So much chat about schools, why is no one looking at the NHS?

[headachehenry]

So much ripping apart of the plans to get schools back with different measures, what education will look like from now on, etc - understandable. I'm really surprised that no one is asking questions about the NHS in a covid world.

I'm in therapies in a role where I need to touch and examine patients in order to assess, diagnose and treat patients. We've been told that we won't be allowed to offer face to face for 18 months and can only treat people over the phone or in virtual appointments - conditions can not get diagnosed this way. Colleagues are having to talk parents through doing procedures on themselves online, talk relatives through doing complex rehab over the phone, procedures we use for diagnostics are suspended long term, therapy assessments on small children being carried out remotely (challenging when they won't stay on camera). Many staff members told to plan to work from home (in unsuitable environments with lack of confidentiality with family members) indefinitely.

The NHS is not all about inpatient care (which remains) or elective surgery (which is all you ever hear about) - I'm really surprised that people aren't on here ripping NHS services to shreds. I'm embarrassed that it's clap night again because I feel ashamed at the service I'm able to offer from now on (I know it's not my fault, it's the covid NHS) and wish people would shout about it 😢

@Tiatotheresuce

Nobody suggested you are responsible for what hospitals are doing. Or not doing. The point I am making is that a prominent oncologist is warning about an evolving catastrophe because of cancelled cancer treatments and diagnoses. His words suggest the experience at your hospital is atypical

Seems to be a lot of regional variability.

I find it peculiar when something is put on a pedestal only to be quickly knocked off again. Especially when those who are working away and living with the risks had no say in the pedestal being erected in the first place (no thanks), which services were allowed to continue and the how our personal safety is being protected. We have had literally nobody ask us about any of this - add in annual leave being suspended, departments being totally reconfigured with zero notice, the increased clinical risk we are absorbing in the frontline try and keep people safe and the situation feels pretty hostile. So I am certainly bracing myself.

Happy to criticise the nhs here and I work in it.

I’ve been really impressed with how quickly we have re organised locally and think for most primary care stuff can be done over the phone or video which we have set up really really fast along with a text service and electronic prescriptions. Also now have a home visit service for the shielded.

However I’m really worried about the lack of HV visits to new mums and the cancellation of baby weigh clinics. HV have all been redeployed to the district nursing team which has the bigger need (they do the nursing care and palliative care for patients in the community and non nursing Carr homes so very overworked). After seeing a baby with severe weight loss in our practice We have tried to address by buying our own baby scales and now weighing at the 8week check but I’m not sure it’s enough. We have raised this up the chain and are waiting for a response. Also worried about some cancer patients, nearly all going ahead locally but there’s a real issue with endoscopy because it involves using gas it’s really high risk for spreading covid so it’s being reduced to emergencies only but this means cancers may be missed, not sure what the answer is. Ditto with chemotherapy but risk to patient this time- reduces your immune system so covid much more likely to be fatal but cancer not being treated is also fatal....really hard choices there. Dentistry and ophthalmology not my area at all and I don’t feel qualified to comment.

I hope all areas have done the same and if people are finding regional variation then they should totally complain. And that’s where the the difference with teachers Comes in. If patients are not getting a good enough service they should complain and I would support them in that. Very happy for any number of threads if people haven’t got the treatment they need, and always happy for new ideas - current question we’re asking patients is “would they support compulsory mask wearing when coming to the surgery and could they provide their own (homemade fine) or do they think we should provide (not then sure if the legalities of us supplying homemade masks and we don’t have many spare surgical ones)

HVs are still visiting new mums and babies here. Lack of weighing is very concerning indeed.

@BovaryX nhs national guidance is that cancer stuff should be going ahead with use of “cold sites” so non covid hospitals and private hospitals are often being used for this or video/telephone if appropriate) If an area isn’t managing this (excluding the particular issues of endoscopy and immune system lowering treatments) then that’s not good enough and patients should complain loudly - if getting no where with the trust try your MP or the media and I’m sorry that this is happening to your. Your Gp can also advocate for you

I find it peculiar when something is put on a pedestal

I find it peculiar that the response to a health service which has cancelled millions of operations is fawning adulation. Then again, the entire religious fervour of the NHS is peculiar. Its dysfunction is perfectly represented in the phrase 'protect the NHS.' An inverted slogan displaying the priorities which Karl Sikora is trying to warn about. The UK already has the lowest cancer survival rates in the developed world. In the rest of the developed world, specialist appointments, blood tests, cancer treatment are all still happening. There needs to be a public inquiry, public accountability and robust criticism.

@alphabetspagetti our “doors” are shut but we’re still open. Some of us working at home as we couldn’t all fit in the surgery and be 2m apart. All practices in the UK should be doing telephone triage and then seeing face to face if needed, with home visits to the shielded if needed. If your one isn’t then the place to raise this is the CCG as they are being paid to do this and they should be. It wasn’t clear from your post if you personally have called for an appointment tho?

@Nonotthatdr

I am not in the UK. Medical services continue as normal pretty much. If the rest of the developed world can do it, why can't the UK?

Glad we agree about the pedestals then Bovary. Best avoided all round.

@Tiatotheresuce sorry I mean't to ask which area the OP was working in

@BovaryX I am not sure if you have the timescale that Professor Karol Sikora mentioned when talking about the 60,000 deaths ? I heard him interviewed and I think he was talking about if normal service for oncology isn't resumed for over 6 months ?

It must be different by area. The team I work in has been up and running for the last 3 weeks. If we need to touch patients we do

@bovaryx

I agree cancer services should be going ahead in the UK. They are where I am as well. If there not in other places they should be highlighted at a National level

I’m not sure any country has figured out what to do about endoscopy, we are looking at international data to try and figure out a way to see which patients to see now and which can be more safley Delayed.

Strong chemo is an individual problem. If you give lots of chemo you destroy the patients immune system, if they then get exposed to covid they are a much higher risk of dying. That needs to be a discussion between each patient and there oncologist.

@Nonnotthatdr

Karl Sikora mentions that. Obviously, there is a balance of risks when it comes to advanced cancer. But he is talking about diagnoses too. He describes a significant reduction in patients presenting at the initial stage. But it's not only cancer. There have been two million cancelled operations. What about blood tests? I don't know how the UK treats Type 1 diabetics, but as a rigorously well managed cohort, comprehensive blood tests every few months is standard. In a functioning system, all of that stuff continues. What kind of 21st century health care system can't cope with continuing to run the majority of its services? It's astonishing.

I'm starting to feel the impact - ortho consultation with expected surgery delayed indefinitely, physio done over the phone with my lying there trying to imagine and copy the poses I'm being asked to do.
Some aspects have been great. dh needed an emergency appointment and that was done by video. It worked really well, there are other aspects that have been put on permanent hold.

It makes me so sad for teachers that NHS professionals in this thread are talking about planning to get back safely and with the necessary PPE, staff being tested weekly and patients being tested before they’re admitted.
Why do teachers not need/deserve the same care?
I’m not having a go at any NHS worker’s on here. I am really glad that the NHS is taking the safety of staff and patients seriously. I just don’t see why any teacher who dares to ask for the same care is made out to be lazy, precious, over dramatic etc etc.
I guess the argument is that kids don’t spread it, I think we all know that’s not definitely true though.
I absolutely want to get back to work. I absolutely want to see my nursery class again. I want to get back to normal. I also want to be safe.

I work in CAMHS. We’re doing almost all appointments via video call or phone call. We are mostly working from home, with a skeleton staff rota in the building each day.

I’m not ashamed. I’m proud. We have managed to quickly adjust, delivering a service through this crisis. Parents and patients seem to really appreciate the effort we’re putting in to keeping things going.

Push on through. This is not forever.

We have also received the NHS England briefing which states we need to keep 80% workforce WFH to avoid staff transmitting the virus around the entire staff team. Therefore that 20% ( who will be on a rota so not just the same staff each month) will only be able to see the most urgent cases.

18 months is as far ahead they are hoping we have to look atm.

Push on through. This is not forever.

I appreciate the sentiment and it's really good to hear that CAHMS appointments are happening virtually.

At the other end of the age spectrum, my 85 year old father's eyesight, mobility and mental health are all deteriorating. His eye examination has been delayed by months and he's been offered a telephone appointment for his Parkinson's check-up. He struggles with speech and hearing, which is a consequence of the Parkinson's. So a telephone call will be a complete waste of everyone's time.

I do think that this situation, for him, will probably last forever. He's declining visibly, but not fast enough to get on any emergency list. He could easily be dead before he gets any more genuine face to face help.

I do feel that people like him have more or less been written off.

How do you manage a fully working hospital or clinic under these circumstances

I can not fault how we were managed by our trust the changes that took place were so swift and it was so smoothly done we changed how we worked over night. The only issue I had was PPE. I work in MH we can’t social distance but we don’t provide personal care so we were low on the list.

I have attended hospital a few times in the last two months it is not the place I went to in mid March but was surprised how many clinics are running of course at a much lower capacity

I know some who are still getting cancer treatments some are not the cases are looked at individually. Does that help those that are waiting no of course not.

Our trust is moving towards a more normal service but the new normal service has to take into account issues that were not there six months ago (and have never been an issue that we needed to consider ever)

Unfortunately these threads become political or draw the attention of those who think all this covid social distancing is nonsense and we need to get on with life how it was.

There is a balance and it’s very very difficult to manage, this will mean some people will suffer for longer (and worse), linger waiting lists, some nhs staff are working flat out while others are left frustrated at not being able to do their role throughly. It’s going to take a long time are clinics going to be working 24/7 to deal with the backlog of appointments

And my family/friends dotted around the world are all have the same concerns we are having here even in Germany

Things clearly need to settle, if 18 months is workable then the service should stay online, clearly you think it's not so there needs to be better filtering as to what can / can't be done by phone. I think there is an opportunity to move some services online but a patient should be able to give an opinion as to whether they can be seen online and processes set up around that (e.g. blood test first). Sometimes it might also mean those without video call capabilities have to be seen in person too.

I'm waiting for a few hospital appointments, but I know the trust are trying to get things up and running; I've had letters with dates, one call and one blood test. I suspect it might also be that some trusts are better than others, or have been harder hit by covid patients, because it does sound like there's some variation. Making noise about it should help, because noise seems to lead to clearer guidelines. I hope it isn't missed that some of us are happy to have appointments by phone where those appointments can be done by phone.

How do you manage a fully working hospital or clinic under these circumstances

Everyone wearing masks. Temperature check at the entrance. Social distancing in the waiting room. The waiting room isn't busy because services have not been suspended at any point Blood results took a couple of days instead of an hour, but saw the endocrinologist, everything is fine, got a copy of results. The rest of the developed world is managing to function.

What masks ? For staff or everyone coming in ?

I said a fully working hospital. You can’t have a fully working hospital with the measures you have added

where are hospitals working at full capacity in the developed world?

Hospitals might not be working at full capacity but in the developed world beyond the UK, routine appointments, blood tests, etc, etc, including cancer treatment are still happening. I have described my own experience with my endocrinologist. I am not sure why people are so defensive about the difference between the UK and elsewhere.

@BovaryX blood tests for diabetics still going ahead, also blood tests for patients on other drug monitoring, some routine yearly blood tests such as for hypertension monitoring have been delayed for a while on a risk eve for analysis. Every patient that needs a looked at individually. We have set up a “drive through” phlebotomy service to remove exposure risk and are doing home visits to those that are shielded. All practices I know are doing similar and I would encourage anyone that cannot access a needed test that their dr hasn’t explained can be safely delayed after a risk analysis to complain vigorously

On a risk eve - after a risk