Thursday, 9 February 2017

The Fucked NHS and lack of Cohesion.

Much noise in the press over the past week about how the NHS is on it's knees and close to collapse.

Of course the standard model is to demend more money is thrown at the NHS to help it cope. We all know that's only part of the answer. The general concensus is that all thet happens to the money is it gets swallowed up and quite often does no good at all and produces nothing in the way of betterment.

What needs to happen quite frankly is for the medical profession to start working as professionals and to work in a cohesive way, from GPS at the front end, hospitals providing specialist treatment and at the back end improvements in post-operative and social cafe outside of hospitals.

GP surgeries have long been criticised for the length of time taken to get appointments. In some cases it's been up to a month before you can get to see a GP. Great if you plan to be ill in a month, but bugger all use if you have an illness right now that needs non-specialist care.

Many GP practices in fairness have recognised this and gone to a new model: you can only book appointments on the day. So for instance you book an appointment at 8:30 when the surgery opens and get an appointment for that morning. Hopefully by the time you've battled through the continual busy tone and the hordes of callers you get a an appointment for that morning. The same then applies for an afternoon slot if you fail to win the morning lottery: you phone up at 12:30 and hopefully beat the hordes to get a slot. This then gets repeated ad nauseum possibly for a number of days until you're lucky enough to get through to the appointments person.

Of course if you work, this new scheme is completely unacceptable, because even if you get an appointment, because it's on the same day there is no way of letting your employer know in advance that you have an appointment and will not be in. Taking time off without permission even for a doctors appointment in quite a few businesses is a disciplinary offence.

It's also unacceptable if you are in pain, or feel you need urgent assistance.

So, for employed people it's not an improvement, because you still can't access GP services. Which then means that to get access to a doctor, you're going to have to access a 24hr medical service, i.e. Accident and Emergency.

In the febrile brain of some top-level NHS manager, I suppose that access to the 111 telephone service fills the gap. It basically avoids the GP's surgery and gives you instant access to medical advice. But not being face-to-face with a doctor, but instead talking over the phone to a non-medical person working from a script, means there will be mistakes. People with conditions that need urgent attention will be missed and those that don't need A&E will be sent there. It just depends on how the patient answers the questions on the NHS script rather than on proper medical experience.

Without some modification of GP and other services at the front end the pressure on A&E will just continue to climb.

I've seen it first hand: Ambulance crews queuing up because they can't hand over to A&E staff, the A&E ward full so patients have to queue for hours in corridors. And grown up children throwing a tantrum in the waiting area because their hangover isn't being attended to.

Of course at the other end of the hospital process beds don't get cleared quick enough. I've been in hospital sat on a bed for hours waiting to be seen by a doctor to be declared fit enough to leave. That's an issue of management that needs to be improved. Having to wait most of the day for doctor bloggs to come and sign you off is a waste of a bed. To be honest it always smacks of an ego trip, in that dr bloggs and only dr bloggs can sign patient X off. Tough shit he's on a late shift today and can't sign the patient off until the early evening. Just doing a shift handover to say patient x can be signed off in the morning if he passes fit by another doctor would be a simple change that eases the problem.

Of course those people which have no immediate carer pose the biggest problem due to the lack of social care. In our modern society of fractured families and an ageing population, the problem can only get worse.
Where patients cannot be discharged because they are not well enough to look after themselves, the lack of investment in the care sector is by far the most troublesome issue currently.

First I have to declare an interest. My wife is a carer and looks after people with learning disabilities.

The challenge facing the care sector is the larger numbers of people living longer lives. Not only the elderly able-bodied, but those with learning disabilities, those with longer term health issues and those with terminal illnesses. Medicinal science has worked wonders prolonging the lives of people with a number of health issues. Drug companies have developed medicines such as statins and others that prolong the lives of people with cardiac problems, diabetics are able to take advantage of a range of drugs to help them live longer... So it goes on.

In the last couple of decades the care sector has changed in a huge way. Issues with care had led to organisations like the Care Quality Commission that have pushed for a more professional service, raising standards of professionalism of staff. But the funding has not followed the improvements. Many, many staff are paid no more than the minimum wage, a fact covered by staff doing considerably long shifts to disguise the poor pay. The carers working day is typically 12 hours. When staff shortages or illness strike, that working day can easily extend to 18 or 24 hours. No overtime rates either, standard hourly rate is the norm during overtime, at weekends and bank holidays. People being paid minimum wage are tasked with giving out medication on the basis in some instances of no more than filling out a questionnaire.

If there was a prime candidate for some sort of union or professional representation, it would be the care sector. Of course that would increase wages and therefore costs, but it would be the start of a push for better funding and I doubt unions would be castigated for raising standards and wages for the people who are looking after our sick and disabled.

Care at the moment is provided by a hodgepodge of small independent private enterprises. Costs are high despite low wages, standards are variable and provision is always on a knife edge.
One of the issues with funding of care is the disconnect from the greater NHS in an administrative and budgetary sense. Care budgets are decided by local authorities. What needs to happen is that care provision needs to be taken in hand by the NHS and funded by the NHS budget, so that the benefits of more professional care, better wages, proper investment and closer integration with the rest of the NHS bear fruit and that caring as a profession shakes of it's somewhat seedy and "cheap" aura..

Until the back-end provision starts to improve, there will always be a pressure on hospitals as they fail to discharge patients that no longer need the intensive, specialist medical care of a hospital ward.

The provision of diagnosis, treatment, recuperation and if necessary ongoing care in the community needs to be provided with holistic outlook. It should all be funded from a single pot and managed as a single entity. You can't run GP surgeries and Care Provision independent from the bit in the middle, the hospital care.


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