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Bossybabe

BBC Two. "Hospital"

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A fascinating exposition of the NHS as it is now - pretty much at capacity. 150 new cases every DAY at St Mary's in Paddington, where I used to work. (Before I had the stroke). 

You can't help admiring the way they cope with the decisions that they have to make. I feel burnt out just watching this:huh:

 

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My wife was hospitalised with bad food poisoning in late November/ early December. While she was there they diagnosed her with Type 1 Diabetes. O.K., so two problems, requiring two different sets of doctors (albeit that the undiagnosed diabetes might have exacerbated the effects of the FP). But co-ordination between them was pretty much non-existent. After she'd been there a week, they came in mid-afternoon and told us that they were moving her out of her isolation room and onto an open ward, since she hadn't been sick or had any notable diarrhoea for three days. At this point her blood sugar was pretty well under control, albeit that I'd occasionally had to prod the nurses to turn up the drip rate when she started to go high. So I piped up with "if she's not infectious, not being sick, and her blood sugar's under control, why can't she come home?". This caused such a look of consternation and surprise on behalf of the nurse and doctor present that it was clear that the idea simply hadn't occurred to them. But it didn't take them very long at all to agree that yes, she might as well go home.

In a situation where the NHS are apparently critically short of beds, I am astonished that apparently they can't find 2 minutes a day per patient to discuss whether they still need to be there, or can be sent home to free a bed up. My wife is 42, she's otherwise fairly fit, and I'd been by her bedside 8 hours a day literally every day she was there keeping an eye on her and chatting to the nurses and doctors about her care, so it ought to have been abundantly clear that they wouldn't be sending a vulnerable person home on her own to fend for herself.

I hope that was an isolated incident; and I suppose it's possible that my local hospital (Lewisham) isn't actually short of beds, since it managed to escape PFI, and thus famously had such relatively healthy finances that Jeremy *unt tried to close its A&E department in order to assist the neighbouring NHS trust. But as I understand it, when one hospital runs out of beds, they ring the next one to see if they can help. I'm sure there was someone on a trolley in a corridor somewhere in London at that point...

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5 hours ago, stormymonday_2011 said:

Hardly surprising the NHS has a bed shortage when in fact it has less beds available to the public than in the 1970s when I worked for it. 

The history of the NHS since the war has been of a fast decrease in bed numbers. From the 1950s Carry On days where any condition saw you brought in to the vast number of available beds they fell steadily until by 1988 there were only 297k beds (NHS England), by 2016 this had more than halved to 130k.

If other areas are like Cornwall then you will be seeing a march towards closing the "cottage" hospitals so even more beds go.

This is why operations get repeatedly cancelled at vast expense because there are no beds.

As a contrast to that programme the experience of a temp at Truro hospital (the main Cornish one) is that the nurses spent much of the day hiding round the corner socialising. But the BBC wouldn't film that would they?

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1 hour ago, Rave said:

My wife was hospitalised with bad food poisoning in late November/ early December. While she was there they diagnosed her with Type 1 Diabetes. O.K., so two problems, requiring two different sets of doctors (albeit that the undiagnosed diabetes might have exacerbated the effects of the FP). But co-ordination between them was pretty much non-existent. After she'd been there a week, they came in mid-afternoon and told us that they were moving her out of her isolation room and onto an open ward, since she hadn't been sick or had any notable diarrhoea for three days. At this point her blood sugar was pretty well under control, albeit that I'd occasionally had to prod the nurses to turn up the drip rate when she started to go high. So I piped up with "if she's not infectious, not being sick, and her blood sugar's under control, why can't she come home?". This caused such a look of consternation and surprise on behalf of the nurse and doctor present that it was clear that the idea simply hadn't occurred to them. But it didn't take them very long at all to agree that yes, she might as well go home.

In a situation where the NHS are apparently critically short of beds, I am astonished that apparently they can't find 2 minutes a day per patient to discuss whether they still need to be there, or can be sent home to free a bed up. My wife is 42, she's otherwise fairly fit, and I'd been by her bedside 8 hours a day literally every day she was there keeping an eye on her and chatting to the nurses and doctors about her care, so it ought to have been abundantly clear that they wouldn't be sending a vulnerable person home on her own to fend for herself.

I hope that was an isolated incident; and I suppose it's possible that my local hospital (Lewisham) isn't actually short of beds, since it managed to escape PFI, and thus famously had such relatively healthy finances that Jeremy *unt tried to close its A&E department in order to assist the neighbouring NHS trust. But as I understand it, when one hospital runs out of beds, they ring the next one to see if they can help. I'm sure there was someone on a trolley in a corridor somewhere in London at that point...

Going by a friend post op (appendix, not *****!) experience, the problem comes down to managing beds.

He had his op, had a couple of days on a drip/observation/pain killers. Then he spent 3-4 days stuck, where he was OK to go but no-one was willing to sign him out. There was noone pushing him - despite the ward being full - mainly of OAPs with no surgery - but thats another story.

He fell asleep and missed the visiting Dr. There's only a few minutes window when the Dr came round. He was up since 5am, woken by an dementia patient shouting - again, this was a post surgery ward not an old folks home. Dr came round at 10am, he feel asleep at 9.50.

He asked if he could get signed out. Noone got back to him.

 

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42 minutes ago, Frank Hovis said:

The history of the NHS since the war has been of a fast decrease in bed numbers. From the 1950s Carry On days where any condition saw you brought in to the vast number of available beds they fell steadily until by 1988 there were only 297k beds (NHS England), by 2016 this had more than halved to 130k.

If other areas are like Cornwall then you will be seeing a march towards closing the "cottage" hospitals so even more beds go.

This is why operations get repeatedly cancelled at vast expense because there are no beds.

As a contrast to that programme the experience of a temp at Truro hospital (the main Cornish one) is that the nurses spent much of the day hiding round the corner socialising. But the BBC wouldn't film that would they?

My Nurse friends finds casualty hilarious.

At her hospital if its a sunny day a good 30% of core sickies dont turn up.

 

 

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6 hours ago, stormymonday_2011 said:

Hardly surprising the NHS has a bed shortage when in fact it has less beds available to the public than in the 1970s when I worked for it. 

Why do they  always say it is a bed shortage when it is staff shortages.....In some cases wards with empty  beds but not the staff to cover......Many of our hospital buildings are very modern, there not sufficient staff on the payroll, is it the wages bill or the actual beds, equipment or the space there is a shortage of?.......and why do so many doctors only work part-time now?

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3 minutes ago, winkie said:

Why do they  always say it is a bed shortage when it is staff shortages.....In some cases wards with empty  beds but not the staff to cover......Many of our hospital buildings are very modern, there not sufficient staff on the payroll, is it the wages bill or the actual beds, equipment or the space there is a shortage of?.......and why do so many doctors only work part-time now?

Gordies doubling of the NHS budget went on admin and cpaital projects.

Sorting out the skills base and actually thinking what the NHS should be and do was too hard and did not get dumb votes.

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Rampant immigration (especially) & NHS tourists are the reason for full capacity - I recall some Labour minister stating it's because we're all living longer, init.

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Just now, mattydread said:

Rampant immigration (especially) & NHS tourists are the reason for full capacity - I recall some Labour minister stating it's because we're all living longer, init.

Back to mate again.

When he was checking into the surgery ward the other 5 people in the room were foreign, cannot speak english foreign.

Then he spent the second night under observation wtach a never endign stream of OAPs turn up with trivial complaints being told that heartburn is not a hosiptal condition.

 

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15 minutes ago, winkie said:

Why do they  always say it is a bed shortage when it is staff shortages.....In some cases wards with empty  beds but not the staff to cover......Many of our hospital buildings are very modern, there not sufficient staff on the payroll, is it the wages bill or the actual beds, equipment or the space there is a shortage of?.......and why do so many doctors only work part-time now?

Over 50% of medical school intake is now female. Females get to specialist training around the usual age for childbearing. Ergo, females work part time. This was foreseen, at least while I worked in Medical Education, in the early 90s, so there was plenty of time to make provision on the service side for it. Certainly, provision was made for part time specialist training. 

Sufficient staff for beds - two problems: paucity of suitably trained and qualified staff and lack of budget ( 30 years of doing more for less). 

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7 minutes ago, mattydread said:

Rampant immigration (especially) & NHS tourists are the reason for full capacity - I recall some Labour minister stating it's because we're all living longer, init.

Rampant immigration isn't a problem IF the majority of immigrants are working and contributing to the public purse. If that's the case, as 'they' assure us, then government is not providing enough funding to cope with extra demand. 

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4 minutes ago, Bossybabe said:

Over 50% of medical school intake is now female. Females get to specialist training around the usual age for childbearing. Ergo, females work part time. This was foreseen, at least while I worked in Medical Education, in the early 90s, so there was plenty of time to make provision on the service side for it. Certainly, provision was made for part time specialist training. 

Sufficient staff for beds - two problems: paucity of suitably trained and qualified staff and lack of budget ( 30 years of doing more for less). 

So it comes back to skills shortage again, why are we not investing in training people, I would love to help but told would have to invest a large sum of money myself to train myself in a place over an hour's drive away with no guarantee of any work at the end.....Hardly surprising that people choose to do other work where they see themselves more valued and cared for.....What about all the money wasted on agency staff?...Why do they not want to put these people on the payroll? Or why do these nurses prefer to pick and choose when and where to work?.....;)

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13 minutes ago, Bossybabe said:

Over 50% of medical school intake is now female. Females get to specialist training around the usual age for childbearing. Ergo, females work part time. This was foreseen, at least while I worked in Medical Education, in the early 90s, so there was plenty of time to make provision on the service side for it. Certainly, provision was made for part time specialist training. 

Sufficient staff for beds - two problems: paucity of suitably trained and qualified staff and lack of budget ( 30 years of doing more for less). 

Partners school is in permanent crisi due to having managing maternity cover of the under 40 women who make up ~80% of the teachers.

 

 

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14 hours ago, stormymonday_2011 said:

Hardly surprising the NHS has a bed shortage when in fact it has less beds available to the public than in the 1970s when I worked for it. 

They don't even keep you in hospital if you've popped out a sprog anymore. I have been told a c-section went home the same day too. 

 

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9 hours ago, spyguy said:

Going by a friend post op (appendix, not *****!) experience, the problem comes down to managing beds.

He had his op, had a couple of days on a drip/observation/pain killers. Then he spent 3-4 days stuck, where he was OK to go but no-one was willing to sign him out. There was noone pushing him - despite the ward being full - mainly of OAPs with no surgery - but thats another story.

He fell asleep and missed the visiting Dr. There's only a few minutes window when the Dr came round. He was up since 5am, woken by an dementia patient shouting - again, this was a post surgery ward not an old folks home. Dr came round at 10am, he feel asleep at 9.50.

He asked if he could get signed out. Noone got back to him.

 

Your friend is obviously a stickler for rules. I had an emergency appendectomy (wasn't the culprit) and simply signed myself out the next morning.

I have also been admitted for acute pneumonia and decided that given the state of the ward I was on I would be better off at home (GF at the time was a nurse). Disconnected drip, removed cannula and shuffled out. No need for a Doc to sign anything.

Being self employed may have something to do with it.

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23 minutes ago, CunningPlan said:

Your friend is obviously a stickler for rules. I had an emergency appendectomy (wasn't the culprit) and simply signed myself out the next morning.

I have also been admitted for acute pneumonia and decided that given the state of the ward I was on I would be better off at home (GF at the time was a nurse). Disconnected drip, removed cannula and shuffled out. No need for a Doc to sign anything.

Being self employed may have something to do with it.

Hospitals are not prisons...people forget this along with Doctors who should know better dont actually give a toss about you.

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51 minutes ago, CunningPlan said:

Your friend is obviously a stickler for rules. I had an emergency appendectomy (wasn't the culprit) and simply signed myself out the next morning.

I have also been admitted for acute pneumonia and decided that given the state of the ward I was on I would be better off at home (GF at the time was a nurse). Disconnected drip, removed cannula and shuffled out. No need for a Doc to sign anything.

Being self employed may have something to do with it.

He was waiting for a dressing to be removed.

The deal was theyd remove the dressing when he was discharge and give him more dressing for later.

 

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57 minutes ago, Bloo Loo said:

Hospitals are not prisons...people forget this along with Doctors who should know better dont actually give a toss about you.

Some guy in A&E screaming about being nearly 4 hours waiting said he'd sign himself out if she didn't do something. The nurse told him to trott off if he wanted and that he didn't need to sign himself out. 

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2 hours ago, SarahBell said:

Some guy in A&E screaming about being nearly 4 hours waiting said he'd sign himself out if she didn't do something. The nurse told him to trott off if he wanted and that he didn't need to sign himself out. 

Some guy screaming on my ward about being kept there.  He only had a pair of y-fronts to his name.  His relative was coming in later with cloths.  He had the option...leave, mostly naked, or wait a couple of hours...that made us fascist pigs.

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15 hours ago, spyguy said:

Going by a friend post op (appendix, not *****!) experience, the problem comes down to managing beds.

He had his op, had a couple of days on a drip/observation/pain killers. Then he spent 3-4 days stuck, where he was OK to go but no-one was willing to sign him out. There was noone pushing him - despite the ward being full - mainly of OAPs with no surgery - but thats another story.

He fell asleep and missed the visiting Dr. There's only a few minutes window when the Dr came round. He was up since 5am, woken by an dementia patient shouting - again, this was a post surgery ward not an old folks home. Dr came round at 10am, he feel asleep at 9.50.

He asked if he could get signed out. Noone got back to him.

 

The issue is that it is the juniors who basically run the wards. There is some supervision from consultants, but the work is typically done by the most junior. The result is that the doctors spending most time on the wards have the least experience, and the least confidence to make decisions, and there may be policies as to who can make the decision to discharge.

The way things used to work when I was a junior was you'd have 4 doctors in a team, staight out of med school, 1 with about 1-3 years experience, one with 3-5 years experience and a consultant. The consultant would aim to see the in-patients 3 times a week, with the most senior junior deputising most of the time, and the very junior ones just doing the donkey work.

Typically, the consultant would be on-call 1 day a week, and would take all the relevant admissions from A&E or sent in by the GPs. On a busy day, for a general consultant, this could easily be 40 patients. If they were on-call over a weekend, you could easily have 100 in-patients on the Monday morning. You've now got the juniors running around like headless chickens fire-fighting because every nurse on every ward is now asking "What do we do about mr. Blogg's insulin?" or "Can Mrs Smith be discharged?"

When I was a junior we did an audit of how many pages to come to a ward we had. In one 8 hour shift, the median number of calls each junior would get was 120. Minimum was 90. When you are getting so many interruptions for "urgent" attention, suddenly you run into a gridlock problem. You are spending so much time dealing with the urgent calls, that you can't do the routine work until that too becomes urgent, and then you have the problem that you can't even allocate 3 minutes for each in-patient per day, because there simply isn't enough time in a shift to answer all the calls, and see everyone, let alone do any of the admin work; in effect it's gridlock and things do not get done in a timely manner.

To an extent good time management by the juniors can help, but one of the issues was that there was very little support staff for basic admin stuff. Simple stuff, like making sure that the ward was stocked with paper for the casenotes often didn't happen, so you'd go to see a patient to check on them, see that the last sheet of paper in the case notes was full, the ward was out of stock, the ward clerical assistant was useless ("not my job") and so you'd have to go running around the hospital to find some paper. In the end, the only way I could deal with this was to turn up 1 1/2 hours before my shift started each day to go through every set of my patient's case notes to enter any test results into the notes, check there was enough paper, hole-punch and file any loose-leaf papers that had appeared, check that the wards were stocked with paper, order forms, etc. and then I'd go round and check basic admin stuff such as a prescription form having sufficient space for additional doses to be recorded. If you didn't keep on top of this at the beginning of the day, you'd end up in pager gridlock by lunch time and nothing useful would be achieved for the rest of the day.

Now, in general, things worked most of the time. With 4 people on a team, the juniors could share the admin/minor work. There would be surges of activity after the consultant had been on-call. The problem was as soon as a junior went on holiday, it was one less person on the team. Or perhaps it was a bad day in A&E and someone had to be drafted from the wards to assist with admitting people from A&E. Once that sort of thing happened, then it easy for the team to just end up in hopeless gridlock. Then you add in a junior who doesn't carry their weight, and things really start deteriorating. 

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15 hours ago, Bossybabe said:

Rampant immigration isn't a problem IF the majority of immigrants are working and contributing to the public purse. If that's the case, as 'they' assure us, then government is not providing enough funding to cope with extra demand. 

It's still a problem even if the money is available if it can't keep up, and hospitals can't be built and nurses and doctors trained in an instant. Rapid increase in numbers is bad in every possible way.

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I don't recognise the NHS that is being described.

I've had two reasons to use A&E in the last 18 months - the first time I had a basilar migraine (a migraine that gives you stroke symptoms), I went to A&E and had a CAT scan, MRI and was in a bed on a ward within about 2 hours. A consultant reviewed my scans the following morning, gave me the all clear and I went home. It seemed incredibly efficient compared to how it used to be.

The second time I hit my finger with a hammer and pretty much turned it into a bag of mush. I went to A&E, had an X-ray, a dressing and some antibiotics within about 2 hours and was told to attend the plastic surgery clinic the following morning (Sunday morning). I turned up at the plastic surgery clinic at 7.30am (it opened at 8), I was second in the queue and was out by 9.30 with a dressing and an appointment for the following week. It was absolutely superb.

Back in the late 90s I cut my arm badly, and ended up in hospital for 4 days, even though I could have gone home on the second day. The X-rays took an age to do and to get analysed, I spent the vast majority of the 4th day waiting for the pharmacy to attend my prescription and waiting for a nurse to remove the insert in my hand that was being used to administer drugs. My recent experience was vastly superior to this. The only thing that has got worse (if it's possible!) is the food. Which was bloody awful when I was in with the migraine.

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The NHS hospitals have got more efficient at getting use out of its beds but they don't control the care of patients end to end. The problems it faces in part are due to the inadequacies of GP support to patients  particularly at week ends and out of normal working hours. When this is combined with the cuts in local authority after care for people in the community then you are almost guaranteed that A&E is going to be overrun, beds are going to wind up blocked  and people end up waiting on trolleys. Of course, it is entirely a crisis made by governments who prefer political grandstanding, piecemeal policy making and  arbitrary financial  targets to proper planning. Thus you get the absurd situation where people are denied care assistance at home which is relatively cheap so that they eventually wind up in hospital where care is extremely expensive. The NHS also seems to spend a lot of time and money screening and running tests on essentially healthy people while ignoring those with real needs.  Everyone knows these are the real problems but nobody seems to have will or indeed the capability of doing anything about it.

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3 hours ago, Riedquat said:

It's still a problem even if the money is available if it can't keep up, and hospitals can't be built and nurses and doctors trained in an instant. Rapid increase in numbers is bad in every possible way.

This "It's ok as long as they pay their way" argument on immigration really baffles me. I just don't know people can think this using any form of logic. 

You can't just keep on allowing people into a football stadium once it's at capacity because they are all willing to buy a ticket and as they come in you'll try to somehow fit in some more seating as you go along.  Something is going to collapse. It's 100% guaranteed.

That's what's happening in the UK right now re. immigration. 

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