Unsafe caseload-NHS

[AndromedaPerseus]

I'm a NHS Professional who is at the end of their tether. Over the past 6 months we've had an unprecedented number of referrals of very sick and time consuming patients. This has pushed our caseload over the recommended numbers and made it unsafe. I've picked up a few mistakes recently which on investigation was because of trying to cope with the sheer numbers; this has all been datixed. We are just about managing to review clinically patients but anything else such as safeguarding, patients needing home visits or problems arising has increased the work and stress levels of our team massively. I've spoken to our line manager who while sympathetic says there is no money for more staff and we need to manage the caseload more effectively. We have done lots of things to reduce our workload: paperless working, telephone reviews whenever possible, cut out home visits but the referrals keep coming and our line manager says we have to accept them. Has anyone else been in this situation and what's been done to improve the situation

I could have written your post! I work in mental health and the system is at breaking point. Other services we work with have managed to hold a boundary and close their doors to new referrals so they're all coming to us.

Unfortunately the more we struggle to cope, the more we send a message that we can manage with existing resources, putting our service users at risk of harm and staff at risk of burnout. I think the only solution is to be more realistic about what you can do and prioritise.

You have my full sympathy , I worked in the community until recently as I reached breaking point..such a shame.
Working to rule was spoken about loads but it's impossible to do.

I now work for the CCG in continuing healthcare. I wonder if approaching the directors of the CCG and stating your case for more funding ???

Thanks for the replies useful to know we're not the only ones. We've had a lot of new housing built in our area and a large tertiary hospital in the city has closed their outpatients service which means a lot of their referrals to have come to us.
I think the only way we can argue to stop referrals is we have now physically run out of clinic slots and physical spaces to hold more clinics. It will affect our local hospital as they need to discharge their patients to a community service so if no community service then no or unsafe hospital discharge. We currently have a caseload of 210 patients with 1.5 wte band 7

Well I may be naive and totally wrong but the CCG as commissioners of your service should be made aware if you feel it's unsafe , they are ultimately responsible for the care the public receive and they have the ability to direct funding to where it's needed.

that funding will prob not be be available ....and they may decommission your service to Virgin ...lalalalalalalalala -god its a mess

I think it's the same everywhere. My workplace has changed beyond recognition over the past few years - more patients living longer but with more complex health needs, more complex discharge planning and no extra resources.

The only way id suggest is put a business case forward to trial a new model of working, or find saving from sharing premises with other community service or a cheaper building.

There is no money, but there is sometimes an innovation fund available to help with upfront cost.

If your service has anything to do with delayed discharge or preventing re-admission, make sure the CCG know it - preferably with data.

Yes, it's a nightmare working in the NHS now. I wake at four in the mornings worrying about mistakes and oversights and I work in admin, not on the clinical side. At my workplace the normal working mode is one of panic and there is just too much to do and too few people to do it. So it's unsafe most of the time.

The NHS is putting everyones health at risk atm - patients and clinicians.

My ds neurology specialist saw him December, upped his meds and did further tests and asked for return in 6 months. I got letter 2 weeks later for appointment in 11 months time! So clearly they have so many patients that's the earliest clinic they could give. Luckily though referral from his lead numerous to specialist neuro only took 4 months.

Last week my friends GP diagnosed Quincy and referred to ent emergency. She went straight there. Spent 8 hours waiting to be seen with no painkillers and no antibiotics to start treating it. She was seen late at night and given AB, sent home with open access if it got worse.

It must be horrendous being a clinician and having the vocation to work long hours and care - yet know whatever you do you can't do more than basics as the time and money don't exist.

The general public need to stop taking it out on those who are first point of access too.

Nc for this. I'm a community OT and our management have been brilliant about supporting us with caseload numbers. We have declined referrals from acute if we don't have capacity. I'd love to know if sickness rates/vacancies from NHS workers decrease if they're properly supported. Probably a stupid question but most people think we get upset about pay. I don't. It's about pressure/patient safety.

I work some bank shifts at an acute hospital and I got shouted at by a&e consultant as I didn't want to dc someone who I was concerned about (no support at home, off baseline). It REALLY bothered me as it felt so humiliating, BUT I knew I'd done the right thing by the pt. My conscience was clear as I hadn't been bullied into making an unsafe dc.

The point to all this is that I have had vast experience of differing management styles, and I would rather drop a pay band than EVER have to feel so wretched and unsupported. You have my sympathies op!

Thanks for your last comment. I've been screamed and sworn at so many times I've lost count.
We need a government brave enough to really face the issue and try to change it.
In the short term though, that's not going to happen.

I know somewhere this happened and 3 members of staff whistle blew directly to Jeremy Hunt saying it was another mid .staffs waiting to happen. I don’t like the bloke but I will say he acted on it and within a month an independent review team arrived. They looked at stats, interviewed staff, etc. Oddly enough the result of their review was never made public not even to staff. Managers reckoned that the review team had said things were ok....but staffing increased.

Has your manager flagged the issues and is your team on the at risk register? This should be done. It will increase chances of a business case to employ someone else.
Make sure you verbalise your struggle and it is documented at each supervision.
My sympathies, I am a clinician too and in a similar situation. I see in future things getting worse and find it sad the only thing we can do is make sure we don’t suffer consequences from how awful the system is at present.

Keep datixing. If your manager can't/ won't do anything, go above their head to their manager. Do it in writing, leave a paper trail.

Failing that, whistleblow.
improvement.nhs.uk/resources/freedom-to-speak-up-whistleblowing-policy-for-the-nhs/

It sounds as though your manager has their head in the sand and is just assuming your team will just keep coping, in my experience a VERY common assumption! Do you know who your freedom to speak up guardian is? If you can't get support from your manager then I would go to your freedom to speak up guardian. I have had really positive outcomes on two serious patient safety issues by taking this route. If things are as bad as you say then patients are being put at risk and a serious incident is highly likely to occur. Please don't be afraid to speak out, you owe it to your patients.

@VivaLeBeaver that's really interesting about Jeremy Hunt. Had no idea he really could be proactive!

I would consider whistle blowing policy or go to pals. And personally I would start refusing some tasks saying I can't do that safely. Harder to do than to say but I am not far from the latter in my work currently.nhs.

I imagine Jeremy Hunt was terrified about another mid Staffs. Which would be bad enough but it would have been 100x worse for him if three staff members popped up with proof that they’d warned him and he’d done fuck all.

Thanks for all your replies and some good suggestions on managing the situation, one of the problems is we are community team but our line manager is acute based so I'm never quite sure he fully understands what we do and the pressures we're under. He has submitted a business case following a risk assessment for more staff but no one thinks we will get it in this current financial climate.