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.

It would also penalise the parents of small children and potentially anyone with a serious long term illness. I can see what you're trying to achieve but I think there'd be too many unintended consequences.

And on the flipside you have people like my MIL who has been in hospital with a broken hip since November and desperate to leave since the day she was wheeled in but they won't release her because her wound isn't healing properly. Her mental health is on the floor sat in a bed on a ward for months on end.

I know several people on levo, none feel better or have been allowed anywhere near an Endocrinology appointment or regular monitoring. Levo is dished out because it's cheap and makes your T4 /TSH look right whether you are converting T4 to T3 or not.

They did that to my father after a stroke - this heading on 10 years ago so nothing new). They packed him off home in a taxi, he barely got through the front door before collapsing and was promptly readmitted.

I still grind my teeth in rage when I think about it. All this shite about being grateful for the NHS winds me sky-high sometimes..

I’ve worked in similar set ups. Obviously you want patients/clients to be happy and relaxed, but that’s completely different from taking the piss. You are in there for rehab, it’s not a rest home. Some people love it because it’s more sociable and supportive than home (understandable) but doesn’t have the negative connotations of being in a care home. They would happily live in that half way situation indefinitely given the choice. But there is a large queue of people who also need those facilities so you don’t want them to get too comfortable!

My husband was discharged to rehab last year.

He's a diabetic and blood sugar takes a while to rise in the morning.

Physio would arrive at 9am before he had eaten breakfast. Then, because he wasn't ready, she'd go off to see someone else and not come back.

It took me phoning the head of therapy to get him moved to a later slot on her timetable.

He had nurses attempting to manage his insulin. He's been managing his diabetes for 30+ years. He had to get his endocrinologist to tell the staff to leave him to it. Part of rehab is to be ready for discharge home rather being infantilised and stopped from doing your own routine care.

The food was also a nightmare. He doesn't eat dairy but the HCA claimed that he had "asked for ice cream" when what actually happened was that she just dumped it on his tray and walked off.

What should have been a opportunity for a 2 week intensive focus on his mobility ended up being 4 weeks of sitting in a room by himself.

The biggest issue is poor lifestyle choices, end of.

I think the bottom line in this case isn’t that her partner couldn’t provide care (some people don’t have anyone - if you live a long way from relatives and have older children with special needs who can’t just go to a friend, for instance) it’s that it’s ludicrous that a hospital can’t provide so much as a slice of toast. Appropriate nutrition is a key part of nursing. Or should be.

This makes me laugh. I have hypothyroidism and take levo. I barely get a blood test once per year/. There are no check ups. I don’t have an endocrinologist. I have never had an X-ray etc. I think you are talking about the perfect service not the actual one people get.

I thought the NHS had negotiated good deals on drugs. Thought that was one of its strengths.

I’m disappointed if the Levo and Nortryptiline I’m on without an appointment in your average year is costing that much.

Annual blood test followed by a text here, too. And no interest as to whether I feel better at that dose.

When they enter your service do they get someone with authority coming around and explaining what the service is for? What I mean is do they get an introduction of this is what we provide but also this is what we expect from you? Do they get told the consequences for failure to engage and is this followed through? If the answer is no then that is where the first failing is. There will always be CF around and they will take advantage if they are allowed to. The only way the service can work is if it is running efficiently and rules are adhered to and there are active consequences if not.

As a pp has said there does need to be good communication between care and nursing staff as well as physios if they work there too. For instance a physio working there should have a list of patients and enough info on the patients and medication they are taking to be able to organise a 'ward round' to decide who to see at what point in the day.

So you're criticising both the patients and the staff?

A bit contradictory. The staff on one hand are running around them, allowing them to 'behave like VIP celebrities' but at the same time being lazy and not working 'gassing about the dogs and holidays'. Which is is?

Are the expectations and routines clearly communicated with new patients?

“Costs the nhs” very likely isn’t the direct costs of the drug- in fact your comparison proves it isn’t, of course the nhs don’t pay the manufacturer £2k for something the Portuguese get for £8.

“the cost to the the nhs” is the whole supply chain of patient contact to drug delivery. The staffing, premises, logistics, operations.

There are two real elephants in the room regarding the NHS but I don’t think the behaviour of individual patients is the issue- one ‘elephant’ is huge social inequality and the other is the way that- in large (but not total) part as a result of this inequality- people care for themselves so badly, often due to factors such as…..

• lack of/ lack of cheap and easy access to sport and fitness facilities, green spaces etc
• shift work/ long hours/ lack of time
• inadequate housing with damp etc
• food deserts and supermarkets stocked with cheap shit food that is quick and easy
• whatever on earth has happened to gp and dentistry services over the last few years

On the local news recently they had various people complaining about NHS waits etc. could not help noticing that every single one of them was properly obese. Not blaming the people themselves for this but surely there should be some preventative healthcare going on and I don’t mean shaming individuals , I mean that means tackling ufps, additives, the big supermarkets, access to leisure facilities etc

You’re talking big society though, which nhs is only a small part of. I agree with the poster above- we need a national conversation about what the nhs is for.

when you’ve cured or prevented, or made easily treatable the awful disease and illnesses that took people in their childhood or prime- polio, measles, scurvy, birth defects, infection etc…. When you have hugely reduced heart disease due to healthier diet, when you have hugely reduced smoking related disease by reducing smoking, when you have reduced workplace accidents to a minimum through health and safety, when you have high driving and road safety standards reducing road deaths….

the hard truth is we will be left with a disproportionate number of people with “self induced” disease, or crippling social problems, poor mental health, or the pressure to treat complex “luxuries”- 25 week old babies, IVF, in utero surgery- things that simply would’ve have happened in the 1950s- and we need a conversation about how much of that our society is willing to support.

As well as a lady forcibly being evicted for overstaying at hospital

A young woman staying in a hospital bed for 18 months clearly has some complex needs - I don't even have to read the article to know that. Hospital isn't the right place for her, but it doesn't sound like home is either. No one in their 30s (or any age really) would just choose to chill out in a hospital for 18 months.

Well she didn’t have a home (despite being offered some choices) so she was there to sleep and get food, which as a homeless person wasn’t a given for her.

I believe she has NPD and was extremely difficult to deal with

I wonder - what’s the admission process like?

Does anyone sit down with them when they arrive / before they arrive and spell
out the expectations and the commitments expected for their stay there? From what I’ve come across that’s not the case.

I compare that to my grandfathers stay in a rehab facility in Switzerland post heart surgery. There was a contract he committed to on admission, and it required participation in the rehab program, honouring quiet hours, visiting times, meals, respect for staff etc.

There’s no reason that couldn’t be done in UK council run facilities, but there seems to be a reluctance to set and hold
people to standards.

For every responder who says you're cruel and heartless OP, there will be 100 people reading who agree with you, silently.

We've lost sight of so many things in this country, one of which is taking personal responsibility and not expecting everything for free.

It really depends on what a person is in hospital for. For things like infection, a week in bed might be what's needed and there's little risk of a person becoming permanently disabled by doing that. But those patients won't be discharged into a a rehabilitation program.

For other conditions like major joint replacement, stroke, brain or cardiac injury, bed rest might make things worse.

Rehabilitation or Re-enablement placements are there to get people back on their feet and functioning as independently as possible so that they can actually go home. The alternative is often full time care. So support staff, physios and OTs are on hand with a specific program designed to get a person as well as possible.

Patients are given information about the programs before they go there and again when they arrive.

This is a horrible thing to say but I think longer term- within 20 years- this will diminish as the generation who were told they would be looked after cradle to grave die out. Many of them have lived their lives with this expectation (understandable) and are not set to take personal responsibility. They are also the source of much of the pressure on the nhs currently

This was my thought too.

Also, people need to be motivated to engage with rehab. It’s hard work and requires discipline. If there is no assessment to check if someone has the motivation to engage, you can’t really be surprised if a cohort of your parents don’t engage. That’s a system fail, not an individual fail.

A lot of the examples we see in the press aren’t in that age group. The woman who has been clogging up the NHS bed for 18 months is 35.

Many of these rehab hospitals are for people who have had strokes. They are left exhausted and probably don’t want to be up early, dressed and doing activities! They need rehab of course, but also their bodies need to heal. You wouldn’t expect that of a middle aged person, but with older people we expect them to comply as though they were toddlers… only they haven’t got the energy.