Why the NHS needs to change...

[CogitoErgoSometimes]

Basic care denied to elderly patients

Yet another story about the NHS failing to provide basic care to patients. The NHS, like the curates egg, is only 'good in parts' and given that it costs so much and given that we are meant to be a modern society that is an appalling state of affairs. What good is free healthcare if it means you are condemned to suffer malnutrition, lie in your own filth or need a doctor to prescribe water to you so that you're sure of getting a bloody drink?

There is a lot of knee-jerk 'hands off' opposition to the NHS reforms but how can anyone honestly defend a system that allows such laziness, complacency and neglect?

[AliGrylls]

Completely agree with you OP. Over the past year the problems with care of the elderly in the NHS has been quite a focus for radio 4. It is disgraceful that elderly people are treated with such disrespect - they have spent their whole lives paying taxes into a system that should, quite frankly be prepared to look after them.

I understand what Greenmonkies has said - I agree with that too. What teh NHS needs to do is get rid of the middle managers that paper push and put proper staff on the wards so that nurses can get back to the job that they are meant to be doing (ie, caring for patients).

[glasnost]

Signed.

[Tianc]

Nope, the home wasn't closed down. It was given a "chance to improve" . I understand councils do this because they need the number of beds, so can't just move all their fundees out (which can anyway be traumatic).

No prosecutions because the individual death the police were investigating was due to cancer rather than the way the person had been treated. And anyway a lot of the staff were employed illegally but desperate for the work, so were too scared to talk to the police.

There were fundamental problems with the home and the reasons and ways it was being run. For all I know it may still be going. If I knew where it was, I would have jumped up and down, but my friend was concerned about the impact on the staff who were her friends but working illegally.

[glasnost]

Wonder why it's been quite a focus for radio 4 over the last year? The BBC should be renamed PRAVDA. The rightwing propaganda is shocking. The current NHS has been worn down by awful New Labour middle management guff. What it needs to do is revert to how it was intended to be by its great founder Nye Bevan. Free marketeers crying crocodile tears for the elderly in a bid to argue for privatisation is actually quite vile.

[OriginalGhoster]

The report out today is terrible and Im glad these bad practices are being exposed. I dont think more money is needed, as some places do very well on the money they've got.

I was in hospital very recently and saw some fantastic nursing going on. They were professional but very caring, and did their utmost to lift the spirits of some of the more elderly patients who were facing a long recovery. At meal times there was support with eating and drinking, I never had to ring twice for a nurse. Their sense of humour was brilliant, I laughed until my stitches hurt

At one point a nurse gave an old lady a cuddle as she was upset that the nurse was going off duty for a few days. Even the cleaner had their heart in it, he told me he loved his job. My consultant phoned me personally when she got some important results.

I wonder if the NHS need to appoint random patients 'mystery patients', and 'mystery relatives' like mystery shoppers, and audit care from the patients point of view. If the staff did not know who was going to report back, they could not get away with poor care.

[niceguy2]

I do not think that there is a funding problem.

The problem in my opinion is two fold.

Firstly the money which is pumped in is often directed in other directions. The best example I can give is when Labour came to power they increased funding dramatically to the NHS in real terms. What happened was a load of dodgy PFI deals, massive pay rises for doctors & nurses and a £40 billion IT dodo. How much of the billions extra injected actually made it into the wards? Not much.

So what we need is for a wholesale change to how we use the money, not continually throwing more good money into a black hole.

Secondly morale is one thing but certainly judging from my recent experience there was no staff shortage. Like I said, the impression i got was more apathy than stressed out, sad staff. It seemed to me they were more interested in chatting and giggling than patient care. Obviously I cannot speak for the entire NHS but like I say, not in my experience.

Maybe in A&E there is a bigger staffing issue? My friend is an A&E nurse and he's always talking about being understaffed so maybe its true. But then the other problem is the sheer amounts of morons he has to deal with. Perhaps if we can restrict the number of timewasters who present themselves at A&E, the existing staff can work better?

So being honest I'm not 100% sure what the current NHS reforms will have. But I know that currently its got a lot of room for improvement so let's give it a chance. If it doesn't work then fine. But I've yet to see any govt proposed changes which are not objected to by someone.

[glasnost]

Please call them NEW Labour, niceguy.

[NightLark]

niceguy, you say 'let's give it a chance. If it doesn't work, then fine'.

My problem with that is I can't see a way back from these reforms to an NHS as we know it.

They are, effectively, privatising the delivery of healthcare.

OK, for now it will still be free at the point of use. Though I guarantee that the 'core' of free care will be eroded (e.g. those GPs last week offering minor ops thorough, surprise surprise, their own company). But health care will be delivered through private companies, some based in the UK but mainly HMOs from oversees who have been waiting and manoeuvring for this chance for a long time now. And all will be administered by management consultancies employed thorough GP practices.

The NHS will withdraw from being an employer of staff, a setter of standards, a deliverer of care, and be reinvented as a contract management service.

The costs of the state re-purchasing hospitals, re-employing clinical and managment and backroom staff and re-forming a state run NHS will be prohibitive.

It is a massive channeling of public money out of the state and into the hands of private firms on the untested and unproven basis that this will raise efficiency and effectiveness.

Tis all bollocks and I detest the sharks in this government who will have sold off our NHS from under us.

[Tianc]

Destroying a structure is almost impossible to reverse, and extremely expensive, as Norwich council discovered when Connaught went tits up during a £125 million contract to maintain council properties. Reassembling the teams to do the job when people have gone off to work elsewhere is very slow and very expensive.

One of the problems with the whole "If you don't like it, chuck out the provider and start again" is that it assumes the costs of churn are negligible. Actually they're massive ? to the point that chucking more money at a problem with a current unsatisfactory provider is often cheaper ? and less destructive ? than undergoing the change.

[CogitoErgoSometimes]

"chucking more money at a problem with a current unsatisfactory provider is often cheaper ? and less destructive ? than undergoing the change."

Isn't that entirely the current problem? Labour spent 13 years stuffing the NHS full of money and it was still never enough, the Trusts were broke and we were told they were understaffed and overstretched and demotivated etc. The definition of madness is doing the same thing over and over and expecting a different outcome....

[breadandbutterfly]

Excellent post, cogito.

I too suggest that we throw out the baby with the bathwater. Works every time.

By the way, your rabid pro-Tory views are most definitely out of step with the vast majority of the voting public, before Tory Central Office get any funny ideas.

[breadandbutterfly]

niceguy - I was in A&E about a month ago. The care I received was exemplary and professional at all times. Absolutely no change needed, from a very recent and satisfied user.

[breadandbutterfly]

cogito - it's easy to say that more money is not enough or not the solution. This ignores the fact that as the baby boomers get older and the UK population continues to grow, the demands on the service are going to grow - and ergo cost more.

Reorganisation is neither needed nor the solution. A recognition of the fact that the nation did not vote for a reorganisation and that public approval ratings for the NHS as it stands HAVE NEVER BEEN HIGHER is needed, however.

Yes, the NHS is not perfect, and improvements should obviously be made where identified. But overall, it is something that the average British person both vehemently supports and is proud of.

[breadandbutterfly]

cogito - it's easy to say that more money is not enough or not the solution. This ignores the fact that as the baby boomers get older and the UK population continues to grow, the demands on the service are going to grow - and ergo cost more.

Reorganisation is neither needed nor the solution. A recognition of the fact that the nation did not vote for a reorganisation and that public approval ratings for the NHS as it stands HAVE NEVER BEEN HIGHER is needed, however.

Yes, the NHS is not perfect, and improvements should obviously be made where identified. But overall, it is something that the average British person both vehemently supports and is proud of.

[swedie]

Just want to address the points about paper pushers and middle managers. For those who think there are too many in the nhs can you please tell me who you think should be doing administrative tasks? Doctors and nurses who should be treating patients? Many tasks are needed just to make a ward run eg ordering stock, meals, etc. Many are done to fulfill information needs set by government bodies eg reporting on waiting times and types of treatment. If these tasks weren't done by non clinical staff there would be even less patient time.

[Tianc]

Your fundamental assumption, Cogito, is that the NHS is an unsatisfactory provider and can be replaced by more satisfactory providers. And that for less money, too.

Whereas many of us feel that actually the NHS is pretty damn good, although no company, system or organisation will ever be perfect; and that it provides pretty good value for money overall, although again nothing's ever 100% efficient.

Further, administering the contracts and billing and financial procedures between multiple small providers is hugely expensive. Did you know that US primary care doctors spend up to 30% of their working time dealing with insurance companies? How efficient's that?

[Lucyannieamy]

Profit and healthcare do not fit in the same sentence. Please mr company, I want to chose a service where you earn 5% of the cost of my treatment, paid for by taxpayer next door so when they want treatment there is no money left. ...Saying they can delver the same services but for less money so they can still take their cut just means poorer working conditions for staff. That sounds so left wing! (I'm not- just think it's the wrong place for profit. Charitable trusts, corporate management styles maybe

[glasnost]

And these "sharks" NightLark have NO mandate and these plans were in neither of the coalition parties' manifestos. This is a very British coup.

If THAT isn't enough to make you wanna take to the streets I sincerely don't know what is.

[BoffinMum]

Sat with a very neglected patient in A and E this week in a leading teaching hospital. They were pathetic and the GP had to phone in to kick them up the arse. I knew more about medicine than the people offering treatment. I was quite

[BoffinMum]

I mean, you don't send someone home with a suspected stomach bleed with instructions to take ibuprofen, do you????

[niceguy2]

I want to see a NHS which is free for all to use. But that does not extend to continually pouring more money into it without any expectations for improvements.

Frankly it's a complex beast and I don't think there is a magic bullet solution. Labour tried the throwing money at it solution and that failed. The coalition are now trying this.

I can understand people's concerns but then I'm not billy on the spot. I'm not the one who has to try and make things better in a fast crumbling economic climate with an aging population.

The truth is I do not know if the planned changes will make things better or not. But I do know that doing nothing is simply not an option.

[PIMSoclock]

Could I ask a question?? I dont mean to be controversial, but I know this will be. Why is this being defined as just a failure of the NHS, the overarching system running the service.

I agree there are defiantly systems problems, lack of staffing and poor quality of meals. However or 50% of the problems in this article are not due to systems errors:
staff leaving patients exposed
staff having conversations with one another while feeding
patients not been given the opportunity to wash their hands
staff ignoring a patient crying out for help

Increasing staffing levels would not fix these, for staff to achieve this they do not need more time or money.

I do work in the NHS and I understand the strain that its staff are under, but there is no excuse for the majority of the mistakes made. They were not the fault of the NHS, they were the fault of the staff.

The NHS has some wonderful nurses, but equally the NHS also (clearly) have staff who think that walking past a patient crying for help and not acknowledging it is acceptable. Or not shutting the curtains properly if a patient is exposed. That is not an NHS problem, that is very much a professional one and so I think this article highlights multifactorial failings, not just the 'NHS'

The head of the RCN had some very interesting thoughts on tackling this

[niceguy2]

Exactly PIMS. None of the above problems are fixed by throwing money around like confetti. Money we don't have.

There are problems with money but personally I don't think its the lack of it per se. More that money is not being spent in the right areas.

[kittycatlove]

One of the major issues that is never addressed is that elderly people often do not need to be in acute hospitals.It is surely not the best place for them if they need supportive care-washing,changing ,feeding etc.

Hospital are noisy,bright and not conducive to providing the calm,quiet environment that the elderly need.
Their confusion increases and they become more vulnerable as a result.
There is often NO funding for their community care , I know of several areas where there is simply no more funding for community care -it means that a person has to either give up their existing care or die before patients can gain access to care in their own homes - a desperate situation.
The small rehabilitation or community hospitals that once existed have largely been closed due to funding issues.

The reality is that for example a stroke patient who is being cared for by his wife with help from their son/daughter might become ill with an infection and be admitted to hospital.Despite being MORE unwell they will then be cared for along with 8 or 9 similar patients by one R/N and one HCA or if very lucky two HCA .So they are more ill/vulnerable and less able to cope and yet they are being cared for by far less people. This is the Bloody scandal - that Nurses and HCAs are being given far more patients than they can ever hope to care for . Its a legal requirement in Nurseries,Schools and Prisons to have a LEGAL ratio of Carer to cared for and yet we dont have this in Hospitals.We are the ONLY country who do not have this .

Anyone who really cares- Please write to the government ,NMC and RCN and demand that a legal R/N :Patient ratio is instigated.

[GreenMonkies]

Pims, the problem is, if you pay peanuts, you get monkeys. The support staff are often under-trained, poorly paid and work long and anti-social hours. Over-worked staff stop caring. I only work 3 short days a week and I find the emotional impact difficult to deal with sometimes. I don't think I could maintain the level of genuine care that I show my patients if I was working full-time, doing 12 hour shifts, over days, nights and weekends. Add to this the kind of middle management pressure that we clinical/ward staff work under, sick-leave that is scrutinised as if you're a slacker, even though you deal with all manner infections day in day out, annual leave recalculated, working hours recalculated so that we are either working more hours for the same money, or retaining our old hours but taking a pay cut. We are abused by patients and relatives far more than we are thanked. Don't believe what you see on Holby City, if we spoke to patients the way they do we'd be out the door faster than you can say P45. Everything we do is scrutinised, and controlled, but the emphasis is all wrong. Our uniform policies are getting stricter, so earrings, hair styles, even what colour socks we are allowed to wear is dictated and enforced. But we waste millions of pounds printing duplicate or edited referral forms, and hours resolving inappropriate referrals because ward doctors don't realise what they are asking us to do half the time (like requesting a CT scan that requires oral contrast [a drink] for a patient that is constantly vomiting, or an MRI scan for a patient that can't lie flat).

I too work with some unbelievably dedicated nurses and radiographers, but I also see the system failing when patients arrive in my department sitting in a puddle of shit, in soaking wet beds, or inappropriately dressed, or confused and agitated.

It's not just a question of throwing more money at the NHS, it's a question of making sure the money is spent on the right things. Consultants get pay-rises, and overtime, but support workers and clinical staff get pay cuts and extra work.

And you wonder why some staff are losing the will to live?