Has care in the NHS and in social care improved over the last year? The Department of Health wants your views: £50 to be won NOW CLOSED

[RowanMumsnet]

Hello

As some of you will know, following the public inquiry into the failings at the Mid Staffordshire NHS Trust, the government responded last year with a set of commitments for improvements.

A year later, the Department of Health would like to know what you think about whether there has been a real improvement in the care provided by the NHS and social care providers as a result.

They say:

"When we receive care, whether that is in the NHS, social care or in our own homes, we expect, and have the right, to be treated with dignity, respect and compassion."

"Two independent public inquiries reported appalling failures in the standards in patient care at Mid Staffordshire hospital, and in the system of healthcare regulation. As a result of these inquiries, the Government said that improvements had to be made. These include a new inspector for hospitals and a tougher, independent inspection system; more nurses on hospital wards; and plans in place for turning around failing hospitals. (To see the Government's response in detail, have a look here.)"

"We are looking now at what progress has been made in improving patient care."

"Have you noticed an improvement in care you or your family have received in the past year? Do you have examples of how it's improved or changed? Do you feel more confident that any changes introduced will improve NHS care? What do you think are the biggest challenges for making care even better?"

"Material from this thread (and from another thread we're running on Gransnet, and other activities including discussions with people working in the NHS and care providers) will help inform our assessment of progress. It may also be included in an annual progress report, the first of which will be published later this year."

Over to you. Everyone who posts on this thread will be entered into a prize draw where one MNer will win a £50 John Lewis voucher.

Thanks
MNHQ

few years ago not rew

My mum is a district nurse. She raised concerns about patient safety years ago, and was bullied horrendously for doing so. The concerns she raised are still an issue & have not been sorted. I truly believe NHS management culture is rotten to the core. None of them seem to have the balls to stand up and take responsibility when something is wrong. And whereas people used to be promoted to their level of incompetence, they now seem to be promoted above and beyond that until they become truly dangerous.

In terms of social care - my son is severely disabled and things have become much harder over the last year (his care comes via SS though, so not sure whether you're interested in that). I expect there to be future battles as the cuts really kick in.

Getting appointments remains a challenge. For example my youngest needed regular hospital appointments. I explained there are some times I cannot make as I am a carer for my severely disabled son (and I couldn't bring him with me) and asked them to arrange around those hours (basically any time within the school day was fine). They twice arranged an appointment for after school - the one time I had said I couldn't do, and when I phoned up to change the time after the second time I couldn't make was told because I'd refused 2 appointments I wouldn't be given another one. FGS - this is madness, I hadn't refused the appointment, I'd explained beforehand I couldn't make that time.

I am very conflicted about this as I think NHS care is patchy, sometimes excellent and, sadly, sometimes awful.

Just outside the one year limit of this survey I had an elderly relative taken to hospital after a fall, while in the hospital she was injured by a healthcare assistant who carelessly pushed her wheel chair into something, badly injuring her leg. This led to a hospital stay, not very good care, a stroke not identified by staff but by family visiting later and ultimately her death. The hospital "lost" complaints and managers dealing with it failed to turn up to meetings with family, it is no wonder people take legal action as it often feels like the only recourse for appalling treatment. Another relative developed bedsores in an NHS hospital despite repeated appeals to staff.
On the other hand my mother, in her 80s, has a good GP surgery, has had lots of help, home visits from physios and OTs and is alive today because of good NHS care.

I work in the NHS and am very conscious of the incredible, sometimes unreasonable, expectations and demands made by the public. We put on more and more appointments over longer and longer hours yet can never meet the demand. We got internet access which is popular yet our phone lines are still swamped. We introduced a "same day" system for urgent appointments, within 3 months it is full every day and we have people turning up in person on top of that expecting to just be fitted in. It seems like whatever is offered quickly becomes the norm and then more is wanted.

Most patients are very good but we do have a fair number of those who fail to attend appointments, who are rude or demanding and those who know how to play the system. All the staff work incredibly hard, often above and beyond the call of duty despite having their pay frozen for years.

I don't know if it is getting better or worse for patients overall. For me, working in it, it feels much harder year on year and I suspect a lot is running on the goodwill of the staff. I think we all know that there is only so far you can cut things while expecting them to improve

The NHS that my family accesses has deteriorated hugely over the past four years, and the service I have seen offered to my OH's youngest son who was finally diagnosed two years ago as having ASD is abysmal.

Errr - no. You can't get a GP's appointment for love not money these days. I remember a couple of years ago remembering how hard it was to get a GP in the 90s and marvelling at how bad it was. Right back there now.

Working in the NHS, it can be hard to tell. I work mostly in acute hospitals and what I notice is the ratcheting pressure to discharge on the consultants and all senior leadership, which is fine if the social support is there, and not fine if it is not. In general, people are being discharged earlier, which means less work for us, but we have to see people faster and it does feel like spinning plates. I fully agree that nobody should be in hospital for a minute longer than they have to, and that it is a good thing to be organised about discharge from the start - the old days (long, long ago now) when people sat around sometimes for weeks before being discharged are a very distant memory. However, I do notice that this pressure is sometimes coming through, more often in junior staff and perhaps most often in junior doctors who after all are barely postgraduate and with huge responsibilities, in a certain brusque attitude to patients who for whatever reason don't fit into the plan - they are struggling too much cognitively to learn to look after complex medical equipment needed to get them home, for example, or they just won't come up with symptoms that make sense, or relatives absolutely refuse to be a 'supportive family' and say they can cope when they clearly won't be able to. That I think is getting worse.

In community services, which in my profession and area is part of the same team, things have gone downhill - the number of referrals has truly skyrocketed in recent months and my colleagues are under huge pressure - we've had four resignations from the team in three months. Why would that be? Well, where do those people go when they are discharged earlier? To community. Where do those people go who've been discharged because someone has decided that they HAVE learned how to handle their medical equipment, only once they're at home things don't quite seem to work - to community.

From a personal point of view, DH had a severe MH episode last year and there were no beds for him, none at all. He ended up having ECT with enormous logistical and other support from me and his parents. I kept working, with adjusted hours, because I knew what things were like in the acute team at the time. That was daft - I should have taken time off and if it happens again I will. To be fair, his team remain fantastic and the support round here is really good. It's a bit scary not having ANY beds though, and that's a change from last time it happened.

Likewise, I took a day's leave yesterday to do open mornings and what not at school, but there's a patient I haven't been able to see who is one of the 'awkward squad' as described above, so I did go in under the radar in the afternoon, and took the delicious pleasure of seeing him with absolutely NO time pressure at all.

Not locally;
Our trust has been closed and merged with another.

We no longer have a local OOH GP. There was one 5 minutes down the road (London, close to a train station, bus routes & walkable), now it's 40 minutes drive in the opposite direction, inaccessible if you want/need to walk it & no direct public transport links, getting a home visit isn't an option!

I gave birth last year and although the staff were fabulous they were over stretched compared to the year before when I gave birth there!
I'm due another baby at the end of this year and the amount of useful services which were available to me this time around are laughable.

There isn't the time or facilities for the midwives to go over homebirths, it's now done by a volunteer coordinator, one day a month, what happens when she decides it's not worth her time?
They've closed the local maternity ward with 'birth ward' (was closed in early 2011) and the promised replacement low intervention birth centre (that I was due to deliver my first baby in!!) is still not finished, and won't be until next year.
They've cut the number of antenatal parenting classes & the number/location of health visitor drop in sessions.
The midwives I've seen have been the same as the last two times but the appointment times are shorter, always overrun because they're not given enough time to do anything!

As mentioned I'm in London & if cuts are that drastic in the most populated city how does it fair for the rural population?

As an employee and a user I can't even bring myself to describe how bad things are as I will get too angry. I am also concerned that all the negativity generated will be fuel for further sell offs and privatisations as the govt will say that will improve everything.

I would like to say that I'm glad people are having positive experiences. The staff I know are trying extremely hard to do their best for the patients in their care. However targets and limitations created by budgets and ever changing policies and guidelines can make it appear as if we don't care when we do, and really wish we could go back to working how we used to.

Oh CAMHS by the way seems to be a national joke. Unfortunately some of my disabled son's support needs comes under CAMHS & as soon as I hear they'll be involved I don't even consider that support anymore / I just assume we won't ever get it.

I am also concerned that all the negativity generated will be fuel for further sell offs and privatisations as the govt will say that will improve everything.

^^ This.

The NHS is capable of delivering incredible care.

But no system can deliver adequate, universal care if it's not funded.

Privatisation and fragmentation not only increase costs and risk of "falling through the gaps", they encourage cherry-picking of quick wins and the dumping of the chronically ill and old.

I am a home care worker and I've noticed a huge deterioration in the serve and they was it owrks over the last year; service users being discharged before they are ready resulting in re-admissions, sporadic visits from the district nursing teams, ambulances being sent with two HCAs who have neither the experience or qualifications to deal with transferring ill patients. An emergency response paramedic telling my that my 92 year old dementia sufferer with a gash in her head from a fall met the criteria of being left for four hours to see whether her condition improved. She had neither the ability nor the will to self assess and I couldn't stay with her for those four hours to monitor. Also, service users being badly let down by the systems that are meant to be looking after them and struggling to get service users with worsening conditions reassessed for additional mobility aids etc.

On the flipside, I have a long term health condition and the service I have had has been second to none in general. I've aslo had a few emergency situations where the care I received eas outstanding, and follow up from other services quick and easy to access.

There was one incident though when I had a flare up of my condition. I was told by my rheumy ward to go to A&E and ask to see the on call rheumatologist as my usual department was shut and I needed a steroid injection quickly to stop the flare. I was passed from pillar to post in A&E, no-one listened to me, I was left on a trolley in a corridor for four hours before being transferred to the cardiology department of a sister hospital due to the chest pains I was having (which I knew were due to costochondritis and tried to tell them several times), given a whole raft of unnecessary tests plus the cost of the patient transfer etc, to be told almost 24 hours later that it was, indeed costochondritis and to see my rheumy team after the weekend as by the time they contacted them to see about the steroid injection I had been asking for since I arrived at A&E, they were again closed. So, instead of getting the injection I needed on Thursday from A&E, or being able to access it myself from my own team on the Friday as I was in the hospital, I had to spend a very uncomfortable and painful weekend until I could get to the rheumy clinic on the Monday. In the 24 hours I was in, I never once saw a duty rheumatologist.

Listening to a patient with a long term condition should be a priority, as that patient is generally the best expert there is on their own symptoms and how to manage them.

I live in Staffordshire but use services in North Staffs (not South Staffs). I hear plenty in the local media about the problems which still exist at Stafford hospital and I'm surprised that more isn't being done to make this a fully functioning, quality hospital again. I had both my children at North Staffs University Hospital and was pleased with the care I receive but people I speak to tell me cuts are affecting staff and patients. Our NHS is fantastic and the government should support it (and it's staff) more.

Everything just seems to take so long! The NHS is so overstretched and it takes such a long time for referral appointments to come through, which if you have medical concerns, really effects your well being and stress levels.

It's a crying shame what is being done to the NHS at the moment. The cuts and increased paperwork/inspections are not going to improve things, but let's be honest,no-one really expected them too. The NHS urgently needs more well trained, permanent staff with a more realistic workload for real improvements to happen.

I have a disabled son, and community NHS services have deteriorated hugely in the last year. The staff are amazing, especially in our case the clinic administrator, but staff are leaving hand over fist (4 paediatric physios in 4 years all of whom had long service with the trust) due to pressure of work, reasonable demands turning into unreasonable demands, ie to try and vaguely keep to guidelines when the service is seriously underfunded, changes in process and procedure etc. it's creaking and wheels fall off. The pressure to cut costs also in our case costs ( orthotics always take 2 attempts and often more to get right because the company making them is underfunded and the contract went to the lowest bidder ) nothing in the community joined up with the hospital.

And GP commissioning is a disaster. The GPs do not know what to do, they don't understand how the system works with anything complex, so to have my son's care transferred I had to literally tell the GP what to do which the consultant's pa and a clin neg lawyer talked me through. It's not the GPs fault they are too busy, too many patients too little time, but I do worry what people who can't work a system do.

My own GP is fantastic, triage works, they have weekend appointments, and you can get appointments on the day, and with a named GP within a couple if weeks.

A+E also fine but waiting times getting noticeably longer.

There is a real lack of joining up though. Because my son needs therapy at home, therapists come to our home, the NHS used to provide parking permits valid in the residential streets for this, but now the parents have to arrange, and it can be free but to make it free you have to pay for the doctor to write a private letter to convince the council the NHS need it. Which is just a huge waste of time which could be spent on treatment or paperwork, or quite frankly anything other than the pointless bureaucracy.

A similar example my son needs an operation ( nationally commissioned, being done at a tertiary centre in our case Great Ormond Street ) but to let GOSH do it they need the aftercare in the community plan in place locally, but the local offer can't provide it because the national funding doesn't cover the local offer. so NICE and GOSH say you must do x, but locally they don't get the money for x which means GOSH can't do the op even though my son is one of the children across the whole country who has been assessed as being absolutely ideal for this, as locally they can't afford it. It's kafkaesque. No-one takes responsibility if it costs them money, even if everyone thinks it is clinically what needs to be done. And that's after nice have agreed to fund because they haven't set designated funds. Again it's frustrating as doctors should be able to be doctors not bureaucrats fighting the system.

Mental health care is very poor. My severely ill sister nearly got sent several hundred miles away but luckily in the end got sent to a unit 40 miles away who were very good once she was in there. The maternity unit nearest to us has been closed so it is 45 miles to the nearest consultant led unit which is too far. I work in social care and the DGH discharges many people into the community without proper care and support! The council I work for is very caring but is facing massive cuts! It is no use saying that the NHS will not be cut and then saying that local authorities need to cut services to the bone. Health and social care need to be integrated.

Local GP service, previously good is getting worse in terms of getting appointments.

I find it's easier to see my GP which is a real bonus. I think the waiting times have only reduced since an extra step has been put in place in many services where indeed you are seen within 12 weeks but this is not your main appointment, it's more an introduction with a Nurse then you have a further wait to see the Dr.

I have witnessed the stress of an employee who lost her father a few weeks ago, and who only in his 50s had chronic and severe health problems. He was in and out of hospital in this last 12 months. The care, or more to the point the lack of care he received much of this time was tantamount to torture. On very many occasions he was left without food as he was unable to feed himself. Simple measures would be taken to help this such as placing a nasogastric tube but no-one would use it until it was signed off as in the correct position - however this may take more than 24hours...in all that time he was left without any nutrition. Whilst protocol is important it should not stand in the way of patient care. The right people being able to do their job efficiently instead of being snowed under would have made his difficult last months somewhat more comfortable. For the most part the staff they encountered were caring and kind and worked hard, the trouble being that they were so overworked and overpressured that they simply didn't have the time to do everything that each patient needed. It is quite easy to see why patient care suffers in these situations and it is ever more important and urgent that staffing levels are sorted out properly in every ward in every hospital. Too many are already running on skeleton staff levels and if someone is off sick, on leave or moves job there is zero slack in the system to compensate. I would imagine that locum cover is more expensive than employees too so this lack of staffing is ultimately costing the NHS a lot more money. If wards were properly staffed in the first place it may well work out cheaper overall as well as improving efficiency.

I've been impressed this year. I have been pregnant with DS (born end aug) and cannot fault the service at all. I didn't have to wait long at my appointments and the birth was fantastic with the staff being very efficient.

I had mastitis the other week and called 111. They booked me in with a GP (was a Sunday) less than 2 hours later. I was in and out in less than 10 min and felt the care was fantastic.

I am not a fan of the NHS, I will admit, but I have recently had a great experience.

No, I haven't noticed any change - it has been terrible all year and continues to be so.

My elderly mother is currently in hospital (3rd time this year) after falling downstairs and losing a significant amount of skin from her shins. One arm and both legs are bandaged, as is one shoulder; she also has a broken finger and a black eye. She is on her 3rd lot of antibiotics as a) one wound is infected and b) she was diagnosed with pneumonia on Monday, which was her 3rd week in hospital. Oh, and she has significant edema in her legs since the fall. DM is 88 with a history of TB, a nephrectomy 50 years ago, COPD and a weight loss of at least 3 stone this year.

Despite this, according to the doctors she was medically fit to be discharged (and go home) one week ago. I refused to accept this diagnosis, and challenged on the obvious medical grounds and advised them I regarded their decision as verging on medical negligence. the nursing staff were in full support of my decision.

Only today, the beginning of her 4th week in hospital has a dietician visited her. they have no idea if she's been eating her meals in hospital and as she is slightly confused DM doesn't really know either.

Three days later DM is diagnosed with pneumonia. The doctor I spoke to today seemed unaware that this was highly likely to occur in an elderly patient with her medical history who had largely been on bed rest due to her injuries and the fact she has COPD and can't move around very much.
In January, DM fell out of bed and had hypothermia by the time I found her. the medical staff advised me she was going into multi-organ failure and so I put the necessary DNRs in place. DM made a good recovery but it was obvious she was no longer able to cope at home. The medical staff refused to believe this. I had to tell them that DM was not going home until I was satisfied she would be safe and that as I had her house keys, she couldn't actually get into the house. Eventually they agreed to do a full assessment and discovered she needed carers 4 times a day.

Then we had the saga of the oxygen - hospital said she needed oxygen at home. day off work for fire brigade to come and do safety check. Second day off to wait in for oxygen to be delivered. then the hospital decided she didn't need oxygen. third day off for them to come and pick it up.

The second hospital admission was actually ok until it came time for her to come home. I don't drive, so patient transport was needed. Hospital very reluctant to organise this and when they eventually did, they managed to cock it up totally and then lie about it. it took three complaints and two investigations before they finally admitted the truth and we got an apology.

One of the nurses on the ward is amazing, and I thank God for her. We've decided that DM will move in with me and she is helping to put the wheels in motion so we can achieve this. But it seems the NHS doesn't give a toss about the elderly. My dad managed to "escape" from a locked ward in the same hospital, get into the morgue and then out into the car park where he wandered around for a couple of hours before anyone noticed he was missing. This was about 10 years ago.

I'm there to fight for my mum and to try to help her get the treatment and support she needs and deserves - but not everyone has relatives who are able to do this. God help them

I think I have to say, as someone who works in the NHS, that one of the problems is the endless reorganisations. We have tiers of managers who reorganise then, even before things have settled, reorganise again. I have just spoken to a friend tonight who worked in a team that was merged with another and moved to a central location, losing several members and moving premises in the process only to be told before they have even settled that they are to be split into two and moved somewhere, but who knows where as their premises have been sold

KatieKaye - your mother is clearly very old and wearing out (my father is also very old and wearing out).

This is very difficult and sad for her and all her family. The NHS cannot, however, reverse the trend.

Mixed experiences here. My son has complex medical needs and during the last year became an adult and transferred to adult services. On all his subsequent admissions to adult wards a number of patients were kindly concerned "that he was in the wrong place on an adult ward" . I had to concur, there should be more teen adolescent units especially for children who reach 18 and who are life limiting, they should stay on an extended paediatric ward that knows their history.

The first adult ward was short staffed one night and The staff were run off their feet trying to cope not just with the workload but with some verbally abusive patients who werefed up waiting for help with their condition. It was an eye opener just how quickly it appeared to deteriorate. Adequate staffing is critical for good care, the NHS needs to pay for more frontline staff.

Another adult ward my son stayed on for 5 weeks was brilliant, the staff were busy, I was impressed with their caring and professional attitude, the ward was very well run, compared to the previous ward mentioned it had not reached "the tipping point".

In the last year we have begun to access adult community care and I am impressed particularly at how the different specialisms interact , we have had multidisciplinary meetings at home involving the OT, physio, respiratory nurse, district nurse and learning disability nurse and it seems to be working very well.

Agree the NHS cannot reverse the inevitable fact of death. DNRs are in place so that when the end does come she can pass away without heroic measures.

however, I fully expect my mother to be given the correct medical treatment and to be treated with dignity and respect, regardless of her age.

I also work in the NHS. It's getting terrible. Everyone is working 50-70 hours weeks and everyone I know also seems to spend their evenings and early mornings drinking (!) and working. I can send emails at 3am and I'll often get replies from other managers. Everyone is trying so hard to keep things afloat but numbers are up and there are only so many hours in the week. People do it until they burn out - that's why they are leaving, they are not mildy frustrated, they are just on the brink. We've had loads of horrible staff sickness in the last year (young people, very ill) and I can't help but think it's all related. Meanwhile the people who are left are trying to cover all their work. Basically the staff in the NHS are trying to keep it afloat but with too early discharge, and social care on its knees, we are letting people down, we are letting people live without sufficient support, we are not giving the service patients deserve.

And I think we are all so, so sorry when we know things go wrong but it is going to happen more and more.

Bonsoir I have yet to meet someone who has experienced both the NHS and the French system who has compared the NHS favourably, other that it being 100% free.

However, that doesn't mean that the NHS is awful. It isn't. But it is definitely deteriorating. Everything about it. My grandmother was in this year and her care compared to previous years was awful. They are understaffed and the food is getting even worse. Thanks Tories.

I am concerned that the Dept of Health could use negative stories on here as an excuse to further batter and privatise bits and pieces of the NHS. I wouldn't trust this government an inch with the NHS.

The solutions appear so simple. They could save it if they wanted to. But they don't. Aided and abetted by the right wing press they are turning the Brits against a wonderful system. All the while cutting costs, refusing treatments, adding layers of bureaucracy. And making a private system like the States appear to be so much better.

It is disgusting.