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??

There is no prescribed amount of carer/dependent leave,its wholly discretionary how much is actually given. otherwise annual leave or unpaid leave.the two latter options again need agreed by employer.

As i said hospitals shouldnt simply assume,presume families will get involved to support duscharge home for older adults.its not always practicable.

The discharge coordinator role is to discharge pts from beds,and theyll have a particular preference that families get involved to help speedy discharge.families are under no compulsion to step in for older adult care provision. For a multitude of reasons people are unable to be involved in caring for an older adult. That isnt necessarily appalling,its just how it is for some people. A discharge coordinator will likely have a particular opinion that families should be involved in care for older adult to speed discharge along

to cover a hospital admission discharge

Pausing that is one way yes. But what I am really talking about is the family being active advocates, as I mentioned investigating options, moving things forward, rather than the passivity or quiet obstruction that my Dsis so often encounters.

Short term social care on discharge isn't a problem here, that's relatively easy and cheap to sort out. It's people with long term complex needs, who's care will cost hundreds of thousands, who would have been in continuing care wards in the past, who are stuck in a hospital bed.

It's also a fact that lots of people who would previously have died are being kept alive these days with lots of coo morbidities and complex case needs. NHS is a victim of its own success in many ways.

And yes, often families need to be more understanding about what is possible and be flexible at looking for solutions.

Well Tribeca I think it's very clear things can't go on as they are now. There may not be a legal compulsion to care for (or facilitate that care)elderly relatives. I would argue that there is a moral duty.

Let hope when the "boomers" need this sort of care their children have a different attitude or we are really screwed.

Have you considered your sister narrative,as a discharge coordinator,its subjective and not impartial.and well she would say that wouldnt she...

Again,not all familes have the ability to be involved in supporting a discharge
In which case the hospital take on that role
Familes shouldnt feel berated or compelled into suppirting discharge planning

Stillwishihadabs
These are people who are actually still too ill to be out of hospital. I am talking about people who should probably still be on IV medication, people with serious heart conditions who could collapse and die at any moment. It is really worrying.

OTOH, I would like to see MASH type tents/vans for drunk people staffed by large male nurses, experienced in triaging, who would sort out the ill from the intoxicated and keep the latter away from A&E. I think that would go a long way towards freeing up A&E space.

Initiating a standard community at home ,care package isnt so hard
Its the complex packages,with bespoke and specific needs that are hardest to plan.and to fund

That's what these threads are for though different perspectives and all that.

3 little frogs I think we are talking about different things. Of course patients should be fit before discharge. Interesting point made about the continuing care wards. It's all just acute services now isn't it ?

desperatelyseeking Do you not have a separate OOH Dr service with it's own phone number? We do and I am assured by our GP that DD has been 'flagged'on their system. This means they have access to more info about her complex needs - as input by our GP. I have only had to use the system once - and it worked. I needed extra Oxygen for DD, the Oxygen Co would not deliver as it was a weekend and we had had the maximum prescribed number of cylinders. Rang OOH, spoke to someone who seemed to have clinical knowledge (nurse?) as she asked intelligent rather than algorithm questions and got a Dr to ring back. He ordered an O2 Concentrator to be delivered the same day - we were desperately trying to keep DD out of hospital and he understood that. In the hands of 111, DD would have had an ambulance and been in A&E. The 111 system cannot cope with people with complex needs and experienced carers who are trying desperately to keep their loved ones out of the hospital system. Not everyone wants to go to hospital.

Moral duty to care for older family. That will manifest as womens work,and expectation will fall to women

I have already told my boomer MIL that there is a place for her in our house. Dh cares equally for our dc,why shouldn't he care for his DM when the time comes ?

Again,as i said not all familes are able to care for older adult.and residential care is required

My local hospital is where there was a little boy in the news past few days, waiting hours in an ambulance after a seizure. I was in AnE on Saturday night, it was remarkably quiet in waiting room but we all needed seeing fairly quick, there was a fourteen weeks pregnant woman with severe pain,, a little girl with her arm in a sling, crying her eyes out and me with a shoulder almost out of its socket and an inch lower than the other side. We left at 3am after 6 hours as they'd closed Minors, moved everyone from minors up to Majors, had two doctors in the whole emergency department and 8 ambulances queuing. We just couldn't wait without painkillers any longer, and no one would tell us anything.

A poor woman in her 70s had been told she was staying the night, and was then turfed out of her bed and sent to sit in the A&E waiting room in her pyjamas because no one could drive up and fetch her so early in the morning. She spent six hours on hard metal chairs, having been kicked out of her hospital bed :(

(And before anyone accuses us of wasting time in A&E... I called OOH who told me that they can't relocate joints so it has to be A&E. The pregnant woman spent an hour in hold to OOH before deciding to come to A&E)

I haven't said it isn't, what I have said is that the family have a duty of care to their parents (which doesnt necessarily mean physically caring for them, themselves) but does mean not opting out .

A hospital bed,is a scarce and costly resource.a patient may not be able to remain on ward,in acute bed,waiting on transport.as the bed is needed by another acutely unwell person

It is of course dreadful to be sat in a packed A&E waiting on transport.i hope the lady was ok and things resolved satisfactorily

Can't see why the hospital couldn't order a taxi

You really do misunderstand duty of care.its legal responsibility imposed to act responsibly and cause no unreasonable harm or loss

Duty care applies to employers,public sector,contractors
Family members are not compelled under any duty of care.at all

As I said not legally. I am well aware of duty of care.

I'm surprised no one has mentioned mental health as an issue. As far as I'm aware if you're not already in the system the only way to get quick access to a psychiatrist is to go to A&E, otherwise you're looking at a several week wait at minimum which really isn't feasible if you're in crisis. And even if you're in the system there is no out of hours service outside of A&E.

Then when you get to A&E there's a huge bottleneck waiting for beds. Last time I had to be admitted I got super lucky and was admitted to a psych ward within 12 hours but a friend of mine spent 36 hours in A&E recently in a very distressed state until a bed on a ward opened up.

A taxi? Why didn't they think of that? Just because someone is for for discharge doesn't mean they are fit enough to travel independently in a taxi. Do you really think hospital staff are so stupid that they wouldn't consider public transport if that is an option?

OP asked why GPs don't work shifts.

1. We still wouldn't have more appointments no more GPs and I am going to take another pay cut this year to employ another GP.

2 we would have to have our staff working shifts.(ok really but the phone would still ring as fast so we would need more staff so this would put up the staffing bill. Remember GPs pay nurses and staff out their own money) 3 can't do bloods after 3.30 pm or at weekends 4 can't get X-rays or other routine examinations at weekends. Like GPs hospitals only provide an emergency cover service at weekends (A&E probably staffed fully but not the wards)

Lots of you have made some excellent points
Chronic underfunding
No beds
No joined up thinking between social care and hospitals or GPs (weeks to organise care packages to go home)
Patients discharged too early. We have re admitted several this week who should have been kept in until a lot better but there is pressure to discharge so can get more beds.
Re giving up out of hours and overtime.
We gave it up as the days of doing 24 hours on call are long gone. Working a full day being up half the night and then working the next day is not on anymore. We work solidly from when we go in 7.15 for me today until we go home which is just now for me.
We used to have local co-ops which were made up by regular locum GPs and GP partners or salaried GPs they took the calls and triaged them. There were several over edinburgh. Now it is 111 and to be honest the algorithms that they work to don't work like someone further up said. The person who triages should be the most experienced like a GP or a very experienced nurse practitioner who can think outside the box but no. They wanted a cheap way to do it and you get what you pay for. No disrespect to the handlers but they don't have the experience.
You cannot have health care on the cheap. You need to pay for it.

GPs are not lazy (there will be some of course) but we are battling against the system as everybody else is.
People are living longer and I notice a huge change over the 24 years I have been a GP.

Sorry that's epic but please work with us to fight the government over these cuts and get rid of the tiers and tiers of management.

The hospital where I work is in an area with a larger than usual proportion of older people.

There is a crisis at our hospital right now - we had 104 people waiting for beds last time I was working!

The problem is that we do now have lots of elderly people with complex multiple health problems who need to be in hospital but once they are well they require social care or a nursing home & it's finding the social care / nursing home places (and the actual funding for them) that is slowing the discharge process... so there are well patients in acute hospital beds which means longer waits in the ED, and cancelled elective surgery.

Locally we used to have a large 'geriatric' hospital which was used for elderly rehab & just as a place to put 'well' patients awaiting social sort out. That was a good hospital and it got sold, demolished and built on. The large council-run nursing homes got sold off too.
So now our hospital has slowly started to open 'interim' beds in local nursing homes where the 'well' patients can go - it's expensive but may be the only solution.

The main presenting problems at our hospital are, as well as the usual 'emergency admissions' of Strokes & heart attacks - pneumonia / chest infections; uti / dehydration; falls & acopia - all mainly older person's problems & some of these problems could be preventable with early interventions by healthcare professionals in a community setting.

We already have 'community outreach' from the hospital for COPD patients to prevent admissions; perhaps they could come up with similar ideas for other illnesses / conditions.

And I don't want to upset any social workers here but the system for social care is achingly slow.

Added to all this I believe there has been a nasty chest infection type bug going round at present which many elderly people have needed to be admitted for as it can lead to pneumonia / sepsis.