To ask what can be done immediately to take the pressure off the NHS?

[Twinklenoseblows]

I've been reading stories about people waiting 4 days in A&E, people being taken into A&E in the back of a van with a broken hip as there are no ambulances ,and doctors and nurses pleading for something to be done right now as lives are at risk. But what can be done that would make a difference within the next week or two?

Promises of more money and more staff will presumably take years to filter through and make a difference.

I guess what is worrying me beyond the immediate crisis is that some bright spark in government is going to say we need a circuit breaker lockdown to reduce flu and covid admissions for the next few months to take some immediate pressure off. The thought fills me with horror so I'm hoping there is something else.

E.g. as a very short term measure could some people be diverted to make use of any spare private GP capacity to try to reduce the number of people going to A&E who could instead be dealt with by a GP if only they could get an appointment. Or is that madness?

Ah. I thought you meant the buildings themselves were literally imaginary 🤣 which would have been weird because I've seen one.

The Nightingales weren't hospitals. They didn't have hospital staff or facilities or equipment.

Most of the Nightingales didn't even have ambulance bays for patience to be delivered.

You couldn't even call them "wards". They had no facilities for washing or feeding patients, no toilets on the "wards". No IT set up for record keeping. No admin staff. No porters. No pharmacies, so no prescribing. Which was lucky because there were no doctors. Or nurses. No way to do chest X rays, no oxygen...

They were useless white elephants that were a form of pandemic profiteering. They enabled the government to gaslight the British people about our pandemic preparedness which had been completely screwed by first David Cameron and then Boris Johnson, and funnel £500 million of public money into the hands of their donors in the construction industry.

Four of the Nightingales never treated a single patient.

Because they were completely incapable of ever doing so.

The other three briefly admitted about 250 patients in total between them at a cost of £1.8 million per patient.

Putting beds in a room and calling that a hospital does not make it one.

The decision not to be treated really needs to come from the person themselves so we need to write our DNR etc stuff - I doubt many of you have or that your relatives have. We are stuck in our 'I hope it doesnt' happen to me' mind set.

I am amazed it ever becomes an issue! We’ve been sent three DNAR forms for DD with learning disabilities, aged 28 by her GP practice. The last one over Christmas; and it’s not just about CPR. The form asks us, if she gets ill, do we want her to stay at the care home; or do we want her to go to hospital. She has epilepsy, but otherwise is in good health. In fact, she is as strong as an ox.

Nobody has sent us a DNAR form say for DH in his 60s, who has had 2 heart attacks.

MIL broke her hip 2 years ago. She was given a DNAR to sign between A & E and the ward. When SIL asked her about it, MIL wasn’t aware she’d signed anything!

A month ago, DH (LPA) rang MIL’s GP to request a home visit, as MIL was confused and had spent all night in her armchair, because she couldn’t stand up. The first thing the GP asked DH, was if MIL had a DNAR. This really upset DH, who felt it was very insensitive. Eventually MIL was admitted to a Frailty Unit for investigation into her delirium and inability to stand up. The hospital rang up SIL and DH to discuss DNAR - DH went through the roof, mainly because of us being sent them for DD twice by then. He sees them as a proxy for no treatment! We went to visit MIL, and the sister approached us, to discuss the DNAR.

Every person past a certain age (to be determined following a proper consultation) should be sent medical forms and DNR type stuff to read through by their GP and consider and have the conversation with their loved ones. People usually make wills. This type of form should become commonplace. Same applies to organ donation.
My grandmother died happily and comfortably in a care home for this very reason, abroad. Because the right paperwork was in place. The doctor attended for pain relief.

Regarding ambulances and category 1s, personally I would always prioritise a Category 1 child or infant over a Category 1 elderly person. Is that not already the case? Is a floppy infant really not the absolute priority? Is there not some sort of system that takes account of age? I would be really interested to know that. I do not think it is ageist. I think as a society we should have a moral compass to prioritise children, then adults, then the elderly - that is all within category 1s of course.

It is based purely on medical need as it should be. Babies are often at greater medical risk.

Elderly people who do not have DNRs are generally those who are extremely healthy. If you are having ongoing treatment it is normally discussed with you.

But there is a lot of disablism so I am wary of them. Lots of disabled people who are younger and healthy get them pushed on them.

DNR is fine, but it should not be pushed, it should be a choice.

@Quisquam - why did your DH hit the roof? A care home or hospital surely just needs to know what to administer and how to treat a patient? As pointed out, more treatment isn’t always the kind or right thing to do. It isn’t proxy for no treatment. This is all about legal liability foremost. The more certain the instructions, surely the better for a patient? Or does your DH think hospitals or care homes do not try otherwise? I mean a form should always also include direction to keep a patient happy, sedated etc, and comforted. The vast majority of nurses and doctors will always do this regardless.

@BradfordGirl - the disablism is shocking and misplaced. Particularly, where a disabled person cannot give informed consent themselves. Pretty cruel asking a parent of a young adult disabled child to make certain choices by sending a form. These matters should always be discussed sensitively. Any parent of a disabled child has worried about not being around anymore to advocate for their child.

@Quisquam patients don’t sign a DNAR hence MIl not remembering signing one.

The form is completed by a doctor who is obliged to document whether it has been discussed with patient and family. There has to be a good reason why not ( such as patient too confused to participate). Sometimes if very clear reasons for not attempting resuscitation such as a very elderly frail patient with multiple comorbidities who cannot participate in the discussion the form will be completed and the family informed retrospectively at the earliest opportunity.

@Quisquam patients don’t sign a DNAR hence MIl not remembering signing one.

Ok, she had no idea she had agreed to it!

Slightly alarmed there are still people who don’t understand what the deal was with Nightingales.

Wasn't Brexit supposed to solve all this?

Do you remember the TV ads?

www.politico.eu/blogs/on-media/2016/05/brexit-campaign-broadcast-vote-leaves-nhs-warning/

Me too.

I agree with that.

To ask what can be done immediately to take the pressure off the NHS?

Everyone do their best not to be ill.

Not an immediate fix, but if we want a functional NHS to take care of our families when needed then the first chance we get we need a different government.

why did your DH hit the roof? A care home or hospital surely just needs to know what to administer and how to treat a patient? As pointed out, more treatment isn’t always the kind or right thing to do. It isn’t proxy for no treatment.

I have already explained in my post! Iirc, when I looked at best practice when we were sent the first DNAR for DD; it said there should be sensitive discussion, preferably in person by the senior doctor involved in the patient’s end of life care.

DH found it extremely insensitive of a GP, who he had asked to visit his DM, because he suspected she had a uti (causing the confusion), to ask if she had a DNAR as his first question. It wasn’t done in person and how was it sensitive?

Likewise, a sister ringing him up at home expressly to ask him to agree to a DNAR was not a sensitive discussion in person either.

Actually the hospital discharged his DM into a step down care home, as medically fit for discharge. The care home told us yesterday, she was not medically fit for discharge, when we and SIL were shocked at the state she was in. Our view of the care home could be summed up as apathy! Her home LA has made a safeguarding referral to the LA of the hospital and care home.

What's that old quote about Conservative governments?

"I warn you not to be ordinary, I warn you not to be young, I warn you not to fall ill, and I warn you not to grow old."

Here’s another quote about Conservative governments.

We went to visit MIL, and the sister approached us, to discuss the DNAR.

Well did MIL have a DNAR. I would think it's due to bed blocking. If she didn't I can't see why you get offended that people ask.
Resuscitation isn't the same as prescribing anti- biotics or painkillers.

No realisation that this is often a shocking question to ask exhausted, anxious relatives? And even using the term bed blocking is unpleasant in this situation.

Here's the thing re; DNAR decisions... They absolutely wouldn't be used to avoid bed blocking. If a medic thinks rescusitation isn't appropriate because it's almost certain to fail then they will consider it. This decision has no bearing on how busy a hospital is.

However, if the health service is overwhelmed than it's much more efficient( and kinder on a patient and their family) to proactively make that decision and communicate it to the family before the event. Otherwise if the worst happens the whole hospital and its dog will come rushing, may have to perform CPR anyway until the patient's details are fully explored, traumatise the family and break the patient's ribs and generally suffer the patient a horrific and undignified death. Far better to consider all this before it reaches this point surely especially when resources are severely limited...

Another thing to bare in mind is that doctors do have a duty to 'do no harm' therefore if they think CPR is going to harm the patient and not going to bring them back to a half decent quality of life then they will eventually withdraw CPR whether it's on a piece of paper or not and that's entirely their clinical decision. They will take on board what the patient/family say but actually the final responsibility rests with the treating clinicians.

I do appreciate that these discussions aren't always done sensitivetly but we're living in desperate times I'm afraid. A GP discussing CPR is entirely reasonable though. I promise though however sensitively/insensitively the subject is broached that the only reason it is bought up is the desire to give that patient a dignified death and appropriate treatment. The kindest, most proactive thing we could all do is to do our own research around DNAR so that we're really clear about what it means and aren't scared of it when it's bought up by the professionals.

That is rather a patronising response. If the NHS is too overwhelmed to be able to be sensitive in these situations then that it is more proof that it is not fit for purpose.

I just caught the end of a politician talking about this on radio - good suggestions around social care, overall health and a committee set up to focus on how to deal with demographic change

Pretty much what I think - not sure it’d happen (think it was a Lib Dem Norman Lamb)

Totally agree it isn't fit for purpose. Disagree until my dying breath that going private is the solution or that it's in any way the fault of the front line staff who are trying desperately to keep it going.

Of course some private input is the solution! It doesn't have to be a US model. The European model - explained ad nauseum - with non profit mutual insurance companies would be worth a look.