To ask HCPs their opinion about appalling care and protocol breach?

[yolofish]

My DM aged 88 has been in and out of hospital for the last 8 weeks following a fall. Her care has been dreadful, eg untreated pneumonia and bowel infection for 6 weeks across 2 different locations which caused toxic delirium. It is too long to go into, but today my DB and I caught the hospital out lying about two different issues (which were in her notes), and total incompetence in several areas.

We are going to make a major complaint, and met with the PALS person today after standing for two hours in the ward corridor trying to get some answers about her discharge and care thereafter.

We are articulate, educated, middle-aged (ok older than that), confident people and DB worked for the NHS for 37 years. We were treated with utter disdain and contempt for daring to ask questions about what happens to a very frail lady on discharge.

Finally, I spoke to the PALS lady on the phone this afternoon, 2 hours after we met her. She had still not managed to locate the discharge manager - but in the meantime, my SIL had phoned and was told DM was being discharged in the morning. This is quite weird, as SIL is 200 miles away and DB and I are the ones on the scene with the info. No matter, I love my SIL. Yet I am the next of kin and its a clear breach of protocol to release info to anyone else.

Sorry that's a bit of a rant, and I love our NHS and have only had excellent treatment in the same hospital, but ffs! at one point we were told that an 88 year old lady with 2 fractures would be sent home to an empty house!!|

my thinking is: do not get old and rely on the NHS unless you have active advocates around you, and even then it's a struggle.

They have too many people to look after these days. It’s all a bit of a mess from what I can gather.

Maybe your SIL phoned and asked what was happening, rather than the ward phoning her? Believe me, they will not have oodles of time to contact random relatives. BTW, it is not a breach of protocol to inform a relative of something before the official NOK has been informed!

Often medics say the patient is medically fit for discharge, forgetting that the social care side needs sorting in order for it to be a safe discharge. This will of course delay things.

Does she have capacity? She is allowed to make unwise decisions if she has capacity. Patients do sometimes decide to go home when staff really would advise they wait until support, or whatever needed, is sorted.

Sorry, OP, this does sound very defensive of the NHS, and, of course, I have no idea what went on in your DMs case. But there are 2 sides to everything and I can tell you they are all doing their absolute best in tough circumstances. More is done right than done wrong.

I hope you get some satisfactory answers to your questions, and I hope your DM recovers well.

Social care is a mess. There isn't enough money/staff by a country mile. Poor discharge decisions will be made as a result of this. There simply arent the resources to send everyone home with the care package they need (especially if there are attentive/capable family members nearby). This is the reality of the NHS. It's crap but it's only going to get worse.

Yabu re next of kin. I'm afraid it isn't really a thing, unless you have LPA. A relative phoning the ward is likely to be given information unless there is good reason not to. It is also more than possible that busy ward staff assumed she was you.

I'm sorry you have had a tough time, but it's armageddon on hospital wards atm (especially first few weeks of August). Junior staff are inadequately supervised and stretched too thin. This is what the strikes were all about. Decisions have been made about where cuts will be made and you are seeing the consequences.

Imagine what it would be like if you weren’t articulate people who knows their rights. Or what should and shouldn’t be happening.

I had a very similar situation and I thought if I wasn’t a hard nosed fucking nightmare (though nice of course) the person who I care for would have been utterly fucked.
So they only end up listening to the nags (because that’s what I was)
What about the old people who have no vocal person on their side.

I can’t fault the individuals for what they were trying to do, but I found it was loaded with red tape and no one talking to each other.
Adult social care for the elderly is abismal.

Realised I haven’t actually been articulate in my post at all! Or grammarly correct!
Sorry!

My grandmother was in a similar situation recently. She had a fracture and needed an operation. The hospital didn't discharge her though until they had secured her a place in a respite home so she could get back on her feet.
Sometimes I think in busy wards with different staff coming into different shifts, certain things may get overlooked or missed from time to time.
I would say put your complaint forward with PALS and let them look into it. If they feel everything was handled correctly then there won't be any harm done by complaining. If something is going wrong in that area, it might not get noticed if no-one actually raises a concern? I have found in hospitals they are so busy and overstretched, sadly sometimes you have to yell the loudest to get heard. The staff are trying to make the most with what they have in terms of budget cuts everywhere.

Well it seems that the hospital has rather shot itself in the foot. I tried to put a review on the NHS choices website, but my complaint is 'too serious to publish' and therefore I must follow other routes. Cracking result, I'm not giving up on this one but will keep my powder dry til we get mum out of there.

Elderly people get the worst of everything in terms of hospital care and I think it is probably because there is probably no positive long term good result (they are old: they will die).

PALS woman took the not being next of kin thing very seriously, probably more seriously than she did the fact that we found mum with her legs hanging off the side of the bed with her body across it, unable to move - and the staff nurse was in the ward at the time. SN had been 'unaware' and mum was unable to reach her bell. No idea how long she had been there but she was very uncomfortable in pain.

totally appreciate that social care is underfunded; that's not really my DM's problem though is it? She is medically fit for discharge and currently bed blocking through no fault of her own - and not being cared for while she is there.

not attempting to dripfeed, but it would take a lifetime to go through the crap care she has had since June 7. Paramedics and A&E - lifesavers, wonderful people in very difficult situations. Once you get on the ward and you are old and perhaps not totally compliant - different sitch and it seems to be the luck of the draw.

I've seen this happen, I wouldn't blame a nurse for not seeing a patient laying sideways on the bed, that can happen very quickly and the nurse may well have been with someone else. One of my relatives was transferred to a carehome before their spouse had even been to visit it, they were self funding and no one even called her to say he's been discharged. I've been to visit n.o.k. a few times only to find they've been transferred elsewhere or sent back to their carehome. I try to convince myself it's just overworked staff, incompetence and lack of attention rather than deliberate neglect. I hope she's ok and gets home when she is able.

This all sounds very familiar from when my grandmother was in and out of hospital in her last year. Several times she spent weeks in hospital when she was well enough to be discharged...bedblocking unwillingly. We had a call to say she had passed away but the care home had been told she was fine and was returning back. We actually had to ring the hospital to make sure it was the right 'Doris ' that they'd called us about.

My dgp actually refused an ambulance, they knew if they went back they would die there.
That’s fucking sad

I'm so sorry for those of you who have experienced similar difficulties, my heart goes out to you and your relatives.

Re mum falling sideways very quickly: well, she said she'd been there a while, couldnt reach her bell, so who knows? but with a broken shoulder and humerus righting yourself from that position would not have been easy or pain free or good for healing. And I personally saw that SN being in the 8 bed bay; she was obstructive to us for the previous 2 hours, and went to deal with an 'emergency' with a single ball of cotton wool (no gloves) basically because she couldnt/didnt want to answer our questions or try and find out the answers...

It's also worth saying that the beds weren't full, the staff ratio seemed pretty high (to my ex-NHS nurse DB) and there was nothing urgent happening.

eightfaces yep that's what DM says, and also others I know. Appalling. And given this experience, I wouldnt make DM go again, I would say "just stay in bed at home" and what will be will be.

We are under massive pressure to discharge as many people as quickly as possible , we get loads of emails a day pushing us to do so. It's a fruitless exercise because it results in failed discharges. I hope you get some answers and that your mum is ok.

oddcat medically she is fit to be discharged. But they have to put the social care package in place (dont know how it works elsewhere, but here she gets 3 days of up to 4 nurse visits daily who assess how she can cope in real life, followed by 12 days of SS carers while a plan is put in place). That's amazing, but she cant be discharged until the nurses can accept her - only a certain number can be accepted per day. We could take her home and care ourselves in the short term, but that means she is no longer eligible for any of the care/assessments/resources mentioned above. short term thinking all round.

and honestly, this is not a bitch about the NHS, it's just the rubbish thinking that seems to go on, and the fact that overstretched underpaid people cant do everything and no wonder they get compassion fatigue.

It’s so heartbreaking
I agree, what will be will be.
I forced them into hospital the time before and I’ll never do it again.
I ended up paying for a hotel with wheelchair acces and a wheelchair access shower whilst I looked after them for 2 weeks before they could handle being back at home.
And I could afford it. What about the people who can’t.
I have upmost respect for all that work in the nhs, but I am so saddened by how the elderly are treated.

The whole assisted dying thing is a real issue, and I think it will only pass in parliament once the state cannot afford to keep people alive. It’s always about money.

And I’m sorry! My case is in no way as extreme as yours x

There seems to be a great shortage of community staff, that's usually the hold up with discharge planning, could she go to a rehab unit or a respite bed until they find the community staff. Sometimes the delayed discharge team can fund a community bed for a few weeks to free up the hospital. It's easy to get side tracked when you're upset, I made a written complaint through PALS and it was hard just keeping to the main concerns, we got an apology, there were no individual members of staff who were to claim, it's just a shite situation. We've had several carehomes and our local nhs elderly rehab hospital close in the last few months.

we have had some wonderful experiences with care in the NHS but we have had some dire ones too. I think its very much an individual situation, caused by understaffing in some cases, bad organisation, bad practice which is not reviewed & therefore nothing changes & serious or dangerous incidences can occur. We have personally experienced the worst in the case of a single surgeon & the pre operative post operative & the operation its self but we have also seen (at Papworth! I want to mention that hospital it was great) the kind of thorough interconnected care & practice that couldn't have been better. It is important therefore to make sure if bad practice occurs that it is reported. OP get your mum's medical records!