To be furious after tonight and feel the NHS is not good enough

[DespairingofNHS]

My mum is in hospital with a chest infection. She's bedbound and has little mobility after suffering from a series of strokes over the last several years. She can speak but has absences, forgets she's talking, eating etc. She needs help to eat and make sure she's eating enough.

I arrived at the hosp. tonight at 7pm and a tray of food was sitting next to her, untouched, cold and still sealed. It was clear no attempt had been made to get her to eat or even to take the film lid off so she could try to feed herself. I asked to speak to a nurse who advised that the doc had decided at mid day to put her on nil by mouth. I had to ask a series of questions to find this out, nothing was willingly volunteered. Apparently they were worried about her swallowing. I asked what the plan was and they said they were waiting for the SALT (I had to ask what this was - speech and language therapist) to come by. When I asked when that would be they said 'tomorrow or the day after'. I said 'so your plan was to let her go potentially 48 hours without food or drink?' the nurse said 'well no one ever died from not eating for 48 hours'. She advised me that mum had eaten loads yesterday including lots of chocolates fed to her by the nurse (wtf - she's diabetic), This begs the question why the next shift decided she couldn't swallow to the point where she shouldn't be fed. She can be a bit absent and forget she's eating/sit with the food in her mouth. This had been communicated to the next shift as 'she's refusing to eat'. I asked why they didn't intubate or put her on a drip. not procedure apparently! why didn't they consult us? because they have 55 patients on the ward and can't check with people's families about treatment...or deciding to starve them.

Needless to say I requested the doctor to come and attend - the doctor assessed her and saw that my mum was able to swallow liquid fine. BY the time we finally got her some food it was gone 9pm and my dh had to stay to feed my mum personally while I took dd home to bed.

I am furious that this could happen and that if I hadn't visited (some of the patients on the ward had no visitors at all) they would have happily left her with no food or water for 48 hours till the SALT could attend after the bank holiday!

Partly I'm writing this to remember it accurately later. But I also really want your thoughts and advise on how to properly complain about this in a way that ensure it gets dealt with. The nurses and docs simply said 'we've only just got on shift'. Nothing was written in the notes to say why the nil by mouth was put in place or even that it had been (the ward manager showed them to my dh although said he wasn't really supposed to). Their response was simply to hand us a complaint form...we had to ask them to sort her out some food. I have no confidence the same thing won't happen again tomorrow. I feel like they unilaterally decided to put her on a Liverpool care path and let her die. She just has a chst infection and is not terminally ill. I am shocked by the lack of care and compassion and feeling very scared about getting old one day and having to be entered into this NHS system.

That is unspeakable Jimjams.
These professional associations act increasingly defensively. God forbid anyone should criticise a member of their hallowed ranks. Still, it keeps a whole other raft of suits in work. I was lucky to have the union more than willing to help me push this through. My dh was very worried about my job security but the injustices meted out to my nearest and dearest drove me on in a white heat.

There are organisations and pressure groups who can help but when one is in a very stressful situation, it is not a good time to be carrying out careful research and one is just a frightened individual against an army of suits armed with their platitudes and lies and white wash.

I agree with you totally Sparkly. The incompetence of those 'leading' beggars belief. The NHS is full of people who do nothing at the coal face, but need to justify their existence and do so by ensuring those doing the real work, move in ever decreasing circles. I've had to involve my union again to see off some serious harassment recently (successfully, I am pleased to add), including ringing me in my holidays and demanding to know what holidays I am planning to take for the next year.
I can only assume the individual asking me this has nothing better to do.

I have also given my family quite serious instructions that if I were to become infirm in my old age, I am to be put down quickly and efficiently by them.
I have advised them to do the same.
I can think of nothing more terrifying than being an old person on a hospital ward. I would rather die.

I don't honestly see how the NHS can possibly care for all the elderly people who are in the system and on the way into it without the goalposts shifting a bit and family routinely doing things like taking shifts by their relative's bedside in hospital, keeping them in the right place if they try to wander, feeding them and so on. I've been in an assessment unit with an elderly relative and it's absolutely terrifying. I could be outraged (and we did complain over some things) but at the same time I can't see how the system is ever going to manage all those people long-term.

I don't think an alternative system is going to be magically better, especially not any kind of private one where all you have is an extra layer of firms wanting to skim off profits and take money out of the system, while avoiding treating the difficult and most expensive patients. I do have some hope that technology maye help with some things over the next few decades - it will have to, or we're really screwed.

I think as families like it or not we might have to change our expectations to some extent when it comes to what we might have to do for our relatives if we want them to be well cared for in hospital (as opposed to well nursed or well medicated). Right now I absolutely wouldn't trust any elderly relative to a hospital without being in there for a good part of each day, not because I think the NHS is fundamentally awful (I don't) but because I think there's too great a risk of them encountering an overstretched ward or unit for some of their stay and suffering as a result.

I've also read that hospitals (like many other organisations) would benefit from some of the techniques they now use in aircraft cockpits, for crew resource management, where the whole system is set up for people to be able to make good decisions and deal with problems without conflict and blame. But for years everyone has behaved as if the only way to solve problems is to put people's jobs on the line if they don't hit targets, it's all divide and rule, get people competing with each other, fake it if you can't make it, hide your mistakes rather than learning from them, and so on. Something has to make that change (and it won't be more threats and vitriol about the NHS as a whole that solves that - all that does is help the big firms that are circling hoping to cherry pick the profitable bits).

No op it's not acceptable.

When I trained as an SRN in 1982 there were 2 intakes of student nurses and 2 intakes of pupil nurses who were the old SENs.

We learned the craft of nursing on the wards with some times spent in the nursing school in site if the hospital.

We didn't have vast resources if staff but we had vast resources of second and third year students and pupils teaching and helping junior colleagues.

We didn't site drips or take blood but we washed and cleaned lockers and patients alike.

A patient with a bed sore was a disgrace not an inevitability.

Junior nurses fed patients, the ward had its own cleaners and woe betide you stepping in a cleaned floor.

Noine had a degree but a professional qualification.

You can't learn nursing at university.

And if anyone wants extra motivation for e.g. giving up smoking, eating better, taking exercise, saving like mad for retirement and even swallowing pride and mending bridges with family (seriously toxic ones excluded of course) - I recommend being forced to spend time in an overstretched hospital ward filled with sick elderly people. You'll breathe a huge sigh of relief every time you walk out into the normal world again, and suddenly any lifestyle change to help delay the day you might need to be a patient somewhere like that will seem worthwhile.

bodypopper {bows.}

Honestly, a friend of mine was in Turkey 35 years ago and had appendicitis and was operated on. We were all agog when she and her boyfriend came home and he explained that he had had to stay at the hospital, 24\7, sleeping on the floor to make sure she was properly cared for, changing her sheets and paying for new ones, going out only to get her food and water.

Without a lie, if a member of my family was admitted to an NHS hospital now, I would pro bably refuse to leave them for more than a few hours because I would not and do not trust those who work for the NHS, particularly nursing\HCP staff - and who can tell the difference to care properly for them either clinically or socially.

We shoukd not be grateful for the NHS we now have, we should be anbsolutely outraged. Anyone who stands by and allows patients to be treated without respect, to receive shoddy and substandard care is a disgrace, has entirely lost my respect and shpould be treated with the level of respect too often shown to patients. You know those people who fund the cash seepoing monstrosity that has forgotten why it was founded.

When I fill out the E&D form now when I attend a hospital I strike through it now and write "not statutorily required information but respect for all is required and you should not have the financial resources to facilitate this claptrap.". I really do write that and I feel very strongly that if every individual were properly treated in accordance with the traditional mores of a first world country the info requested shoukd be and is entirely irrelevant.

up the thread people have asked why my mum hasn't been moved to another nursing home.
she is mentally alert, physically fully incapable and deaf, with a long history of mental illness and this is the only place that could take her - but she's on a unit with people who have dementia so she's very much 'alone'. especially now she can't spend any time in a chair as it hurts too much, and has to lie in bed all the time. the home is about a mile from my house and a mile from my dad's, which matters to me as i can walk to and from. dad drives but he can also walk that distance if he needs to. we need this to be able to keep up the number of visits.
the home is run by a well-known organisation. there are food and drink logs and i've heard staff offer to falsify them ("do you want me to re-write that page?") when they've written down the truth rather than what their superiors want written there.
they bully, they lie, they cover up for each other, they use her expensive prescribed food-thickener for other people and steal her prescribed incontinence pads for other people too, then leave her weeks short of pads and only being changed twice a day (and they try to demand that my dad buys extra pads. she is allocated enough for four changes a day by the incontinence service and its a rare day if she gets that). stuff goes missing from her room. my dad provides her food, as mentioned previously, and bottled water to mix with thickener because it makes a better drink. there are two staff members who seem to be kind and efficient.
the organisation sent round a questionnaire to families at Christmas and we did fill it in, in detail.
this nursing home is considered the best around here. God only knows what happens in the others. they're probably as bad as the hospital.

rabbitlady my grandma spent seven years in an nHS geriatric mental health unit. She got a place there after I complained about the manner in which my mother was spoken to and reduced to tears by the consultant in charhe of the service. It was absolutely the very best care, private or public available in the county.

She spent 7 years there because mymother and grandad visited daily. They monitored pads, they made sure doctors were called, they washed her clothes and changed them daily, they fed her and they made sure she drank - often bringong food from home. Hjad they not, I am absolutely certain she'd have been dead within two years. They also bought her a vibnrating bed to prevent bed sores ( I think it was 3k, and the unit retains it willingly. Care available in the UK has become a fucking disgrace. This was fro 1994-2000. There wasn"t a sudden influx of love. Or resources psot 1997 so this is defintely not a tory propblem

YANBU. But the problem isn't the NHS or its staff, it's that the NHS is being deliberately run down by the government. Their aim is to make it both easier and cheaper for private contractors to take over its functions, while gathering popular support due to the increasing crapness of NHS services. Those services have no choice but to be increasingly crappy, as they're suffering ongoing cuts while being held to ever more exacting standards, which are even being applied retrospectively in some cases so as to justify further cuts ('sanctions'.)

In 2010, Mark Britnell told a conference of commercial healthcare providers "The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years." The government also committed to shave £20billion a year off NHS costs by 2015, which is only next year now :(

Cross-posted with you, Windmill, and I agree things had already started going downhill when the ConDems took power. The current approach to dealing with that by making it worse, however, is pure Tory.

When I say it didn't work moondog, it's not quite true. My mum did (eventually) get the lies acknowledged as lies and removed from her record although she was told that the matron (who was later promoted) 'didn't mean it like that'. My mum was also allowed to change her working conditions, which had initially been refused because of the lies. That was no thanks to the union though, that happened using the technique you mentioned of copying in everyone and raising grievances and documenting all their inconsistencies until there really was no way they could hide. The lie was in writing and was clearly untrue - so all they could do in the end is say 'oh whoops she didn't mean it like that' (like hell she didn't).

However the initial concerns raised (patient safety) and bullying of junior staff by senior has still not been tackled. Management & HR have gone out of its way to avoid tackling the issues - I think that surprised me more than anything. No-one would take on some sort of responsibility and deal with the issues, they just did their best to bury them. And so the issues remain, and continue to cause ongoing problems, and the working conditions of many nurses & junior staff and the care of patients continues to suffer. I think my mum would recognise a lot of what Leverette described. From seeing what my mum and colleagues went through UNISON seems a better union for nurses than the RCN - at regular nurse level anyway. She does still bring the issues up everytime they dish out another inconsistency but I think she thinks there's little she can do until she leaves the profession when she will insist on an exit interview and document everything again.

I'm going to tell you my experience not in an acute hospital but in an elderly care ward about trying to get care right:
I am not too worried about outing myself because I don't think we are in any way alone.

Before my arrival the trust and the unit got a pasting from CQC. I don't know all the ins and outs of this but it seemed to me that some was fair criticism, some was not.

The staff tell me they had tried to flag some of the problems especially the crumbling infrastructure and were told there were no funds to fix it so soldiered on.

After the bad CQC the trust acquired a whole new top management. The new chief exec then basically fired or redeployed all the lower and middle managers who he held responsible for the failures.

Well it's one way to go for sure and it makes a big impact but it meant that on my ward there was; no consultant (locums only), no ward manager, no deputies, no divisional manager. There was only a band 5 trying to act up and a very, very demoralised team who had been slammed by criticism and were in fear of losing their jobs, loads of sickness, no goodwill at all. Is it any wonder the care was then worse rather than better?

I was fairly unaware how bad things were when I rocked up all excited about getting my 1st consultant post. No wonder there were no internal candidates.

It was so hard at first that I wanted to quit on a daily basis. One person cannot turn that around on their own. I was just firefighting writing care plans myself, spending all my time on the ward (fortunately I was allowed to drop clinics temporarily to do this), trying to input systems to make sure that basics were getting done with constant audits and pressure from trust management but no resources (trust finances were in a mess too so we were supposed to improve standards and save money).

One year later things are a lot better and I now on the whole feel my patients do get good care, feedback from them is mainly good. It took a long time to get the vacant posts filled, we had no good applicants at first due to the bad reputation. The trust did spend some money doing the place up which made everyone feel better. Team morale is a lot better now, sickness down so less bank and agency spend.

I think that staff generally really do care about their patients. We all went into this to make a difference. We could surely earn more money for less stress elsewhere. But if you do flag things up and are knocked back, not listened to essentially get the message you can't make a difference then after a while you just give up and accept it is how it is. If you have to work in a crumbly environment without equipment or resources you need and management treat you very badly then it is very hard to keep striving against that for good care.

Some paperwork and statistics is necessary because you need hard data not just a feeling to know how you are doing but wherever there are targets there are perverse incentives and it is much easier for management to request data on x,y,z things than for shop floor staff to spend time collecting that data. The more they are filling in surveys and audits to monitor care quality the less time they are actually caring.

I don't know what the answer is at a meta level but I don't think it is money or high level systems. It starts from valuing staff and empowering them , resourcing them to do a good job. It needs carrot as well as stick (and I don't mean some pissy employee of the month award which is just patronising and people see straight through).

There seems to be lots lots of people talking about how care was better years ago. I've been nursing since 1986 and things were bad then, I have some horrendous memeories from my student training of students being left in overwhelming situations and just expected to cope. I am lucky enough now to work in a Hoppice, mostly privately funded as a charity. we are relatively well staffed and out patients are treated with dignity and get great care at the end of their lives. However we still hear the horrer stories when they are transferred from NHS wards and it breaks my heart.

I was fairly unaware how bad things were when I rocked up all excited about getting my 1st consultant post. No wonder there were no internal candidates

This is something my mother has tried to point out repeatedly to the managers as an example of how bad things were in her (now ex) team. There are never any internal candidates and most people come in from outside, usually new to the type of nursing as well, realise if they don't get out quickly they'll end up on some sort of disciplinary from the psychopathic management and so try to get out as fast as possible - meaning there are always vacancies. No-one will apply there still. They get more and more short staffed (my mum's new team is now having to provide cover for the old team because they cannot fill vacancies). This could have been sorted 3 years ago if the concerns had been listened to , but it just gets worse.

Appalling. Your poor mum.

My mum is a nurse who jas jist read this too and she said she would complain to the hospital and also write to your local mp.

I am not from here,so do not have a dog in the fight.How on earth people can possibly expect good care when it is all free astounds me.Even well off people will not pay for anything ,they feel so entitled.Do not even talk about hospital parking whining when they get thousands of pounds of cancer treatment free.

Here,people, is Socialism writ large. Utterly unsustainable.

Ps in my previous post I did not mean to suggest I somehow did this on my own and am some kind of hero. Very far from it. I did a bit but the service manager and the clinical director did a whole lot more and most of it was down to the nursing staff picking themselves up and persevering.

The NHS is of course not free rather it is paid for out of general taxation so it is free at the point of use. It costs us all a lot. The cost of someone's very expensive cancer care is shouldered by us all instead of by that one unfortunate person. For me that is exactly as it should be in a civilised country where people care for one another. I am proud to be an exponent of socialised medicine. A decent standard of care for all rather than excessive intervention for rich people and nothing for poor people.

mamadoc are you in Cambridgeshire?

Erm yes
Whoops outed!
Situation maybe not as generalisable as I thought!

It's not free gotthemoon. It's just a nonprofit tax-funded setup, there are plenty of those everywhere, e.g. police forces, armies etc. No reason why they shouldn't be perfectly function.

I feel the person who makes most difference is the nurse in charge on a ward. But that role seems to have changed a lot and they spend most of their time being harassed by the matrons on statistics, not able to exercise leadership.

I also think that nursing functions best when you have all the patients visible, e.g. in the very old school Florence Nightingale wards; these were horrible in some ways, but they did allow you to take a single glance and assess the status of every patient. One of the wards I work in has single rooms only - lovely - but hell to nurse and to be honest the patients are horribly isolated in there, I'm not really sure the benefits outweigh the losses, given that nobody's going to employ enough nurses for the scenario.

I'm an adult SaLT so I recognise the original situation very much. The lack of documentation of the decision to place your mother NBM is outrageous. The lack of bank holiday and weekend SaLT cover is terrible (I'm not at work today because it's a bank holiday - spent most of the night awake worrying about my patients so what's the point! All hospitals are talking about implementing this cover, so ask for it in your complaint; the trouble is they want to do it with the existing resources as a rule, which will mean working 1 weekend in 3 or so for me, which I'm not exactly looking forward to, but what the hell).

People treat NBM documentation so casually; it's right that if your mother has a chest infection and is aspirating she may well improve a great deal if she doesn't have food and drink landing in her lungs on a regular basis. But if so, that needs to be communicated properly. I arrived to see a patient recently who was nil by mouth (and properly documented, and on a nose to stomach feeding tube) only to find she'd been having all her medicines orally anyway...oh and 'just some sips of water' and God knows what else. Actually she was fine. But i should write an incident form... again... only there were 3 of us supposed to be working yesterday and 2 are off sick...

mamadoc I'd apply to work in your team, it sounds great and you sound like a fab consultant. Most of the ones I work with now are like you and care about patients and colleagues and even though we are crazy/occasionally scary busy it is generally a happy place to work and our patients get good, often excellent, care.

joan wtf!!! Nbm, ng tube and they gave oral meds???? What did they document? I've seen some shite practice but nothing that bad.

Back to the OP, that nbm should have been documented and as a nurse I would have written myself 'dr x at x time instructed that mrs a should be nbm pending salt assessment' otherwise legally I am in the shit and can't show I'm not maliciously starving her, I also would chase the person who made the decision to properly document it and write that I had explicitly requested they do this.

It is in everyone's interest to keep full and accurate records and fwiw I can't really think of any of my paperwork I could safely not do, it all has a purpose and benefits patient safety. I could do with enough time to do it all well though!

(I would of course also ask for IV fluids writing up for a nbm patient!)

Is it just me or does anyone else think - and more to the point would it be feasible - that the incredibly large bonuses and salaries paid to those who work in rather more power and money orientated jobs could be better used to make our hospitals fit places for people to be treated in?

I'm not talking about ordinary hard working people who simply earn a lot.

I'm talking about the arbitrary stuff that is beyond ridiculous.

The NHS needs money and it needs it fast.

When I get old - after experiencing hospital fairly recently, when someone close died - I will just stay at home. I'm not going near a hospital.