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 )

Right, so you get urgent leave for a day to pick your elderly relative up (assuming they can get from ward to car, then out the car and to the house which has a toilet, bed and chair which said elderly relative can get to) the only thing is that emergency leave is meant so you can sort alternative provision for care.

But if the hospital and social services haven't managed to source care, then the family is not going to be able to magic it up either - privately arranging a care package takes a while too, even if you have money to throw at a situation, it can be incredibly hard to find care via a care agency.

While I understand the sentiment, caring for an elderly relative for one day to get them out of hospital is one thing (and IME, many families who can, will manage a couple of days until an agreed care package starts). But it's an entirely different thing caring for an unknown amount of time for an elderly relative who needs help with everything, may be confused, may be incontinent and need frequent help with hygiene.

A huge part of the social care problem is Brexit. I go into care homes several times a week. Virtually none of the staff are British by birth. You can argue about the ethics of relying on people from poorer countries to staff our care homes, but the fact is that we did. Pre-Brexit, Eastern European staff were the mainstay of most care homes. Now they have gone. This was widely predicted pre-Brexit and after the Referendum, but nothing was done.

Im not saying they can go home, I’m saying that the population of older people in care homes Source is much much less than older people living at home. I’ve worked on ageing issues for 30 years and it’s always been the case that the vast majority of older people remain at home (tho given current shit show, expectation os population in care homes may increase simply because people will reach crisis point, be unable to cope and end up in a care home precisely because there isn’t the community support)

However because the government only ever thinks about social care in terms of “selling family home/care home” scenario, it doesn’t look at funding social care to support people to remain at home.

In the last 50 years, we have had a labour government for 18 of it.

Its the tories and the people that vote for them

I heard the head of the service in Wales on Times radio this morning explaining that they lose a third of ambulance availability every month because of ambulances waiting outside A&E.

Right wingers love to criticise NHS inefficiencies and tell us how much better it would be to privatise it. Frankly - having a third of ambulances unavailable is beyond outrageous. Imagine a third of airplanes or ferries being unable to disembark passengers? The Government would have to act.

But this is only the NHS (and Social Care).

Where I am in Scotland, it’s local authority community alarms teams who respond to falls and similar events. In my experience this is a pretty efficient system, and no need for an ambulance unless medically required.

The other thing when taking about family support to help discharge (by which people usually mean adult children generally daughters!) is that 1.5 million people over 65 in the UK don’t have children and 4 million people over 50 don’t have them.

that’s before you even get to the issues PP have pointed out about families working/living along way away/the more complex issues associated with very old age and how long they take to manage

It may possibly work for some but it’s not a workable solution for most

What did they do to improve it during their 18 years?

Here you go How waiting lists have changed over the years

We are forcing the elderly to live way past the age they'd NATURALLY live to and the already over stretched NHS can't cope.
My 96 year old gran is suffering from paranoia and dementia, has lost the physical ability to stand up without fainting and is being given antibiotics every 5 mins to keep her alive when she says she wants to die. She should be allowed to pass away peacefully and with dignity in her sleep.

People were lectured "don't smoke" and viewed as selfish when they got cancer from it but guess what people who quit or didn't ever have bad habits are living 10-20 years longer.
Today I read dry shampoo causes cancer so avoid it. Why? So we can live to 100 when our mind's garbled and we have no independence.

This. Frail older people insistent on being discharged to unsuitable living accommodation and falling about, only to be readmitted several days or weeks later to repeat the cycle. And refusing to pay for carers.
I was a district nurse for many years and saw this time and time again.
Only part of the problem of course.

Was talking about this earlier with DP.

Could NI not be increased? I don’t mean by £1 or 2, I’m talking like £85 a month type deductions? I’d be happy to pay.

People seem to be eager to complain but as soon as anyone mentions increased contributions the conversation changes. The money will have to come from somewhere xxx

MH services have also been cut which leads to a knock on effect to the NHS as well (suicide attempts drug/alcohol abuse, etc).

It’s not just the elderly in A&E. We were there for 7 hours 3 weeks ago. Loads of babies and teens waiting for hours.

For most of the last 15 years, we have spent about 1.5% of GDP less on healthcare than Germany. That might not sound like a lot, but it's a difference of 15 billion a year (corrected for relative population sizes).

Germany has 4.3 doctors per 1,000 population, the UK has 2.9. We are particularly short of GPs and other community-based HCPs, compared to other countries - we not only have fewer GPs, but they are expected to deal with a broader range of conditions and do not have direct access to many tests, so are working with one hand tied behind their backs.

Crucially, Germany more than 29 beds per 100,000 population, whereas the UK has 6.6. Despite that, until Covid, I regularly heard twats from NHS England arguing vigorously that we had too many beds.

Having seen social media posts where people have complained that they had to get a taxi to hospital (and did not need treatment en route), I'd hazard a guess that part of the problem is some people using ambulances as a free taxi.

Everyone who gets any life saving nhs treatment is living outside of the natural order

Be then 90 or 9 years old

We could save a fortune if we didn't treat self inflicted illnesses also but I think refusing to treat fat people is as bad a refusing to treat elderly

Well, the wait for a hip replacement where I worked was 22 days from the GP making a referral to discharge home with a new hip implanted.

99% of patients being seen and treated or discharged from ED within 4 hours.

Referral to treatment times have increased every year since 2012, reversing a trend of them declining every year for the preceeding 8.

Basically every metric has deteriorated in the last 12 years, although I did see one that had improved - GPs saw more patients in November than any other month on record...

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.

This has been a problem for years, not just since covid/Brexit and it's so common. And speaking from experience, you can complain all you like to the CQC, but it has to be really bad, or something major actually happened, before anything is done, and even then, most of the time the care staff on duty are the ones that get thrown under the bus, and the actual problem of too many people, with too greater needs being cared for by too few people with inadequate resources and training, is not addressed.

Care providers, local authorities and the government are standing around wringing their hands, bleating that they don't know why they can't get good care staff to work in the sector, while treating them like a necessary evil, training them to the minimum standards (or not even that) paying them the least they can legally, using zero hour contracts, no job benefits, expecting them to work for free, expecting them to provide their own equipment.

Society says they don't want people in it for the money, and then tell them they're unskilled so they can't expect much, while expecting professional standards and behaviour and the best care possible. The standards have risen and risen while the investment hasn't, and what has is used for profit rather than improving the care already being delivered.
People don't want to need care and they resent when they do, they don't want to sell a home to pay for it, families don't want to lose inheritance, government don't want to pay for it.

I worked in care for years, I now work in hospitality and get around £5k a year more - same level of supervision. That tells me that society is more willing to pay more for a leisure experience than they are for the care of the elderly and vulnerable, and that's the root of the problem.
We want gold standard care for bargain basement prices, and are allowing some of that money that is paid to bolster private profits.

But it's a subject people don't want to discuss and I'm very surprised no one has yet mentioned euthanasia or said it won't happen to them because they'll be off to Sweden if they get to that stage - while euthanasia has its place and I truly believe that it's a conversation to be had, it's also not the answer to the issues that social care is facing, which is exacerbating the issues facing the NHS.

I have worked in health and social care for 30 years. Things actually changed a little for the better in the Labour years imo when I worked for health. Now 20 years social care, the last 10 years things have got rapidly worse. Community hospitals closed, wards closed, no nurses to staff wards, no carers/care packages, so people are on wards and cannot get home as no community care, ending up in care home beds they dont need waiting for care packages for months on end until they are deskilled and instautionalised and cannot go home as have lost independence.

Carers can earn more in Aldi than by doing their essential work and are not valued. This is where it needs to change decent pay and proper recognition for carers (and NHS) will make a huge difference.

And yes, I do blame the Tories!

This

I've also seen same issue re discharges when people think because they came in via ambulance this is the only way to go home which of course is preferably done with patient transport but not always!

YY re MH. My Dd has been admitted twice from A&E the last few months. Mental health provision is completely broken, they are doing nothing. This government just doesn’t care- not about the elderly, struggling teens, mentally ill adults or children. Nurses and ambulance drivers are trying to plug massive gaps.

We need a different government.

Can we please stop blaming older people for being old? I agree that people should not be kept alive against their own wishes. However, people who live to very old age actually spent fewer years in serious ill-health (on average) than people who die younger. On the whole, we have succeeded in extending average lifespan without extending years of poor health - though of course there are individual exceptions.

Everyone, no matter how old they are when they die, cost a lot of money (on average) in their last year of life. This is true when people die younger too.

Thanks this is a really interesting thread

Problem with erecting social care porta cabins/temp buildings is that they can't find enough staff to staff them. I wondered why they didn't convert those big temp hospitals they built for covid into a sort of temp housing for those who couldn't get social care packages but there weren't enough nurses

I read an article yesterday that said even though we lost a lot of carers post covid and brexit they have largely been replaced by non EU citizens coming in. The other big issue is medical staff retiring because they hit their pension limit and get taxed every month. The government needs to urgently sort that out like they did for legal staff/barristers.

Btw there was a social care NI levy that was put in but it's got reversed though I think sadly, even with money, this isn't going to be fixed quickly.