The NHS: Dumpster Fire That No-One Has the Will to Tackle.

I've had yet another "interface" with the NHS over the past week. Not for myself, but for my 90-year-old Mother.

The "interface" was not a good experience. Yet more evidence of incompetence and lack of care.

One evening before Christmas she was admitted to the hospital with Pneumonia. Notwithstanding she was in A&E on a trolley for 8 hours before being seen by a doctor She was on oxygen overnight and also had two courses of IV antibiotics. 

She was discharged the next day, in the afternoon. I have yet to confirm this, but I suspect she was discharged with no regard to if the antibiotics had worked or her oxygen levels had improved. 

I say this, because that evening she collapsed whilst in her flat. Luckily she is in a block where there are support workers. She doesn't have any support at the moment (this will have to change) and onl;y by luck one of the carers called in to see how she was after her trip to hospital. 

Cue another call out of an ambulance and another trip to A&E. This time a 13 hour wait to be put in MAU again, where she was being assessed the previous day. 

This time, her stay is going to be a prolonged one because when she fell, she fractured her pubic bone. 

We suspect she may have had low oxygen levels and been unsteady enough due to this to fall.

Way to go, NHS. You just transformed what should have been a three day stay into a 6-8 week stay in hospital. All because you were too incompetent to check my mother's stats to confirm she was fit enough to go home.

As it is, this second stay in hospital has outlined even more incompetence. She is now on an Orthopedic ward. Yet the nurses on that ward do not know how to handle a patient with a broken pubic bone. Some of them have stated they have never heard of a fractured pubic bone before. 

Now, given the fact they hadn't had much experience in the care of a patient with such a fracture, you'd think someone in a senior position would discuss the nature of the injury and any special requirements. Bu no. Instead, nurses we pulling my mother's legs apart while trying to move her. Just the very thing designed to cause the most pain. Rather than the correct way, which is to move both legs together and cause the least amount of pain. 

The other incident was a young Doctor coming up to my mother and stating glibly "well, I think you can come off the oxygen now". Luckily my ex Sister-In-Law was with my mother at the time. She quickly retorted "So has the Pneumonia suddenly cured itself?" "Have you checked her sats to make sure she can come off oxygen?". To which he made some comment, faffed about with my mother's notes and promptly disappeared. 

Then later a nurse turned up (we assume by order of the embarrassed doctor) to remove the oxygen from my mother. To which my ex S-I-L let her know what had just happened with the doctor and to cover herself, the nurse may want to check my mother's sats before doing anything. 

Obviously, my mother's sats were depressed even with oxygen, so the nurse didn't withdraw the oxygen support, thankfully. 

But yet again another example of poor care. That doctor may have seen a dozen similar examples like my mother. But each patient is an individual and should be treated individually. I don't care how many 90-year-old ladies you've seen this year, there is going to be one that requires oxygen for longer than normal because she also has the added complication of having pneumonia. 

In other words, read the notes you fucking lazy quack.

These are the people the NHS needs to weed out. The incompetents, the people that have attracted complaints. The NHS needs to stop protecting incompetent staff. The NHS unions likewise.

These are the people causing the NHS to spend money settling lawsuits. And yes, I'm going to be looking into the circumstances surrounding the discharge of my mother before her fall. 

Care Home Residents and blanket DNR (Do Not Resuscitate) Order During the Pandemic.

 I've blogged before about my wife's experiences in care homes during the pandemic. 

She noticed that DNRs were being written for residents of the various care homes she was managing at the time.

Over a year ago, this report in Learning Disability Today went some way to highlight the issue, but it doesn't delve deep enough. 

There is plenty of anecdotal evidence that DNRs were being issued by GPs without the permission or giving notice to care providers or family members of residents. An illegal practice under article 8 of the Human Rights Act.

Let's be clear, during the pandemic it was a pretty dodgy time to get ill and be referred to hospital. The first thing that ambulance crews asked before scooping the patient up was "do they have a purple form" (DNR). 

That then set in motion the limitations of the medical response by the NHS. If you weren't lucky, the presence of the DNR allowed ambulance crews to refuse to take residents to hospital. Instead leaving them in the residence to effectively die, no matter how bad they got. 

If the resident was "lucky", then they would be admitted to hospital, but the presence of the DNR affected the level of care provided. Anecdotal evidence suggests that LD and elderly care home residents were only given minimal care while in hospital. 

Of course there's a chance that the resident survived despite the best efforts of the NHS to deny them care. 

In that case, you'd think that any hospital patient would get a Covid test before being released back to the care of the care home? Nope. The attitude of the NHS at the time appeared to be that they didn't care what happened after the resident had been released from Hospital. "Not their problem" I guess.

So residents, still infectious with Covid were released back to the care of the homes they came from. 

The savvy homes put in place infection control and isolation measures for any and all residents returning back from hospital, whether they presented with Covid or not. Those that weren't so savvy paid the price and had to deal with outbreaks in the home that could have been avoided had the proper measures been put in place.

After seeing the debacle unfolding in New York (thanks to brave YouTubers and Alt Media) and other houses  around the country decimated by Covid brought in from Hospitals, I'd discussed this at the beginning of the pandemic with the wife and I'd said the prudent thing to do would be to set up isolation measures for anyone leaving the protection of the home's "bubble".

Staff were LF tested on a daily basis and PCR tested weekly.

That was about as biologically secure as you could make a care home. 

But I digress. 

We were appalled at the real risks that a care home resident falling into the clutches of the NHS was exposed to. Certainly what residents experienced in some if not most hospitals was a grossly poor level of care. Certainly from the management side of the NHS.

Someone within the NHS must have instigated the signing of DNRs by GPs. It can't have been a local thing, because the evidence (again anecdotal) suggests that this was a nationwide phenomenon.

Here more recently in the Telegraph, it's reported more DNR notices were given to care home residents, but there's no appreciation this was done without consultation with care providers or patient's families. 

The last paragraph in this section should be a scandal:

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“However, what is clear from our results is that for a significant proportion of clinicians, resource limitation continued to factor into clinical decision making even when pressures on NHS resources had returned to near-normal levels.”

The Telegraph previously reported that children with learning disabilities were offered “do not resuscitate” orders during the pandemic, amid concerns about the pressure on the NHS.

Investigations by this newspaper also uncovered reports of adult patients with mental illness and learning disabilities who were given DNACPRs at this time.

A survey by the Care Quality Commission, published in March 2021, found more than 500 care home residents were made subject to DNR orders without their consent.

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That last paragraph, although a scandal in itself, doesn't tell the whole story. Elderly residents of care homes were regularly denied proper levels of care. People's Parents and Grandparents were shuffled off to side wards and denied basic care to die.

THAT is your NHS. That's what the nation clapped for. Feel good about that now?

It's a fucking disgrace and heads should roll. A full, independent investigation should be launched into how the most basic of care was deliberately denied certain patients. This was no accident, no result of negligence. This was a deliberate action by the NHS.

Someone told those GPS to write those DNRs. They didn't do it off their own bat.

Hospital staff accepted the discrimination of care home residents and didn't red flag what was going on.

This has got to be investigated, the people responsible removed from the NHS and it should not happen again.

Finally, the question that has not been addressed is:

Are those DNR notices still in place now? Are care home residents still at significant risk of reduced care levels when admitted to hospital?

UPDATE:

It very much appears as if the DNR orders are still in place. The wife has only recently heard of a resident that went into hospital and instead of receiving a pre-pandemic standard of care, they were actually put on the Liverpool pathway. 

Anyone in care knows and probably despises the Liverpool pathway, especially if they actually do care about their charges. 

The Liverpool pathway is a set of protocols for palliative or end of life care. It effectively withdraws nutrition and care in a way that speeds up the dying process. 

Except the Liverpool Pathway is being instigated on people that have a fair chance of recovery, if only they were actually given a decent standard of care. It's effectively euthanasia by the back door. It's effectively saying that there's a portion of the population that don't deserve care. 

We're back to the 70's and 80's when it comes to care for the elderly and disabled. Before disability rights supposedly protected people from inhuman and discriminatory treatment. 

This is an NHS that is now prepared to refuse care to a proportion of the population. 

It's a scandal that is not being reported. How many people have to die needlessly before the media will pick up on it? 

Or are certain thing taboo now with the media? Just like the extent of Muslim grooming gangs, are they going to stay quiet on on the mistreatment and discrimination of the elderly and disabled?

COVID-19: NHS Death Cult.

 I've mentioned the wife is a care manager before. She's currently dealing with a Covid outbreak at one of the homes she manages.  The virus has spread despite workers wearing full PPE. Thankfully only the workers have been affected, none of the residents have shown signs. Until now.

Similar stories are going round the care community that this new variant of the virus gets round all the usual protection (masks, face shields, aprons and gloves). 

Certainly it seems a magnitude more transmissable. The jury is out on whether it is getting through masks, or it's transmitted by a small slip-up in PPE protocol. At the wife's home, because the staff and none of the residents are affected, then it does lend credence to the slip up in PPE protocol theory, or that the virus spreads past masks when being in close proximity for long periods.

Obviously the wife is stuggling to cover staffing with the majority of staff off. The two ladies left working in the home have stepped up and worked long hours to cover. That's how care workers do things because they care.

However, it's the treatment of people in care by the NHS that I want to concentrate on here.

With an outbreak amongst the staff, everyone at the home is wary of the residents coming down with covid. Being learning disability there isn't the option to test them like a normal person would be, so it's a case of monitoring symptoms and reporting back.

Yesterday one of her residents had a temperature and started with a cough. All the protocols were followed, the resident was already isolated because of the staff outbreak. So the residents GP was called.

The immediate reaction of the GP was to get the home to call 999 and get the resident taken to hospital. No test, no confirmation of covid, just scoop them up and dump them in the plague ward. If they didn't have covid, you can bet within hours they would.

So, they dutifully called 999 and the first response of the ambulance service was for the home to confirm the resident had a DNAR form. A Do Not Attempt Resuscitation Form. That tells you what the priorities of the NHS are.

So, attempting to get the resident some care, rather than an NHS death sentence, the home rang 111 to get a more balanced opinion. The response was why did the home go against the GP's instructions? 

So, it seems there is an agenda in the NHS to just assume covid, scoop the patient up and dump them on a covid ward. Where if they didn't have covid before, they will certainly contract it.

It's fucking shit. This pandemic has shown the worst of the NHS. Rather than save lives, they would rather condemn people to death. 

Don't get me started on the lack of care for cancer patients. Patients with advanced tumours that are not getting the treatment that could possibly save their lives.

The NHS has become a death cult. 

To me it looks like the switch has flipped. This is now the establishment killing people off. With the new Police fines, it's the establishment against the people.

There will be a reckoning.

COVID-19: Integrated Response Required.

It's quite clear there is still a disconnection between demand for PPE and supplies.

The fiasco of the RAF plane waiting in Turkey to be loaded. Turkey! Fucking Turkey!

Where's the PPE being made in the UK?

The rumour is there are warehouses of the stuff here in the country, but it's not being procured by the NHS. They prefer other means of supply.

Like acquiring shit quality Chinese products that don't work, or burning fuel and spending money on putting up RAF personnel while they wait in fucking Turkey for PPE to be loaded.

There's a guy in Portsmouth working in a shed producing face shields for local health providers. He's making 50 shields a day. IN HIS FUCKING SHED!

Now surely it's not beyond someone in government to set up a company in the first instance to co-ordinate supply to the NHS and to commend it if necessary to acquire premises and equipment to manufacture those supplies?

An N95 mask is not a hard thing to produce. Not with 3d-printing technology.

The face frame gets 3d-printed out of polyurethane, then the material gets laser cut and glued to the mask frame with polyurethane adhesive. It's not fucking hard.

But of course the beaurocracy kicks in. Are those masks certified? Is the supplier a trusted/recognised NHS supplier?

Look, the masks can be certified/tested whatever in quick style if you talk to the right people.

And fuck whether the supplier is on the NHS list: It will be a fucking government funded company so I hope to God NHS procurement managers don't ignore it because I'd be naming and shaming those fucking jobsworths.

As you can tell I'm a bit fucked off about the PPE situation and how ludicrous it is. Especially when the solution appears so simple.

In my previous life I was an installation manger. I know how these things are done. I also know how easily the situation is gamed to make it hard. Time to end the bullshit and crack on.

Should Exotic Cancer Treatments be Provided by the NHS?

An interesting report came out today, regarding the National Cancer Fund.


It seems the initial aim was a laudible one, to provide expensive cancer treatments for patients with terminal cancer in an effeort to prolong their life. But in some cases the drugs actually shortened  their life, the exact opposite of the desired outcome.


But, it seems the outcomes didn't justify the cost. It's now been branded a waste of money. Like most knee-jerk reactions to public opinion.


This is what I've banged on about before: there needs to be a grown up debate on what the NHS is for and especially where the limits lie with respect to treatment. The NHS was initially designed to be a safety net, treating those that couldn't afford private doctor's bills.


As medical advancements have arrived, it's been assumed that the NHS will offer those as well, to the point it offers very expensive, world-class treatments courtesy of the tax payer. Can the NHS afford such expensive treatments, or should there be limits. Should people that want world-class medical care take out medical insurance instead of demanding the NHS provide it?


Take the case of the cancer drugs above. If the people are being used as Guinea Pigs for new cancer treatments, shouldn't the drug companies be funding the supply of the drugs out of their own pocket? Sure the NHS can supply the doctors and share the information gleaned from treatment, but why should the NHS actually be paying quite heavy costs for the supply of the drugs.


The fact that the outcomes in some cases were negative shows that these are not sure-fire treatments, that the drugs involved were administered without any clear benefit. In that case it's not treatment, it's a trial and the drug companies should be paying or supplying the drugs for free.


There also needs to be a debate about treatment for terminal patients. Should we be spending tens of thousands of pounds on exotic drugs to prolong the life of someone that is never going to recover? If it was a cure, then the cost may be justified, due to the reduced cost of ongoing treatment. But the money shouldn't be going into vastly expensive trials. Shouldn't that money be going into treatments with a more definate outcome and a long-term benefit, for instance hip and knee operations?


It seems to me a bit selfish for someone that already knows they are are terminally ill to demand from the NHS hideously expensive drugs on the off chance that they may (or more likely will not) extend their life by a few months at most, at the expense of providing a long-term (deceades-long) benefit to people that have other, cheaper treatments like hip and knee operations.


If you want that sort of top-class service, then buy medical insurance.


Of course I'm going to be whinged at by those that see this as a two-tier health service: the people able to afford health insurance will get better treatment, those that can't get bargain basement treatment on the NHS. But expecting the NHS to supply top-class service for the whole population is wrong too. Where does it stop? At what percentage of government expenditure do we say enough is enough?

The very Ancient and Outmoded Labour Party (Part 2).

I was thinking and I think I've hit what it is about Labour that upsets me. It has failed to be aspirational. Sure, it aspires to be in power, but what after that? Nothing. Maybe it moves the deckchairs around a bit, but nothing truly inspirational. It's fiddling at the margins.

When I say aspirational, I mean for the working class it purports to respresent. What plans does it have to make the lot of the working class better?

A popular policy would be to outlaw zero hours contracts. The heinous things trap people by demanding exclusivity, but not rociprocating by providing a decent working week, every week.

In my mind, exclusivity means the company should pay the worker even though they are not working, because the company they are contracted to is preventing them from working for someone else.

If the company states you cannot work for anyone else, then they should be forced to pay a retainer to the employee. Of course minimum wage legislation means that the employee should be paid minimum wage even if they are not being used.

This is a very similar concept to the IR35 legislation that affected IT contractors.

Ok, a zero hours contract is a step up from employing people as self-emplyed contractors (e.g the so-called "Gig Economy") so the employer pays national insurance etc. but the exclusivity clause means that the employee should be paid for the time they are unable to work for anyone elase.

There should also be legislation aginst penalising people that cannot work at a certain time because they are working for someone else.

The legislation should make the agreement fair and equitable to both parties. At the moment the advantage is all towards the employer.

Another area Labour can help working people is social care. Wages in the social care sector are generally the lowest possible. A vast number of people are working for minimum wage despite having the qualifications and responsibility of administering medication and attending to the social welfare of their clients.

A move to professionalise the social care sector, maybe with union representation is sorely needed, it needs to be brought up to the same status as nursing. Having someone having access to and able to give medication including controlled drugs after a basic one day training course, or worse filling in a questionaire in my mind is just wrong. The discrepancy between social care and the medical profession is massive..

Workers in the care sector need to demonstrate a knowledge of social care and safety legislation. The basic care certificate introduced by CQC goes some way towards this, but more is needed.
More professionalism should improve wages for a sector with some of the poorest. That's what I mean by Labour being aspirational: introducing policies and legislation to improve the conditions of the poorest workers, the ones that are really being exploited.

Of course improved wages in the care sector then increases costs, but as I've previously mentioned, improved professional status will make it easier for the NHS then to take on social care and integrate it with the rest of the NHS, allowing patients in hospitals to be moved out of hospital wards.

A penny or two on income tax or national insurance to pay for the integration of social care budgets into the NHS budget wouldn't be baulked at by the majority of people. It would be a winning policy for Labour.

The very Ancient and Outmoded Labour Party.

It's a pity UKIP didn't win the Stoke by-election, with a defeat 2-0 the Labour party might have taken the hint and sacked their leader, Leicester FC-style.

Instead, with a score draw, the Tories can claim a historic result and Labour can carry on deluding themselves that things are fine and dandy, although the claim that Corbyn hasn't lost a by-election will have to be quietyly shelved. Not that it was much of a claim, the incumbent party almost never wins seats when in power.

The fact that the Labour party is really only relevant to students who have never lived a life, champagne socialists in London and militant socialists in Liverpool who have never grown up really, really upsets me. More than it should I know, but I still understand what the Labour party stood for way back when.

It stood up for the working man, it persuaded and didn't need thuggery to press it's point, because it was RELEVANT to the working man.

The working man could see the point of paying a small payment into a scheme so that we could have free health cover.

The working man could see that paying a small sub to a Union to protect him from overbearing employers.

But where is the relevance of the Labour party these days? Union leaders are seen hob-nobbing in posh restaurants with fat-cats, their leader really wants to do away with the Monarchy and wants a republic, he wants to do away with nuclear weapons, the very things that have kept the Russians from swallowing up the greater part of Europe. His policies are those of the trendy ultra-left, the sort of people who are miles away from the labourers, miners, steel workers, engineers and other blue-collar workers that made it.

They bicker and whinge about nit-picky irrelevances, like rights for every minority group going, including those that would deny them those very rights if they ever got in power.

Where is the working man or woman in all if this leftist irrelevance??

Nowhere. The left refuses to discuss substantive issues and place themselves in an electable position. For instance on the NHS they brook no discussion on how the NHS works, they would rather just shovel more and more cash into the black hole and naively hope more service comes out the other end.

The same mantra is pushed by the left regarding local services provided by councils.

Forget the fat cat bosses at the top earning six-figure salaries, forget the waste and the corruption, forget the lack of vocational nursing places, stopping working class girls getting a decent earning job.

Labour is now a party run largely by ultra-left socialist nutjobs that have absolutely no connection or empathy with the working man and would probably call working people fascists for daring even to earn money.

It just makes me sad that Labour is where it is, irrelevant to most of the people it originally set out to champion.

It makes me even sadder that the people Labour have cast aside still vote for them.