AIBU to wonder what the heck is going on in hospitals right now??

[Rinoachicken]

Before I start, I want to make it clear I am NOT blaming the hospital staff in any way.

13 hospitals have declared state of emergencies or whatever it is.

Why is everyone suddenly descending on A&E all over the country all in the same week? Has there been an outbreak of something I don't know about?

I don't get it. A&E is always stretched to the limit, but Why this sudden crisis all over the country?

Am I missing something??

Haven't read the whole thread so this may have been said already, but why wouldn't it be happening in lots of places at the same time? If the systemic issue of difficulty in seeing a GP is a big factor, then it would be widespread. Just one area would suggest local factors. But it's not like that. Friend who works in a hospital told me this had been their worst week ever, cancelling ops all over the place because so many people had been brought in, plus staff being pinched from their ward constantly so running on low staff numbers.

Who's going to want to work nights?

Well many won't get a choice. Most hospitals have an e Rosta system. You work what you're told. Which on my ward means that 75% of your shifts are night shifts.

You're right, we don't get a choice if you work on the wards. But I expect a lot of people will just find jobs that are day time hours. Or leave and join an agency so they can work when it suits. You can only piss people off so much.

Since 2010:

8649 hospital beds lost
1693 mental health beds lost
66 A&E and maternity units closed/downgraded/threatened with closure
Social care budgets cut by one fifth resulting in almost 2 million beds days lost due to delayed transfer (ie bed blocking) at a cost of pork £526 million.
One day last sept there there 4966 delayed discharges (one bed day is a cost of £250)

The pips have been well and truly squeezed and we have nowhere left to go.... That's why ED is sadly bursting at the seams.

It's been going in for months and months but hasnt been reported until now. It hasn't happened overnight at all. We were like this in summer so no winter pressure then

Exactly. I'll be joining an agency if this happens. And will never work nights again.

A lot of people will be worried about losing their pension if they resign and do agency work.
I have done my share of agency in the past, but I am glad I have enough years paid in to a pension that I can retire in a couple of years.
I am looking forward to retiring, but I feel desperately sad for the state the NHS is going to be in, and very sorry for colleagues who will be struggling on.

isn't it about time the very well paid GPs start providing weekend coverage instead of shutting up shop at 5 on a Friday and leaving A&E & NHS direct to cope
Most people only ring up the GPs when they have an immediate problem, but try getting an appointment that same day, that is why people ring NHS direct who then invariably direct them to A&E

I know this issue isn't just about GPs and lots to do with social care.

BUT people are ill 7 days a week. Why the bloody hell can't GPs therefore be open 7 days a week, at least for emergencies? I am not surprised people end up in A and E.

isn't it about time the very well paid GPs start providing weekend coverage instead of shutting up shop at 5 on a Friday and leaving A&E & NHS direct to cope

I work in a GP surgery. We are open (and seeing patients) 0800-1830 5 days a week, and have extended hours 3 nights a week until 2000. We also now open 0830-1230 on Saturdays.

Shutting up shop at 5 on a Friday? I bloody wish

Why the bloody hell can't GPs therefore be open 7 days a week, at least for emergencies? Because there aren't enough GPs Roonerspism. They already work 60+ hours a week and you can't expect the same number of GPs to work 24 hours a day 7 days a week. Doctors just don't want to work in primary care and TBH I don't blame them. I'm only a nurse and I don't want to do it any more...

And it's not just GPs, but the entire system. Theatres, ultrasonographers, radiographers, consultants, ever been in hospital over a bank holiday? You would not think that healthcare is 24/7/365 if so. Then there is this huge backlog the next day back.

We are lucky here that we have a walk in GP which is open every day other than Christmas Day to just walk in and sit and wait to see a GP. Overnight and Christmas Day it is the base for the OOH gp so you need an appointment to be seen.

It is a fantastic resource, they won't treat DS for his asthma which is understandable but when I have been for me then I have found it really good.

It's easy to blame GP's and A&E depts.

What people don't see is that there are no beds to admit people into. Because pts who are medically fit for d/c but who need social care packages can't be discharged until those packages of care have been planned and can be started.

In the run up to Christmas lots of people who work as carers hand in their notice and take seasonal work in shops. So the care agencies have nobody to give the care that needs to be given. The knock on effect is that those pts have to remain in hospital where they can receive adequate care.

The seasonal workers will now be resuming their usual care jobs and hopefully the backlog can gradually be cleared.

That's not to say that there is understaffing within the NHS, there should be more staff present at weekends, or that GP surgeries could help by offering extended opening hours, but from where I stand the lack of joined up working between the NHS and Social Services combined with the annual reduction in numbers of care staff are the key issues.

Expat, I think that depends on the hospital. We work 7/7. The only thing that doesn't happen on weekends is outpatients clinics and elective surgery. Most other stuff runs pretty much the same at the weekend as it does during the week. We are still struggling at the moment.

Increased admissions and reduced ability to get people out into appropriate care have ground the system down. My guess is that the cutbacks in social services budgets is playing a huge part.

sidge
my local surgery is a M-F and shuts up shop maybe at 6, but no weekend nor evening after 6, is this just an odd one out?
It just seems that NHS Direct and A&E are taking the brunt and struggling and GPs are just doing 9-5ish M-F
why haven't we got a 7 day GP service?
we have a 7 day police service, fire service, A&E service

My local hospital, which I've had a number of inpatient stays in (one lengthy) goes into survival mode on weekends. No ops, no consultants, barely any doctors, everything grinds to a halt till Monday. Same with the hospital where my mum was an inpatient earlier in the year

The carer thing is shocking. If it is financially more rewarding to quit for a temp seasonal job in retail, then paying carers enough to retain them is something that needs urgent attention. No doubt we'll be told the country can't afford it but we can't NOT afford it. Perhaps some footballers and bankers could kindly donate some of their spare cash to the cause.

Must be, then, Raffa. My only experience was when DD1 was a cancer patient in a huge, well-known paed hospital. She was always provided with the care she needed, but man, it was like a ghost town on bank holidays, and we were lucky to have the consultant we had, as none other than she were seen for dust on bank holidays/weekends.

As it was, she was admitted on a Friday night. A cons had to be called in, to perform an ultrasound on a great blister she had over her shin, on a Saturday, to ensure the infection had not spread to her bone, as it was known she had myeloid leukaemia, and then ortho cons called in, to decide what best to do.

But oh, the waits and backlogs, pharmacy, lab, all sorts. That should never slow down due to holiday.

It's a relatively new system, although one they've been trying to get in place for years. In theory it should mean patients are discharged quicker, but I'm not sure how much that's helped over the last few weeks.

Bank holidays might be an exception to the 7 day week, thinking about it.

I work in a small department with ina district hospital which services not only the whole hospital but the community too. This time last year we had 12 staff. We are now down to 8. The hospital have refused to advertise the positions to save money.. But managers expect us to cover the work of 12 still: they have also brought in weekend work.. We have to take this as time in lieu as wont pay overtime.. However.. We're so short staffed there isn't the time to take the lieu time.
As soon as my contract is up, I will be leaving. The nhs is going down hill rapidly under the Tories.

jacob I can't speak for all surgeries but many offer either a weekend morning opening, or late nights. I guess if you have a small surgery with limited staff availability or limited demand for late nights or weekend appointments then you'll put your resources in to where it's needed, eg Mon-Fri 8-6.

GP services aren't emergency services like A&E and the fire service. If the GP surgery is shut there are a number of other options such as Out of Hours (which is often financed by the GP service), walk in centres, Minor Injury Units etc.

A&E and Fire, Ambulance etc offer a completely different service, so there is no alternative!

But sidge this is the nub of the problem. GPs are a frontline service and should be able to deal with emergencies.

One if the reasons A and E is struggling is because for whatever reason, GPs can't provide sufficient care.

My surgery closes at 6, is never open late and most certainly is not open at weekends. So it's not rocket science to wonder where all the emergency cases go at weekends or bank holidays.

Re: bed-blocking. I was in hospital for a week 2 years ago, after surgery for a badly-broken leg. I was told I could go home first thing on a Sunday, as soon as my meds arrived, at around 9am. I got ready, and waited. Meds arrived. Then told I couldn't leave until the doctor had checked my wound. I waited. And waited. Was told that the docs all in surgery until late afternoon. Eventually, he arrived, at around 7pm and told me I looked to him like someone who was blocking a bed!! Sense of humour failure on my part and I told him quite bluntly how long I'd been waiting. He barely glanced at my wound and then said I could go. Needed a porter, however. Waited a further hour, with flu-ridden dh waiting outside with car on a yellow line in a blizzard (car park half a mile away on a steep hill). Finally, a lovely nurse dug out a wheelchair from somewhere, and took me down to the entrance. I eventually left the building at 9.45pm (without the discharge papers, as no one could find anyone to fill them in).

Where I am (London) two local A&Es have already been closed, and two more are scheduled for closure.

Good thing the population of London is declining and that London traffic is in no way ever a problem, then...

The nearest A&E to me, one of the ones scheduled for closure - the previous council wanted to flog off the site for luxury flats - is always heaving. I don't know where they expect the people that now use it to go.

I think it is an aditional problem rather than the nub of the problem, roonerspism. The patients that walk in and get treated and walk out again aren't really what's causing the crisis. They are probably the group that could be seen by GPs.

It's the patients that are I'll enough to be admitted that is the problem. They will still need admitting whether they they see a GP or a doctor in A &E. There still won't be any beds to put them in. All you do is shift the problem onto GPs except that patients who need to see a doctor will be at home rather than A&E.

Without extra funding the only way of getting extra GP cover at weekends is likely to be by cutting the number of weekday appointments. And I'm not sure that's going to help.