NHS

[Will!]

25 minutes ago, spyguy said:

Why demoralised?

It's all about lack of performance management.  If you work on a well-run ward where the good people get on and the crap people get washed out the you get a virtuous circle - people want to work there so it's adequately staffed, effort is rewarded so there's a reason to work hard, morale is high because you're not carrying dead wood etc.  If you work on a well-run ward with adequate numbers of competent people then the work is fulfilling.  Many wards I've worked on have been the opposite of this and so you have the vicious circle - no-one wants to work there because it's badly run, good people have to carry the bad people, good people leave, bad people stay, morale is low etc.

At the heart of all the talk about systems, protocols, procedures and policies is the fact that the work is done by people.  If you have the wrong people then all the system management in the world won't save you.

All politicians say that the NHS's greatest asset is its people - it's like motherhood and apple pie.  Until those politicians grasp the nettle and admit that some of the NHS's people are also its greatest liability there will be no improvement.

[spyguy]

2 minutes ago, Will! said:

It's all about lack of performance management.  If you work on a well-run ward where the good people get on and the crap people get washed out the you get a virtuous circle - people want to work there so it's adequately staffed, effort is rewarded so there's a reason to work hard, morale is high because you're not carrying dead wood etc.  Many wards I've worked on have been the opposite of this and so you have the vicious circle - no-one wants to work there because it's badly run, good people have to carry the bad people, good people leave, bad people stay, morale is low etc.

At the heart of all the talk about systems, protocols, procedures and policies is the fact that the work is done by people.  If you have the wrong people then all the system management in the world won't save you. 

Partner works in school.

I tell ehr the best thing that could happen for the people working there is if 30% were sacked.

Id guess the same goes for the NHS. MY Nurse friends was choosey about where and who she worked with.

However, knowing how the cliques work n the UK public sector, we'd probably end up with the right people going, and the wrong people staying.

There needs to be some sort of recession for the public sector. Ive been through - oh - 5 in the 23 years since Uni. Each was has seen quite a few people depart from where I work. The 90s one was the worse. Nov 92 I was working with quite a few people who been promoted to no job, or just crap. Nov 93, 20 had gone. And this was in a site of ~100 in Nov 92.

Since then, most company Ive worked have had the number of people closely aligned to work.

 

 

[Will!]

When it comes to performance management I like to draw a lesson from Officers’ & Servicepersons’ Joint Appraisal Reports in the military.  In a constantly shrinking military it's ever more important not to keep and promote the wrong people.  The military seems to expend a lot of man-hours conducting, moderating and validating its appraisals.  I'm sure those appraisals aren't perfect but they appear vastly better than the tick-box exercises I go through in the NHS.

[Will!]

9 minutes ago, spyguy said:

However, knowing how the cliques work n the UK public sector, we'd probably end up with the right people going, and the wrong people staying.

That's already happening with junior doctors I know.  Those with the most initiative and resource are going abroad.  Those with the least are staying.  I think of it as pulling up the flowers and watering the weeds.

[man o' the year]

 

2 hours ago, rxe said:

What gets my goat is their ability to ignore patients .... until that patient shows up with someone who is remotely competent.   Simple example - my mother (85) takes herself to A&E with chest pains.  Sits there for about 4 hours, and gets told to bugger off (politely).  

So the next day she shows up with my father in law, who is a very capable doctor, now retired.   He doesn't like her story in the slightest.    He doesn't go all arsey on them, just uses the right language.   4 hour wait is turned into 30 minutes.   Proper attention this time, they discover that her blood pressure medication (un reviewed for 4 years) is utterly wrong, and that is causing her blackouts as well.   All fixed.  But if she'd not had someone who gave a s**t with her, she'd probably be in a box by now. 

Similar example when same parent had a (thankfully very mild) stroke.  She'd basically had her arm go numb, it was sort of coming back to life, but I've spent enough years in radiology departments to classify that as "not good".  Drove her straight to the nearest teaching A&E, dropped her right outside the doors and went to dump the car.   By the time I had come back, she was on a seat in the "drunks and low priority" queue.   So I dragged her back to the desk.    Receptionist/Triage person clearly pissed off "look, I've already told you to sit over there...".    Magic words needed:  "83 year old, history of high blood pressure, complaining of her hand going numb and floppy, then coming back to life, what do you reckon, because I reckon she should have been in the CT 10 minutes ago".  That got the required result.  

I could talk about the good friend of mine who had his cancer missed over a course of several months and visits - until it was too late.  He had a complaint upheld on that one, but it didn't really help him.  They'll try better next time. 

The relative with bowel cancer who was fobbed off for a year until it was very nearly too late. 

Oh, yes, the time I had blood pouring out of my **** only for the GP to tell me not to worry - paid a man with a camera 2 grand to make sure, and he chopped a load of stuff out of my lower bowel that he said would have caused no end of trouble in a few years time.  

Honestly, for anything remotely serious,  I'd rather be insured and in the US than over here.    They undoubtedly do all sorts of wonderful things, but the basic level of care is shocking.

Your examples starkly show the problems which seem so widespread.

My own problems have escalated as Mum is ready for discharge as they have not and will not do anything. Having nearly killed my father the same hospital are now determined to take Mum into care, which I believe is financially motivated. This now becomes a deprivation of liberty issue which I will challenge as unless she comes home she stands no chance of any rehabilitation as physiotherapists will not touch her as she has dementia. I will need legal advice to be as sure as possible of my ground (first quote is £200 = vat per hour).

I should emphasise that all of this is done with an air of secrecy and confrontation. For example the meeting regarding discharge was at 10am today and I was invited and attended. I then spent 45 minutes waiting for the meeting to then have a social worker and discharge nurse come (having obviously already had the meeting) to tell me they would need to reschedule the meeting to have an advocate speak on behalf of my Mum.

[ChumpusRex]

15 hours ago, man o' the year said:

I should emphasise that all of this is done with an air of secrecy and confrontation. For example the meeting regarding discharge was at 10am today and I was invited and attended. I then spent 45 minutes waiting for the meeting to then have a social worker and discharge nurse come (having obviously already had the meeting) to tell me they would need to reschedule the meeting to have an advocate speak on behalf of my Mum.

Something sounds wrong here. Although not part of my normal work, I'm fairly sure that the whole point of an advocate is to argue for the person, when they have no family or friends to do so on their behalf. 

 

If you are available to discuss, then there is no reason to find an independent advocate, as that role would be taken by yourself. 

 

That said, there is a financial motivation here. If your mum gets discharged home but can't cope and gets readmitted, then the hospital gets a big financial penalty. 

I think you need to rearrange this meeting, making clear that you will be acting as advocate and that an additional independent advocate is not required. 

 

[crashmonitor]

On 01 November 2016 at 11:00 PM, man o' the year said:

 

Oh as a punchline I get to pay £5 for car parking every time I visit. Total cost so far this year over £600 including discount for multi buy tickets at Kings Mill hospital Mansfield and Newark hospital. These are not available at Nottingham City hospital where my usual 2 hour stay is sometimes more than £6..

 

I never pay parking charges. I'd be looking at the warren of streets around Newark hospital. The City Hospital at Nottingham is a simple one up the Hucknall Road, past gate one and take the first or second left, both proffer oceans of unlimited parking. Depending on which unit you are visiting it can be closer than the official car park. In any case I am too mean to pay parking I would walk two miles if necessary, saves on the gym membership. SAVES ME FROM BECOMING A PATIENT HOPEFULLY.

 

https://www.nuh.nhs.uk/media/2215862/city_patient_and_visitor_parking0316.pdf

[man o' the year]

9 hours ago, ChumpusRex said:

Something sounds wrong here. Although not part of my normal work, I'm fairly sure that the whole point of an advocate is to argue for the person, when they have no family or friends to do so on their behalf. 

 

If you are available to discuss, then there is no reason to find an independent advocate, as that role would be taken by yourself. 

 

That said, there is a financial motivation here. If your mum gets discharged home but can't cope and gets readmitted, then the hospital gets a big financial penalty. 

I think you need to rearrange this meeting, making clear that you will be acting as advocate and that an additional independent advocate is not required. 

 

Something is wrong - social services are fully aware that my mother living at home means they cannot get their hands on Mum and Dad's house. Clearly this means potential conflict of interest for me in their eyes. Equally this means potential conflict of interest in my eyes of social services. With Dad being in care the ultimate cost implications are doubled. However unlike Dad, my Mum cannot cope in care so well, unable to speak up for herself.

The clincher for me is that Mum has spent short periods of time in respite and on each occasions has not been properly cared for, leaving with UTI and being dirty (I can be more specific if necessary). She has dementia and is far happier and content at home. She deteriorates rapidly outside of the home environment.

I have to day involved a solicitor.

[Mrs Bear]

Hospitals are often terrible places for anyone with dementia.  Even if staff are supposedly trained they often don't understand the practical realities - e.g. the person just will not remember to use a call button (or any other instruction) so it's no use expecting that repeating them  is going to work.  From what I've heard so many times, it's quite common for various professionals, including doctors, nurses and social workers, to be pretty clueless about the realities of dementia.  They may have been on a course, but they still don't get it.  

Having said that, my baby grandson was recently in hospital for 9 days - a week of that in intensive care, sedated and on a ventilator - with bronchiolitis.  He was only about 13 weeks at the time. 

I have to say the care was fantastic - he was wired up to various monitors and wasn't left alone for a moment. 

We were all so grateful to the staff, though I know my daughter is very lucky to have a very good hospital almost on her doorstep.

 

[spyguy]

5 hours ago, Mrs Bear said:

Hospitals are often terrible places for anyone with dementia.  Even if staff are supposedly trained they often don't understand the practical realities - e.g. the person just will not remember to use a call button (or any other instruction) so it's no use expecting that repeating them  is going to work.  From what I've heard so many times, it's quite common for various professionals, including doctors, nurses and social workers, to be pretty clueless about the realities of dementia.  They may have been on a course, but they still don't get it.  

Having said that, my baby grandson was recently in hospital for 9 days - a week of that in intensive care, sedated and on a ventilator - with bronchiolitis.  He was only about 13 weeks at the time. 

I have to say the care was fantastic - he was wired up to various monitors and wasn't left alone for a moment. 

We were all so grateful to the staff, though I know my daughter is very lucky to have a very good hospital almost on her doorstep.

 

Dementia belongs in a care home. not a (general) hospital.

Hospital are not expensive old folks homes.

Bets used for acute conditions, not chronic diseases of the elderly.

 

[Bloo Loo]

1 hour ago, spyguy said:

Dementia belongs in a care home. not a (general) hospital.

Hospital are not expensive old folks homes.

Bets used for acute conditions, not chronic diseases of the elderly.

 

my ward, care of the elderly (77+) had a fair complement of Dementia patients, waiting for care home places. Others with families just needing respite from what requires in some cases 24hour hands on care.

[Mrs Bear]

2 hours ago, spyguy said:

Dementia belongs in a care home. not a (general) hospital.

Hospital are not expensive old folks homes.

Bets used for acute conditions, not chronic diseases of the elderly.

 

People with dementia do need to be in hospital sometimes, e.g. my mother at over 90 with a broken hip.  

But yes, the lack of sufficient social care provision does mean far more pressure on considerably more expensive hospital beds.  It's unbelievably shortsighted that there is not more joined up care. 

[spyguy]

4 minutes ago, Mrs Bear said:

People with dementia do need to be in hospital sometimes, e.g. my mother at over 90 with a broken hip.  

But yes, the lack of sufficient social care provision does mean far more pressure on considerably more expensive hospital beds.  It's unbelievably shortsighted that there is not more joined up care. 

You end up with Nurses chasing after dementia patients who have nothing medically wrong with them.

Sounds a bit harsh and out of the blue but I think the solution to Dementia has to be euthanasia of some sort.

Went thru this with my Nan. Fortunately, only for 1 year. Wasn't nice, wasnt my Nan, she would have hated knowing what became of her last 12 months. She didn't though, as my Nan died anoud a year before her body did.

I mean she was 92. She wasnt going to get better.

 

 

[Mrs Bear]

12 hours ago, man o' the year said:

Something is wrong - social services are fully aware that my mother living at home means they cannot get their hands on Mum and Dad's house. Clearly this means potential conflict of interest for me in their eyes. Equally this means potential conflict of interest in my eyes of social services. With Dad being in care the ultimate cost implications are doubled. However unlike Dad, my Mum cannot cope in care so well, unable to speak up for herself.

The clincher for me is that Mum has spent short periods of time in respite and on each occasions has not been properly cared for, leaving with UTI and being dirty (I can be more specific if necessary). She has dementia and is far happier and content at home. She deteriorates rapidly outside of the home environment.

I have to day involved a solicitor.

Councils do not 'get their hands on' anyone's house.  The proceeds of a sale are used to pay care home fees, if necessary.   If the person is at the stage of needing 24/7 care and supervision (often the case with dementia) then this is nearly always less expensive to provide in a care home, otherwise it means more than one person on shifts - carers need their breaks and time off.  

The maximum home visits most councils will pay for is 4 relatively short ones per day, and for many people past the early stages of dementia, this just isn't enough. 

If the person needs a care home and has a house they will no longer be living in, then I don't see why it should not be sold to pay the fees. We have had 3 self funders (with dementia) in this family, and by the time they needed 24/7 care - by which I mean someone on hand ALL day, ALL night, 365 days a year - care homes were the only practical option.  We did look into 24/7 home care for one of them, but it worked out even more expensive than a good care home. 

Might add that all the care homes we experienced over the years have been very good, and none of them was the most expensive by any means. 

Most people do take a while to settle in a care home, some longer than others.  Short respite visits are a rather different thing and may not be a good guide as to how your mother would do eventually. 

[SarahBell]

45 minutes ago, Bloo Loo said:

my ward, care of the elderly (77+) had a fair complement of Dementia patients, waiting for care home places. Others with families just needing respite from what requires in some cases 24hour hands on care.

Was there not some authority that took control of a care home/spare wards and used them as an overflow for people waiting to be discharged back to care homes. As they required no medical help no nursing staff were needed, just care assistant style staff. This freed up hospital wards and cost a lot less for everyone.

[SarahBell]

12 minutes ago, Mrs Bear said:

If the person needs a care home and has a house they will no longer be living in, then I don't see why it should not be sold to pay the fees. We have had 3 self funders (with dementia) in this family, and by the time they needed 24/7 care - by which I mean someone on hand ALL day, ALL night, 365 days a year - care homes were the only practical option.  We did look into 24/7 home care for one of them, but it worked out even more expensive than a good care home. 

So what if they were all in one house together?

[Bloo Loo]

50 minutes ago, SarahBell said:

Was there not some authority that took control of a care home/spare wards and used them as an overflow for people waiting to be discharged back to care homes. As they required no medical help no nursing staff were needed, just care assistant style staff. This freed up hospital wards and cost a lot less for everyone.

There is a whole raft of people finding places.  There is a shortage of places. Some need different types of places, 24 hour care, partial independent living, others want a family to go home to, but sometimes the family just cant cope, so there is a wait while the home is prepared, the family agree a plan, carers arranged.

In other words, its complicated.  However, its not something new.

[SarahBell]

Just now, Bloo Loo said:

There is a whole raft of people finding places.  There is a shortage of places. Some need different types of places, 24 hour care, partial independent living, others want a family to go home to, but sometimes the family just cant cope, so there is a wait while the home is prepared, the family agree a plan, carers arranged.

In other words, its complicated.  However, its not something new.

And it happens every year - lots of old people stuck in hospital beds.

So are there empty wards that could be put into use? 

[Mrs Bear]

51 minutes ago, SarahBell said:

So what if they were all in one house together?

Great idea in theory, but my FiL with vascular dementia had died before my mother developed Alzheimer's, and  it was another 6 or 7 years before she needed full time care.  And she'd never got on with her sister who subsequently got it, so that would really have been fun and games if they'd been living together.  At one point my mother had got it into her head that her sister had 'stolen' their mother's house - even cast iron proof signed and sealed by the Lord Chancellor would not have convinced her - such is the nature of dementia.  I had to say ad infinitum,  Dear me,  how awful, I had no idea, I'll get on to a solicitor first thing tomorrow. Only way to calm her down. 

And although my mother was 6 years older, she outlived her sister by at least 4 years.  

[Bloo Loo]

2 hours ago, SarahBell said:

And it happens every year - lots of old people stuck in hospital beds.

So are there empty wards that could be put into use? 

Im sure if there was an empty ward and staff to staff it, the place would be full in 10 minutes flat.