A&E crisis

[mumsthewordi]

i am shocked to see the images from the wards, particularly impact on most vulnerable. Is this just the reality of a health crisis under any government, or do we think Labour have something to answer for?

Well you hear them at the desk normally
and talking amongst themselves since they’re normally there with the whole family.
And I’ve been in a bay at a day assessment unit where everyone hears everything.

We need to treat this as a proper national emergency complete with extra legal powers, money to draft doctors into A&E short term etc. We are still one of the richest countries in the world but our medicine would disgrace far far poorer countries, unless you can pay for private or can manipulate NHS resources to your advantage (doctors, politicians, NHS workers etc)

All costs money, lots of it and staff that don't exist, more through put of patients in AE, means we need better social care, more beds, bigger buildings, scanners, staff....

We are not rich country, around 27th per capital in the world and fairly down the order in Europe.

25% of the population are classed as disabled, 3.8m on sick benefits and a rapidly aging population.

Also, on the personal responsibility point, at present only around 60% of over 65s have had their flu jab, and only around 24% of eligible under 65s. If each of those figures ad been even 90% it might have helped?

We have a fairly unhealthy population on the whole.
diminishing care within families and marriages

there is only so much the NHS can do

there are men round here sink pint after pint with bloated bellies
people with copd and diminished lung function still smoking
older adults mountain biking and horse riding needing helicopter lifts out of the woods

how many people on here would look after their parent/aunt, help a neighbour out to recover or not go into hospital in the first place? Some but fewer as time goes by.

we all contribute to the strain on the nhs directly or indirectly
people eat rubbish are sedate expect the nhs to provide free home care

so we all wait longer and longer for actual medical treatment and call GPs lazy

25% of the population are classed as disabled

True but disabled doesn't automatically equate to "economically inactive". Many disabled people (such as myself) work and more would do so if society was just minimally more supportive and better organised.

Tbh when I 'm in children's a&e I tend to be there because I am sufficiently worried about my own child to not really be paying attention to what is going on with other people

Under funding for years and It's the fact that we let people from other countries use or NHS for free, if someone from another country falls ill when they're visiting they should have to have medical insurance to pay for treatment.
Also I know a family that in their country have to pay when they give birth so before their relatives give birth they come and stay with them and give birth here for free. Bloody disgusting, probably also means there kids get a British passport.

Ah well weirdly I seem to be able to be still worried (and apart from the broken arm one been sent by GP/111) and my ears still work,

I don’t think it’s controversial to say people seem to have very differing thresholds for visiting A&E and some in my opinion are too low.

Years of underfunding have led to this. It's going to take more than the 6 months Labour have been in power to fix it. Not a job I would want to do but staff retention is surely a top priority. I also read an article about the state of some hospital buildings. Patients and staff need to be safe.
People have to accept that if we want decent public services, we have to pay for them. Governments need to be transparent and make sure they're not giving contracts to their cronies. Last Tory Government, I'm looking at you.
Adult social care needs to improve. Watching the Ambulance TV programme, so many calls related to mental health issues. These people need better support.

Would private A&E in time not take some of pressure off attached to private hospitals? Possibly in big cities? You get seen almost immediately in some countries overseas & the public hospitals are not overburdened.

This ties in with the cries for longer prison sentences or custodial sentences where community reparations have been imposed, or cries against care conditions across a range of needs. Most of the general do appear to be unable to grasp that this needs to be funded in some way that will impact on them.

Yes I'm like you. I have two part time professional jobs. One will physically be beyond me in the next couple of years, even with reasonable adjustments but the other I hope to do for many years to come because I enjoy it and can work from home.

One thing that helped me was being able to retrain in a second profession. At the minute this is far too difficult to do and self-funded. Increasing access to this would massively boost disabled people's ability to retrain for new careers.

The issue with the NHS is not simply that the conservative government underfunded. It's run really badly...
A&E are the crumbling face of all the other departments which can't cope - GP's, Sexual Health Clinics, Nursing Homes, Mental Health departments. They all fuck up and everyone ends up in A&E.

I agree that until Social Care is sorted and people start to take a bit more responsibility for their health and longer term plans, then we are stuck.
Please have conversations about your wishes whilst you are able to. Set up lasting power of attorney for finance and Health and Wellbeing. If you are getting frailer and living in a completely unsuitable property, think about moving somewhere sensible whilst you still can manage it. If you are bending over backwards to support a family member who will not agree to a package of care, step back NOW and get the care sorted. If you are in a completely toxic relationship where you don't want to be, get it sorted, situated your lives and make a plan.
I have worked in NHS for years and there are multiple reasons for the chaos currently but some of them are about US and our lives, not the hospitals.
The hospital wards should be used just for people needing medical care but for years they have been boarding people who do not need to be there.
Reasons people get stuck are as follows
They have been struggling at home for years but not done anything about it and now need to await care package
They have relied on family/ neighbour for years who are now exhausted and cannot continue so awaiting care package
They have had deteriorating cognition at home, maybe undiagnosed dementia, and have struggled on and now in hospital are denying they need any help and wanting to just go home but hospital are told they are not coping at home so need capacity assessment, best interest meetings etc and Social Workers are less present in hospitals since COVID times so all this causes delays
There can be background of toxic relationship where patient refuses to go back to their home or partner refuses to have them back and says they will lock the house and not let ambulance crew in
We have patients admitted whose homes have no heating, no water, floorboards missing etc
We have patients whose families device to get the builders in to re- decorate or adapt the bathroom and dash they must remain in hospital until the work is finished
We have families/ next of kin who just disappear so we cannot contact them to arrange discharge
We have patients whose houses are just completely unsuitable or who need furniture moving to make a hospital bed/ hoist/ commode fit in and we are told there is no one to do this or it will need to wait until the weekend after next when some family member has a gap in their schedule
Were have battles with families where the patient has several children who do not like each other and all have a different view on what should happen, often differing with what patient wants too. Staff get shouted at and threatened with legal action is they suggest a patient needs to return home because that is what they wish and they have capacity.

I could go on and on as the list is endless and all these things occur daily in a busy acute hospital.
Add to that the logistics of trying to manage who goes where in a hospital.
You have a 27 needed ward with bays of 6 patients. In a bay of 6, someone suddenly deteriorates and is diagnosed with flu/ COVID etc. Now all the 5 patients in that bay are considered exposed to flu. None of them can be discharged to a Care home or rehab facility even if they were ready to go that day. No one else can be admitted to that bay until all those patients have been discharged or been cleared of exposure. Same with norovirus and other D&V bugs. Whole ward had to be closed to admissions until there have been no symptoms in any patients for prescribed period of time. These wards have to then hold empty beds whilst patients pile up in A&E.
At this time of year we have flu/ COVID/ RSV everywhere plus D&V. We ask visitors not to come in with coughs and colds but people do not listen. The logistics of keeping a hospital running are a total nightmare of juggling on a daily basis and patients have to be moved around to make this work but that is also not good for patients who are confused and those who are not confused will moan about being moved but there is always a reason, often to do with infection control.
Another factor is that when there is an increased number of unwell needing hospitalisation they is not suddenly more doctors or therapists or pharmacists. The wards get staffed with nurses as there is a template for what that staffing should look like, but the doctors for that specialty just have to stretch and see an extra 15/20 patients a day. Our extra medical patients get boarded on our surgical wards so surgeries are cancelled too accommodate this but a urology consultant cannot review a respiratory patient or a frailty patient. Since Christmas we have had the equivalent of a whole extra ward of medical and Ortho patients and the specialty consultants just have to fit them all in. The physio and occupational therapy resource remains the same but we are not usually needed for many of the surgical patients but are for the frail elderly so those assessments can ask take longer.
If people could leave hospital on the day they were medically fit to leave, we would have enough hospital beds.
But no political party seems willing to sort out social care and these issues will continue until we do so.

Nailed it

Its a realistic time frame.... so you need to get people in their teens to do the right A level subjects to do Healthcare degrees, which take 3 years, so thats a 5 year time lag.... if you started right now.....

It then takes 2 or 3 years for them to gain experience....

Then there is finding land, planning and construction for new Hospitals, my local, Derriford was first proposed in 1950, approved in the late 70s and finished in 1982.

Doctors take 10 plus years to train up.

TBH 10 years sounds optimistic, especially as demand is only going up.

Shorter term, Social Care has to be addressed right now and Labour are bang out of order for not doing this.

The only reason I can see for not dealing with social care and implementing the Dilnot report is money. The government are already in dire straits and promising not to increase taxes means they have no money to sort out social care so Starmer/the Treasury have forced Streeting to announce another review to kick it down the road, despite everyone knowing that will stop the NHS improvements.

It's time for this government-any government-to state plainly and without apology that social care and a good NHS needs money and to put up taxes to pay for it. They need to state it quite clearly with where and how the money will be spent and then announce the increase. But they really shouldn't be waiting til 2028 for the end of another review

I do agree that a lot of people are in for nonsense but sometimes the system doesn't allow for help other than a&e.
I have a varicose that is HUGE. It was extremely painful and NHS wouldn't do the surgery. Np. It clotted. As its from my groin to under my knee, it's a risk of the clot going into my deep vein. So it was a superficial clot BUT it has the potential to become deadly. This requires blood thinners but the injections. To get that I need to see a vascular surgeon. To see one I'd wait probably a year 😂 so my gp sends me to a&e - where I waited 12h for regular check and waiting for a vascular surgeon to be available, sent home and called by vascular surgeon in the am to go back to a&e to wait until he has a spare moment. That was another 8h. I literally dropped my trousers and he said "blood thinners". Plus he was pissed that it was the third time I've got a clot and I know the pain it's on the system but regular gp or a&e dr won't prescribe because dimer was borderline just under. Every time its had to be a vascular surgeon who gives the go ahead in a&e. There's so many hiccups as its a generalised system rather than individual which I understand.

After clots I was sent to vascular because it became a threat rather than cosmetic (even though it was really painful overall) and their procedure is sclerotherapy because its cheaper easier quicker patient awake and not under general like stripping. Let's just say that failed and I'm sure I'll be back again to a&e waiting hours on end to get my blood thinners. Yay. And I know I'm just clogging the system. They're underfunded so I'm not mad, I sit quietly, but I do feel a bit like I'm taking up space for more severe cases but obv I'd rather have blood thinners than risk a dvt! Plus the clot is so painful I can't stand leg has to be up and I use crutches - 3 days blood thinners and I'm walking again and I take for 6 weeks. Its honestly frustrating as I could tell gp over the phone and pick up prescription!

@Alexandra2001

Shorter term, Social Care has to be addressed right now and Labour are bang out of order for not doing this.

This is my point - why not do the ground work or start.

Did you ever nurse anyone with secondary complications from flu, such as pneumonia? Because hospitals filling with sick elderly people in flu season has been happening since the 50s at least.

I'm not prepared to pay more tax for social care, and I doubt I am alone. Social care needs to move towards an insurance funded model or it absolutely will bankrupt us all.

I also don't think you fix the NHS problems with more money. You need better population health, and in many cases, higher quality NHS managers. Some hospitals are absolutely world class models of efficiency, others not so much.

@mumsthewordi they have started, but given that local authorities who are responsible for most social care have been pared back to below minimum standards it is a drop in the ocean.

www.communitycare.co.uk/2024/10/30/600m-boost-for-social-care-next-year-announced-in-budget/

Absolutely agree. Not all of us will need social care, and those who do need to use it should pay for it - and those who end up in care homes should have to sell up if they can't afford to run a house aswell. An inheritance is not a right.

@shockeditellyou it may need to move towards insurance funded model but the current generation has none and need it now. You can't go plan for the future but current needs have to be addressed.

But they have houses that can be sold. Much of the debate around social care is 80 and 90 year olds refusing to sell £500,000+ homes and their children supporting them (because it's their inheritance). That's potentially half a million pounds of care the tax payer will need to find. For a generation where most families only 1 person worked and so they won't have paid in nearly enough to fund their care without selling their home.