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.

Examples in the press are likely to be exceptions to the norm.

we use something like 90% of our lifetime medical costs in the last 4 years of our lives. Hospitals, rehabs and clinics will of course contains a disproportionate number of older people

In the facility I worked at, lack of motivation was expected from every patient who came through. It's a known symptom of the conditions that brought the patients in.

I can only speak about the particular setting I worked in, but it did include contracts agreed between the patients and lead therapist on admission. Individual schedules were discussed every morning on a one-to-one basis as well.

It isn't easy for the patients and it isn't easy for the staff finding the right approach for each person that helps them get through a challenging process. I have no doubt that it was a negative experience for some of the people on the programme, but for others I know it was the best thing that could have happened.

Having such contempt for your patients must make it difficult to perform or enjoy your job. Perhaps it is time for a career change.

Sure, but needing healthcare in the last few years of life is not the same as the point you were making earlier about not wanting to take personal responsibility

Thank you!
This woman wasn’t abusing the NHS. She was badly let down by social care.

There are many reasons the NHS is in the situation it is, far too many layers of management who have little or no patient contact, whole departments dedicated to equality/ diversity and target chasing(Donald may have the right idea about those), before you even get to the problems of a/e, not helped by the decision many years ago to close what seemed like every other a/e to consolidate into centres of excellence which they certainly aren’t, then post a/ e it’s the issue with beds which is massively compounded by a broken social care system which means people wait weeks or months while medically fit awaiting resources to ensure they can be looked after in the community. Is the current government addressing those issues, well it’s having yet another review to tell it what every clinician can already tell them if they bothered to ask, other than that, no.

These are patients that don’t need the acute setting of a hospital, but aren’t well enough to go home. They should be resting and recuperating so I don’t understand what is wrong with a minority of patients:
“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.”

the in group exercise classes might not even be appropriate for this minority of patients. Not everyone is going to be at the same level of fitness.

Well it is because if there is a problem with taking on personal responsibility it can only be a real structural / strategic problem for an organisation the size of the nhs at volume.

We all know the woman who lived in a bed for 18 months is not causing organisational level risks or costs.

for personal responsibility to be an issue it has to be at volume and scale- a significant number of patients.

And with the largest number of patients being older that would mean the volume would have to sit with them.

So how are this older cohort failing to take on personal responsibility in your view?

Or is the issue actually simply one of the current demographics we have, and not one about personal responsibility at all?

I'm not sure you are googling like for like - NHS price list has as little as 49p, depending on brand, pack size and dosage

bnf.nice.org.uk/drugs/levothyroxine-sodium/medicinal-forms/

No, she was offered 1 option only and as is her right, she raised the concern that the 1 option offered was to a place that she has distressing memories of as bad things happened to her there. Our rights have been eroded, you used to be able to have a choice of a few options, then it was right to reject first two options, now it’s you get 1 option and you have no choice- take it or die on the streets homeless. I am sure this is in preparation for go where we say or it’s straight to the euthanasia clinic.

This used to be a thing, none acute cottage hospitals. I think there's a case for bringing some back to reduce the impact of bed blocking and to enable more long-term care of patients who are difficult to discharge.

I agree with you OP to a point. I've worked in the NHS for 45 years and I'm staggered by some of the nonsense that goes on.
People who miss 3 or 4 45 minute appointments for no reason and then expect a new one at their convenience whether we have a slot or not. We are a massively busy and acute department with a long waiting list.
Well off people who insist on being prescribed paracetamol and cheap creams when it costs pennies in the pharmacy. People insisting on home visits when they are not housebound.
That's just the tip of the iceberg.
The vast number of PIP claimants who are not genuine. They boast about it.
Makes me wonder what all this nonsense is costing the NHS.
Many quiet and unassuming people don't get anything because they don't ask for it.

I'm still struggling to understand how the link to the report of the woman with severe mental health issues is illustrative of the OP's point? (Edited to say I see I'm not the only one so not worth going over it, its clear its not relevant)

I think you might be losing track of who you’re responding to/ why you’re responding to them. I didn’t say that older people are failing to take responsibility. I responded to a user who said the problems in the nhs were partly attributable to people who don’t take personal responsibility

This is what happens when you give something of value to people for free. The majority of the people in this country do not contribute to the cost of public services. They are net takers. Until people are made to contribute to the cost of services they use, nothing will change.

Not to mention that NHS is basically a broken, money pit. It keeps getting more money from a dwindling number of people who actually contribute to just fritter it away.

And it would stop people like me with disabilities, cancers and life limiting conditions from getting the medical help that I need to stay alive. I there are times that I need weekly gp appointments that I couldn't go to if I had to pay

@Yougetmoreofwhatyoufocuson
The patent for levothyroxine expired in March 2024, which probably explains why it's much cheaper now.

It's obviously ok to disagree with the op but personal comments are totally unnecessary.

I agree with you Op. Having just spent 12 weeks in hospital I was astounded by some patients behaviours. One particular highlight was a very capable lady who went home the next day (before anyone comments there is NO privacy on the wards) having a go at a nurse late at night as she had requested tea and toast 10 minutes ago. Right next to her was a lady in acute medical distress with nurses and doctors working on her. They were clearly not going to prioritise tea and toast !!!!

When someone one's mental and physical needs, their behaviour and attitude are so extreme, that only one facility was prepared to take her on, Hobson's choice is all you're going to get, especially after over 500 days in a hospital bed

The patient has a ^personality disorder', not considered to be a treatable mental illness.

She can't be sectioned for 'being herself'

I worked as a GP receptionist before I retired.
We used to have a sign saying how many appointments were missed.
At one point it was over 100 for a 4 week period.

Many were repeat patients who didn't turn up.
You couldn't refuse to give them an appointment as they maybe really
poorly. All you could do is tell them about missing appointments.

Sign got removed as there were too many complaints that we were trying
to embarrass everyone. There were no names or clues if it was an adult
or child or even male or female.

People need to be accountable for themselves and not waste resources.

There is a difference between patients who are discharged into a care or nursing facility to rest and recover and those who are discharged into rehabilitation settings.

One involves rest and the other involves increased physical activity.

Your bosses were massive whimps if they were pushed into removing the sign by some random complaints- surely the point of the sign was to embarrass people?!

either that or they realised it wasn’t effective

Exactly. The majority of patients are cooperative. But it only takes one or two people abusing the place to have a knock on effect.