Addressing the elephant in the room; people abusing NHS, health and social care.

[Floogal]

I have seen a number of threads (here and on Facebook) bemoaning and worrying about the state of the NHS and social care in the UK. But what about how the general public treats it? Over the years, so many people used these services incorrectly, or even abused it in wanton fashion. There has been recent discussion about people who go to A&E mob handed. As well as a lady forcibly being evicted for overstaying at hospital

www.mumsnet.com/talk/_chat/5270258-woman-evicted-from-nhs-hospital-ward-after-being-stuck-for-18-months

I have been working at a council run rehabilitation unit. The majority of patients stay here after being discharged from hospital. They usually stay for around 3 weeks before they're well enough to go home (or sadly sometimes residential or nursing care). However, there is a noticeable minority of patients who seem to treat the place like a hotel. Eg,, staying in bed all morning, watching TV all day in their rooms, Refusing to join in group exercise classes, chatting on their mobiles. Socialising with their visitors for hours on end. I mean, they have plenty of free time in the afternoon and evening to chill out.
Indeed, some of the conversations I've heard make them seem entitled. For example , "I should like some tea and cakes brought to my room for when my guests arrive". Another lady kept ringing her bell as a carer made her tea in a mug, she wanted it put in a China cup. Another male patient turned away a physiotherapist who came in to see him. His reason for turning her away was "I haven't finished reading my morning paper". The best one was this woman complaining that she expects room service and that she's worked and paid her taxes. They're meant to be there for rehabilitation, not the Downton Abbey experience!
Also there are other patients who are ready to go home but are very reluctant to leave. Most likely as they get 3 free meals and company and attention. Which is understandable if they're lonely at home. But that's not what the service is for.
I believe this also contributes to the problem of bed blocking in hospital as patients can't leave hospital due to a lack of space at rehab.

Staying in bed all morning and watching TV and talk g to thier relatives - what’s the issue with that? Not everyone wants to socialise with people they don’t know.

People not wanting to go home because of loneliness also totally understandable.

Guy who refuses NHS physio should be struck off the list however. Back of the queue for physio for him.

People wanting to be waited on hand and foot likewise. Cold cups of tea for them.

Incredibly sad but for many people it’s a “luxury” experience. They are warm, safe, and full, no worries. This won’t go away anytime soon.

Also there is a minority of staff who enable them to behave like VIP celebrities. Just because they want to stand around gassing about their dogs and holidays.

People refuse physio and exercise rehab because they're embarrassed by their physical difficulties. FIL did the same until he realised he'd never get to go home without them.

Buckle up op, you'll be hit with a plethora of 'well if you can't take the abuse/behaviours then you shouldn't be in the job... people who need/want care are absolutely entitled to be abusive/rude/aggressive poor lambs, and if you don't like it, you are evil and should be struck off!!'

But surely it's more effective and quicker to recuperate when you feel relaxed and happy.

You sound like you'd rather everyone acted like it was a boot camp.

Here’s something for you to think about regarding the NHS and wasting money: according to the Wiley library of endocrinology, the average cost of Levothyroxine costs the NHS £2500 a year per patient (2021) I admit that I just googled that and it came up on the first page and looks legit. I am in Portugal and have just bought myself 2 months supply of Levothyroxine for the princely sum of €7.50. In the past I used to use a private prescription to buy Liothyronine, it would cost £30 a month. My doctor didn’t want to prescribe it because it would cost the surgery £500 a month. One would think that the NHS has you know that thing of bulk buying making stuff cheaper. How much are they paying everyday for overpriced drugs that no one is checking up on? As in, is no one in charge? The mind boggles at the sheer numbers.
The NHS like one of those massive dinosaurs with a very long neck and a tiny brain at the top.

Christ - these are people who are ill, frightened and have very little control left over their own lives. Whilst what they are saying might not be ideal (and obviously a minority are simply arse holes) it comes from a place of feeling scared and out of control and they are just trying to exert a little control and order back, I am sure that those who work in the profession understand where it is coming from and behave accordingly,

Wow, compassion just flows out of you, eh? I knew you’d refer to that article. That poor woman clearly has complex mental health and social care needs for which finding a suitable provider was a challenge. An acute hospital bed is not the right place for her but she is a very vulnerable individual and I feel for her, as well as the staff as I’m sure providing care is not easy.

Abuse of the system is a scapegoat to hide the very real problem that it's been intentionally underfunded to allow it to be broken up and sold off to American private healthcare companies. Beds are underfunded, care in community barely exists, MH support is laughable. Healthy people do not take up space when it's not needed, it's just tha the space or system that needs to b there to support them doesn't exist anymore. Don't let yourself be distracted by headlines focusing on 1 or 2 ridiculous cases. It allows the governments to get away with it.
It's the same as demonising benefit fraud when it's like 3% of claimants so people who genuinely do need them die because of the stigma and system issues. Meanwhile billionaires don't pay a penny of tax.

"Also there are other patients who are ready to go home but are very reluctant to leave. Most likely as they get 3 free meals and company and attention"

The reasons will be a lot more complex than that. Some will be a lack of support (this was an issue discussed when things like the bedroom tax was brought in and communities split), unsuitable/poor housing, a lack of much needed equipment (I know a family who gave had to club together to buy a bed for their father being kicked out of hospital after a stroke and unable to do stairs), inability to care/feed themselves, fear of their future as they age, being some.

My partner should have went to rehab, they've chucked him out of hospital instead. Tried to discharge him on Tuesday, thankfully he has multi team involvement and some said no, he was discharged on Friday. No-one confirmed with me (I have my own house) that I would be caring for him. I've spent a lot of time in A&E over the last two years and haven't seen abuse of the system. What's made A&E difficult the last two times I've been is the increasing amount of MH patients in crisis. We've lost secure hospitals that they would have been taken to.

OP you aren't very good at your job are you?

People like you illustrated need someone to act like a parent to them. This means give them firm boundaries and ensure other staff members don't pander to them.

I actually have met people including medical staff who have done so to others.

@Ponoka7 it has been common for decades for the NHS to discharge people who are still ill. They are mostly single people who don't have their family or anyone else around who feel they can so will make a fuss.

All that happens is they are normally readmitted within 10 days.

@CaptainFuture way ahead of you 😂.

I think this is way way WAY down on the list of issues that are having a majority negative affect on the NHS.

The Levothyroxine may cost that much, but factor in the cost of the regular check ups, doctors, nurses, Endocrinology Outpatient appointments, phlebotomists, biomedical scientists, laboratory aides, radiology staff to monitor the thyroid and all the admin staff who make this happen and it costs way more than €7.50

Try as I might, I can't find this costing anywhere. I also wonder if this is correct it must include the costs of monitoring the drug, ie blood tests and appointments.

This is not true

From what I can gather, the woman evicted from the hospital had physical and mental health issues which meant she needed to be in a social care environment, and the previous care home was not able to have her back again. Someone like that cannot advocate for themselves and find their own care home, they need officials to do it for them. Yet here you are saying she has been abusing the NHS and the very social care system that let her down so badly.

Do you have any actual genuine evidence you can offer which supports your elephant in the room hypothesis, or are you just here to be goady?

People who are "medically fit for discharge", may not be very well at all

There is nothing medically that the hospital staff can do further for them and the hospital can be a dangerous place for people with compromised immune systems

The challenge comes when someone who needs rest and rehabilitation or hospice care and who is medically fit for discharge needs to leave

That's where social workers, occupational therapists and the discharge teams come in

To prevent an 'unsafe' or 'failed' discharge, they are the ones who have to find respite/hospice/step down places/new homes/rehabilitation or who have to find all the equipment a patient would need to be discharged safely to their own homes

I did also work in a rehabilitation unit for a period of time, and I do understand some of what OP means.

In our particular place, people often came from hospital with dysregulated body clocks, and supporting them to reorient to day and night was important. It did feel a bit like a boot camp at times, but lying in bed all day wouldn't have been encouraged.

It was an expensive service, so if residents weren't following the therapeutic programme, then they could lose the funding to be there.

Exactly! Also considering hospitals charge for patients to watch TV and are restrictive when it comes to visitors (not that I'm saying our rehab unit should follow suit). Boot camp is a bit of an emotive term, but at the end of the day they're there for rehabilitation.

Is anyone actually explaining how the rehabilitation centre works or do you just expect them to understand it?

I think we need to have a National conversation about what we expect the NHS to deliver. All social care for everyone including hospital beds (or even just beds) and carers I think will be difficult to provide for all, without a major increase in funding.

There are massive improvements in care with complex new treatments. Genetic testing and immunotherapies. Screening and now, God help us, Euthanasia. These things will cost huge amounts.

I think the NHS staff are exhausted with more and more change, which usually means more administration taken on by clinical workers.

We should empower workers with boundaries in the NHS. Those services that pride themselves on being good don't really know what they can safely say no to. Eg. Second opinion on the NHS, great idea, but 4th opinions? Transport for everyone that needs it, great idea, but for an escort too? Sure, in an ideal world you can have everything, but it's not an ideal world. I do think people expect a champagne service on beer money.

I would have thought the NHS’s colossally inefficient administration is far more of an elephant in the room than this.