementia not physical) since April - apart from 5 weeks at home with carers, which didn’t work as he needs more care than they could provide.

Both times his discharge was delayed by months - due to shortage of social workers and carers. There are 3 men still in the 6 patient bay he was in who were already there when my DF was first admitted in May. They are waiting for care packages, or nursing home places. Some local nursing homes are not taking any new patients as they do not have the staff.

My DF’s second admission was via ambulance organised by his GP. On a Monday afternoon in June. The ambulance arrived quickly - about an hour after being called. That ambulance then sat outside the hospital along with 7 others for 5 hours until staff shifts changed and more beds became available.

While I was waiting outside the hospital a car drew up outside A&E with a man lying unconscious on the back seat. He had taken an overdose, his neighbours found him, called 999 and were told that it would be better to bring him themselves if they could as no ambulances available.

I’m in Scotland, where, like Wales, Health is devolved. If we’re going to blame the Tories we can blame the SNP and Labour too.

We need to get people moving into, through and out of our hospitals. We need to invest in care for elderly patients who have complex and chronic health problems and who need a high level of care outwith hospital.

@Theeyeballsinthesky are you sure about those figures? A lot of elderly peoples family don't have time to look after their own families and support them. If they could go home like your saying why are they blocking beds?

I do blame the Tories.100%. It’s not just the elderly and lack of care available for them causing backlog. They’ve done nothing to help those struggling with mental health either. There is practically no provision for children or adults. My daughter is Anorexic. She should have been sent to a proper specialised inpatient hospital 3 years ago but there are no beds so instead she shuttles in and out to paediatrics for anything from 2 weeks to 6 weeks. Often the young person section is full of ED patients, some for months. They need specialised feeding 6 times a day which takes ages with support and then NG feeds. It’s appalling. The poor nurses are run off their feet at busy times and those full beds are beds other children are waiting for down in A&E. The Tories don’t care about mental health at all. The system is completely broken and they’ve done nothing.