Late or no admittance to hospital in order to keep the NHS from being overwhelmed

[Sosadandempty]

I have been hearing / reading about this for a long time. Having read this thread and others on here, I wanted to ask how we can highlight this issue so that the media pay attention. I have read a couple of articles but why isn’t it more of a scandal, and why does no journalist seem to be asking the question during the Downing Street conferences?

It seems that in a bid to stop the NHS from being overwhelmed, many people are not taken in to hospital with corona symptoms until it is too late / if at all, leading to home and hospital deaths which might have been avoided. And while I am sure some people are taken in earlier, I have heard and read about countless examples of this not happening.

In fact it seems that hospitals are not overwhelmed (a fact that Downing Street repeats every day as a marker of success), so why is the 111 apparent policy of advising people to stay at home until they are practically unconscious (with blue lips and a lolling head one poster said) in place?

It seems best to bypass 111 completely and to call 999 instead - but even then I have heard of paramedics coming out only to not admit people who are really suffering and frightened . It’s frightening.

Are the lower death rates in places like Germany in part due to earlier hospital admittance?

[Porcupineinwaiting]

@crazydiamond222 from what I gathered they were looking for oxygen sats below 90%, severe dehydration or heart problems all of which equalled "unable to continue at home".

There is no guidance anywhere it seems on the
treatment of moderate cases, were just left.

[Ciwirocks]

Oxygen sats below 90 in an adult you would be expecting them to go into cardiac arrest at any time! That is way too late. People looking visibly blue would likely have oxygen sats in the low 80’s. It’s really frightening if that’s what they are waiting for and no wonder the outcomes are so poor for people who are hospitalised.

[BestOption]

@Sosadandempty

Thank you for starting the thread.

I am very worried about this too. I hope the media picks up on it soon!!

I live alone (no family near by either) & have underlying issues. I'm terrified of not getting any help if I need it.

I'm doing everything I can not to get it (being ridiculed on here for washing my shopping that's delivered) not going out (except to deliver some food shopping to my 92yo uncle -doorstep delivery, wave through the window).

It's terrifying.

All so the Govt can say ' look how well we have done, we aren't even at capacity'

Not interested in political statements any of the others would have been an equal shit show

How do you think we can get this issue taken seriously??

[cathyandclare]

NICE have published guidelines

And no, people don't have to be blue or floppy to be admitted.

i wonder if 111/ambulance paramedics are triaging on other factors- but then saying something like 'obviously if you become blue, floppy or increasingly unwell please call back'- rather than those being the admission criteria IYSWIM

[Porcupineinwaiting]

I was triaged by my blood oxygen sats, temperature, by a heart trace and by listening to my lungs for signs of pneumonia.

The problem is things can deteriorate v quickly, so if you leave people w o2 sats in the low 90s at home then it doesnt take much for them to worsen to below 90.

[PowerslidePanda]

This country is performing appallingly if judged by the same metrics as everyone else, i.e. number of cases and deaths. So the government is trying to distract everyone with the "make sure the NHS can cope" goal. They're applauding themselves for achieving that, ignoring the large numbers of people dying. They even got people convinced that now is the time to lift lockdown - because the NHS is coping! Never mind that we're heading for the highest death toll is Europe - the NHS is coping, so we're doing well!

[PowerslidePanda]

@cathyandclare Thanks for the NICE guidelines - very interesting! I've seen guidelines for other countries that say to give oxygen when O2 sats reach 93, whereas we won't even consider someone for hospital admission until they're at 91 or below!

[NotEverythingIsBlackandWhite]

@MegUffin

This is yet another Tory bashing thread from a 99% percent left wing Mumsnet audience.
I don't think it is another Tory bashing thread (although there have been plenty of those). I am and probably always will be a Tory voter but that has sweet fa to do with this issue.

I do think the 111 service is leaving it too late for many to be admitted to hospital and be saved. Their advice to wait until you are so breathless that you are gasping for breath is appalling.

I am horrified at what MNers on the Lungs threads (and presumably lots of others) are saying they are told when they phone 111 with severe breathing difficulties. How can they not be ill enough to be hospitalised?

Who the heck tells the 111 staff what to say? I mean, really, can someone tell me who does advise them?

[tinkywinkyshandbag]

I am saddened and shocked by this. We are mean meant to be one of the most advanced developed countries in the world and yet we are lagging at 15th in the world in terms of our handling of this crisis. I live in fear of catching this virus (asthmatic) or a family member catching it. I simply do not have faith in our NHS and that's not bashing the very many wonderful individuals who work in it but is is related to the bureaucracy and the seeming lottery in getting proper treatment.

[Humphriescushion]

I will post hosptial no.s in France.
30,000 in hospital at the moment - this number was higher and they were in danger of being overwhelmed at least intensive care.This is after peak has been reached. There are around 6,000 in what i understand is intensive care. These numbers are coming down, but took a long time. I think over 70,000 went hosptial overall ( think more). I have no.s for nos those leaving hospitals.

Uk has 17,000 in hosptial at the moment.

This worries me if i understand there is still spaces. Are people being admitted too late?
I cant find exact no.s for how many have been in hospital in total.and now many are in intensive care. i would like more transparency.

[MoltenLasagne]

I think 111 in general is not fit for purpose. It has always been used as a way of reducing admissions rather than properly assessing people to get them the healthcare they require.

A few years ago 111 told my Dad he should go to the pharmacist for an allergic reaction as it was localised. Luckily his neighbour came round and called 999 just before he went into shock and he was blue lighted within 5 minutes. Is there any follow up on 111 calls when they give bad advice?

My Dad trusted them because he thought he was talking to a doctor but they're just call handlers with minimal training and a script to follow. Thank God he has friends with more medical knowledge.

[Reginabambina]

I would imagine if you applied sensible admissions procedures the NHS would quickly be overwhelmed. There will be far more people who are struggling to breath than those who are struggling to breathe and showing signs of oxygen deprivation.

[cookingmywaythroughlockdown]

We have a pulse oximeter at home. I've done baseline obs on everybody so we will have confidence in it if it shows desats. So if anybody becomes ill the plan will be regular obs and straight to ED if indicated. We are only a few minutes by car so would avoid ambulance unless crisis.

[ChicChicChicChiclana]

I agree 111 in general is not fit for purpose. We had cause to ring them when DH was ill with covid-19. They rang back approx 18 hours later at 5.20 on a Sunday morning. As we did not pick up the phone (we were asleep) they left a message saying they were closing the case.

How can you dispute the facts @Popuppippa? Have you looked at how many people have died of covid-19 in Germany? Their population is more than 20% larger than ours.

[ChicChicChicChiclana]

And when dh was ill, my very good friend who is a healthcare worker offered to drive us to our local A+E (large London teaching hospital) as she said it was pointless calling 999.

[Meredithgrey1]

To be frank, I am worried that there are already bodies lying undiscovered behind closed doors. Even worse is what happens if there are young children in a house with an incapacitated single parent? Are there any welfare checks or follow up calls?

When I had a call back from a Dr at 111, she asked if I wanted to be put on the Covid "call back" list where someone would ring me daily until I was feeling better. The reason I rang was severe stabbing chest pain when breathing and moving but my cough and fever had gone so she thought it was a pulled muscle from coughing so much so she said she didn't think I needed the follow up and neither did I once I'd spoken to her, so I said no. So, I don't know how well it is aactually being followed up. But it was offered.

[Bimbleboo]

111 can be very hit or miss and while I don’t blame individual call handlers, I agree it’s used to bring down admissions. But not fit even for that purpose. They have a checklist and often the wrong callers are dismissed while others have ambulances sent out that aren’t needed, purely because they know the ‘key words’ you have to say that leave the call handler with no choice but to send one. I image THAT problem isn’t current as the goal posts have changed for covid. But it was definitely the case when I was a HCP that ‘frequent flyers’ were often the largest dynamic rushed in ambulances because they had just learned the symptoms you had to quote for action. While many others were not triaged in who absolutely should have been, because they were missing one line on a checklist. Completely unfit for purpose.
On the other hand, the nhs just doesn’t have the resources for what would be a fit for purpose service. There’s no resources for an actual doctor to asses all those calls. There’s no capacity for everyone to be seen before it gets to a 999 level.
I’d assume that’s even more prominent now.

[Bimbleboo]

@RunningAwaywiththeCircus as an absolute Non Tory voter I agree with every word you’ve written. To the letter. Which I guess is evidence of this not being a political argument.

[nellodee]

We have heard for years that one of the main problems for the UK was the issue of "bed-blocking" and the inability to discharge patients due to lack of social care. I want to know, have all these "bed-blockers" been sent to care homes to die and infect other residents?

Any hospital social workers able to shed light? (Are they still social workers? I used to work in home care a long time ago, but I know they have shuffled the boundaries between health and social care since then.)

[Porcupineinwaiting]

@Bimbleboo it certainly is still the case, even with COVID

When my symptoms flair badly I struggle to breathe. This feeling is a accompanied by the feeling of there being a crushing weight on my chest. After a couple of weeks of this I tried to use the 111 system to speak to a doctor (GPs direct a coronavirus patients to 111). 111 call handler asked me to describe my symptoms, moment I used the phrase "crushing weight" I was passed to 999 and ambulance dispatched as it's the trigger phrase for heart attacks. I tried to say I didnt want an ambulance (I'd had the feeling on and off for two weeks by this point) just to speak to a doctor, no dice. Paramedics then arranged for gp to prescribe antibiotics which is all I'd wanted in the first place. Total waste of time.

[MigginsMs]

This is yet another Tory bashing thread from a 99% percent left wing Mumsnet audience.

Bashing aka holding the elected government to account for their handling of a crisis is entirely appropriate.

I suspect it’s been a deliberate strategy to keep numbers down by only reporting on deaths in hospital. If they can stay and die at home they don’t affect the government’s figures.

[Bimbleboo]

@porcupineinwaiting that sounds about right. I’m glad you got some kind of medical attention mind you.
But typically, the 111 service just becomes a revolving door for patients who are willing to play the game properly. Prior to covid, If you mentioned excruciating abdominal pain and fever, or atypical breathing problems or sensitivity to light and crushing headache, that will trigger a response. People learn thats the only way to be taken seriously and not told to self manage. So some will just realise that’s the button to push.
I worry that now ambulances will only be sent out to those who are willing to say their lips have gone blue, when they haven’t. And that ambulances will be dispatched out and then leave those people in their homes anyway once they are found not to actually meet criteria. (Not that I’m advocating for that either. If some threads are to be believed, the criteria is terrifyingly negligent)
Additionally many others will stay at home and not contact services because they’ve been told they won’t be responded to until those criteria are met. That’s even more terrifying and the whole system is a shambles (if indeed it is performing as MN would have us believe across all regions)

[crazydiamond222]

Thanks for the NICE guidelines. It does appear only the most severe cases are admitted to hospital


'3.4. Use the following symptoms and signs to help identify patients with more severe illness to help make decisions about hospital admission:

severe shortness of breath at rest or difficulty breathing

coughing up blood

blue lips or face

feeling cold and clammy with pale or mottled skin

collapse or fainting (syncope)

new confusion

becoming difficult to rouse

little or no urine output.

Use of assessment tools

3.5Although theNICE guideline on pneumonia in adults: diagnosis and managementrecommends using the CRB65 tool, it has not been validated in people with COVID‑19. It also requires blood pressure measurement, which may be difficult or undesirable during the COVID‑19 pandemic and risks cross-contamination (seerecommendation 1.4).

3.6Where pulse oximetry is available use oxygen saturation levels below 92% (below 88% in people with COPD) on room air at rest to identify seriously ill patients'