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?

[kittycatlove]

Mrpants when the NHS contracted cleaning out to private companies instead of the in house cleaners and housekeepers who had worked at their jobs for years and were proud of their work ,what do you think we ended up with??
Yes - the cheapest companies won the contracts and the standards nosedived as a result.
Instead of having Heathcare based on clinical expertise - ie a patient needs an MRI and currently will get one on the request of a Doctor we will end up with cheaper and less detailed scans as hopitals try to cut their budgets.

Do you also think that a patient will choose to have surgery 200 miles away from their home where friends and family will find it difficult to visit and then have follow up there etc
Your views are very simplistic

[Jinx1906]

Kittylove,

If they are working at Tesco's then at least they are not neglecting patients. If they care about their work then why moan and treat people with very little respect. I also do not believe that most people at the job centre prefer to take benefits instead of taking a job that pays abt. 14k

[MrPants]

Kittycatlove Whose views are simplistic? Did you read my earlier post about how introducing competition can go wrong if it isn't done properly? Within ten miles of where I am currently sat there are around half a dozen hospitals. If those hospitals were in competition with each other to attract customers (i.e. patients) there would be six companies on my door step each trying to outdo each other with improved patient care. The choice would be analogous to the choice we all take for granted between Tesco?s, Sainsbury?s, ASDA, Morrison?s, Waitrose et al. Travelling 200 miles is facetious.

As for the contracting out of cleaning jobs, this is an example where had the hospitals faced the very real prospect of patients voting with their feet to stay in a clean hospital (and crucially, taking their money with them - no patients, no fat pay cheque for the CEO), a message would have been sent to the hospitals top brass that there was a big problem that needed sorting out PDQ.

Ironically, whilst it was competition that initially caused the problem, it was lack of competition which compounded the problem and led to delays sorting it out.

[ChickenLickn]

You are right there would be 6 companies on your doorstep, and endless flyers etc. and your taxes would be funding 6 salesmen rather than healthcare.

[ChickenLickn]

'competition' means providers spend their resourses fighting each other rather than treating patients.

[eicosapentaenoic]

kittylove,
Nice carpets though
IMHO, not even, yucky token-effort coffee machine, minimum outlay on jobsworth receptionists, 'information line' which didn't even know the consultant's specialism (she was definitely not on site), next to zero equipment. The temptation to use untrained staff with fake uniforms got the better of them. Total minimum cost to 'clinic', cost-saving paramount over patient care 'we don't do that', no sign of further referral back into NHS.

blue-lighted back to ICU
My fav doc, who is fantastic NHS with 24/7 specialist hospital cover, has a disclaimer upfront on his website that amounts to 'I am like a quack at the county fair, gone next morning. If anything's gone wrong after surgery don't bother phoning here - use emergency services.' I owe him everything, but he even warned me himself - this is one of the good guys.

Don't get me wrong. I'm looking forward to strolling into local triage/GP clinic/eg specialist eye clinic 7 days/week, and local minor procedures and investigations, maybe cracking on through more straightforward ops fast and local without the wait. Also wonderful caring charities tapping straight into the funds.

As greenmonkies and kittycatlove are patiently trying to explain, you can totally doctor-shop NHS now. You have to research who's available, what equipment they've got, what surgical techniques they're into. You then find you know much more about it than the GP (database of specialisms is still not available to them and they rely on heresay). But this is the freedom of which you dream. We already have it.

As further up have posted, it is stressful trying to work out where to take a sick child with a specific problem in an emergency eg epileptic fitting or eye inflammation (v different providers). NHS direct try v hard but the rota/provision is so random I use street telegraph.

The temptation for private providers to treat what they can easily do, kerching, and not to refer you on will be considerable. Currently our NHS/private orthodontics is like this, treatment of dubious necessity dragging on. As the Bill stands, it's unlikely they'll give you ownership/transfer of your medical notes and every time you hit a new provider it'll be another load of blood tests, whatever, US-style. Buyer beware

[kittycatlove]

MrPants -You may have 10 hospitals on your door step . London ??
Most patients dont .My parents have one hospital on their doorstep - the nearest alternative is 100 miles away .My 200 miles was assuming the patient had chosen their Consultant/Hospital under your system. Just an example
You really think that it would benefit a woman to have her chemo in a dayunit 100 miles away rather than at a local hospital where she can have her treatment and then go back to work/pick up her children from school . These things are important to patients .
What about the aftercare-she may develop an infection and need to be admitted - to where -the nearest hospital where there is no record of her treatment or 100 miles back to the hospital she was treated in .This would delay her treatment and may affect her recovery.
Who would follow them up,provide after care in the community ? How would notes be accessed quickly ?
I am a nurse but I am also a patient - the above patient could be me and I would want to be treated in my local hospital .
Your model sounds brilliant - as long as there are no patients in it ! Simple !
chickenlckn -Nail on Head!

[moondog]

One of the key issues in the NHS (for which I work) is an over-reliance on the wrong sort of action. The masses are made to fill out swathes and swathes of paperwork in order that those above them in the food chain can give swish Powerpoint presentations to show that they have met thier targets.

Thuis the minions are rushing about, filling out form after form to keep those above them happy.
Something has to give and it's usually quality of the care at the most important point of all.


Trust noone and swot up on your rights.
That's my advice.

[kittycatlove]

I agree Moondog as long as the targets appear to be met then everything is ok ?
This allows the real issues to be swept under the carpet and staff concerns ignored.
I would love the CQC to go even further and as well as reporting poor care and making recommendations to actually look at the reasons why .

[moondog]

Yes, it's very tractor production in Kazakhstan circa 1958.

[Iggly]

MrPants I want to use my nearest hospital to give birth in. I have no idea how many hospitals are near me - three within 20-30 min drive (London) but the nearest one is the most convenient. It might not be the best one - but it's the one I'll give birth in because it works for my family circumstances. Under your competition model, the hospitals which cannot compete will close. Meaning the local population will lose out (not everyone has a car and wants to travel miles when in labour for example). I want my hospital to be of good quality. I don't care if the next one a few extra miles is better because, to me, it's not a feasible option. It will be incredibly disruptive to have services shuffling about and opening and closing.

We also have a mini NHS hub near us which is great - I can go there for my antenatal care, they have a non emergency minor injuries treatment centre plus health clinic and my GP is there. Saves travelling to the hospital. Opened under Labour - those sort of services I'd love more of. How would that work under competition? Why do you need competition to have that sort of thing?

FWIW, I don't mind having private providers - I just don't want them taking over the NHS. I want it kept in the hands of the taxpayer. Look at why the NHS was introduced in the first place.

[eicosapentaenoic]

Listen to kittylove and Iggly on coordinated provision, local service, local monitoring, local emergency followup.

My DD is tertiary referral paediatric hosp in London, seen in 2 depts every 2/3m (seldom same day), 1 dept every 6m. Each trip costs £50 travel. I am struggling to find work that allows these random days off, but still have to pay travel since, being married, we cannot claim benefit. If she was over 16, NHS would refund travel costs.

On flareup she has to be seen same day in this hosp. We do same journey by rail + underground/taxi, even if she is in pain/cannot see (tube strike was particularly awful, we walked 3/4hr like this, taxi £12 but roads choked).

We cannot use local service for emergency flareups - they have no access to medical history or paediatric expertise. The local private provider has decided against applying for a paediatric licence to practice.

She is currently seen by 5 different teaching hospitals in 3 PCTs, no local expertise. To get round the notes problem, I have to order copies through each hospital's medico-legal dept at £50 each, which I carry with us permanently in a rucksack.

If anyone has any suggestions as to how efficiency could be improved on this I'd love to hear 'em.

[eicosapentaenoic]

boffinmum's experience also tallies with mine. I love medics but the sooner these guys get used to checking diagnosis/treatment using IT the better. DD sometimes does better on diagnosis off her internet phone, certainly on contraindications and side effects

[larrygrylls]

Let's be honest. In what other profession can someone with CCD at a level and working way below someone else suddenly leapfrog their bosses (all with AAA at a level and advanced degrees) in terms of money and be able to boss their old bosses about. Yet this is where we are in the NHS, with ex-nurses moving into NHS management and easily obtaining 6 figure salaries with doing an administrative job. A lot of these people are extraordinarily average and justify their existence by getting those below them to tick an awful lot of boxes and incentivise them in all the wrong ways.

We need to stop exaggerating the intellectual abilities of nurses (or make the entry to a nursing degree some serious A levels, such as ABB minimum). We need to separate out NHS management from nursing so no one can start as a nurse and end a senior manager and we need to make nurses resume doing all the care that they used to do. Sure some are reasonably bright but they are not doctors and nothing that they do is serious degree level work. It is a "fake" degree as the entry requirement to get on to a degree course is so low. If people disagree please show me the nursing degrees requiring serious hard a level achievements to get on to them.

[Solopower]

There are so many different issues here.

As far as the elderly are concerned, as other people have said, a lot of them shouldn't be in hospitals anyway. Their numbers are rising, and we need to get our act together regarding their care - fast. Someone explain to me how the changes the government want to bring in are going to solve that problem? Can't wait to see the private companies fighting over the right to care for the unglamourous and unprofitable, expensive long-term care that elderly people need.

Then there's the people who look after them. What sort of person decides to care for the elderly, and why? How many of them go into it because they love old people and want to help them and are genuinely loving and caring human beings? How may see care for the elderly as an exciting career opportunity? And how many go into it because they simply don't have any other options?

What are the pressures that may be acting on the person who spends her working life spooning purees into wrinkly mouths, mopping up messes and wiping elderly bottoms? How many suffer from low status, understaffing, poor working culture and conditions, long hours, low pay, lack of other opportunities, poverty, poor training etc, and might even be illegal/legal immigrants with worries about families hundreds of miles away?

I'd be willing to bet that if you addressed the problems these workers face, their care of the elderly would become exemplary. In any company, happy employees give better service, no?

[GreenMonkies]

solopower has hit the nail squarely on the head.

[Solopower]

Thanks, GreenMonkies. I thought your posts were very important.

[Iggly]

WTF have A levels got to do with being promoted or having decent practical experience to warrant being managers? larry, what a load of bollocks. No one is suggesting nurses do a doctors job or vice versa - that sort of snobbery causes all sorts of issues in the NHS I bet.

[moondog]

Larry, if you saw the contents of a nurse's degree (as I do) you would have a fit.
So much of it is absolute drivel and nothing to do with nursing.

[larrygrylls]

Iggly,

How does nursing experience equate to managerial experience. What nurses do in the NHS is tantamount to promoting the highly practical and competent guy who services your car over the highly qualified postgrad mechanical engineer who designed it. Just would not happen in the private sector.

[Iggly]

You picked on nurses becoming managers. Same can happen with doctors and consultants - just because they have more academic qualifications, why should they be managers larry? You seemed to imply that nurses are too stupid to manage?

Of course it happens in the private sector. People do a front line job then get promoted to manager. I'm a manager - ok I have a degree etc which would be ok in your eyes - but I got there through experience.

[larrygrylls]

Iggly,

You are making out having decent real qualifications is some sort of an accident and not proof that you have a certain quality of intelligence and thought process. I don't buy it. You cannot join M&S or Unilever as someone who looks after the store room and a few years later (very few, in some nurses' cases) be promoted over a fast stream graduate screened from the best of the best at very good universities.

I totally accept that there are exceptions. Some graduates are not very practical and some non-graduates fail to do well for other reasons than lack of intelligence. However, as a general correlation, it holds up pretty well. In the NHS the majority of senior managers are ex nurses (with a few ex management consultants at the higher grades). In addition, someone should become a nurse because they enjoy nursing people, not as a rung on the ladder to a cushy overpaid administration job. These people are not interested in the patients.

[Iggly]

sorry larry I don't buy your argument either.

I doubt many people become nurses to become managers. But as you move through a career things change and it might suit you more.

I don't think academic brilliance = great managerial skills. I've seen far too many "clever" types be over promoted whereas those who are good at people management are left behind yet may well do a much better job.

[Solopower]

I would have thought it would make a lot of sense to have an ex-nurse manage nurses. Better than someone with a degree in Management but no experience of hospitals, surely? And why shouldn't ex-nurses manage doctors - relieving them of all the admin chores, etc? I don't understand - genuine question.

[wideawakenurse]

I wish you were my manager larry.

You sound lovely.