The following listing shows how a few well-meaning targets and concepts have gradually eroded a useful system and are now making that system virtually useless. It is based on the hospitalisation of an elderly relative with advancing Parkinson’s disease, a person who if properly supported is perfectly capable of a relatively good level of health and mobility.
- Austerity budget reductions create greater pressure to save costs
- Care support contracts awarded by lowest cost after basic safeguarding conditions met
- Bottom line prices, forces hidden reduction of services
- 4 x 30 minutes care visits, gets diluted to less than 4 x 30 minutes
- Time critical appointments, shift to possible on time
- Constant failure reports to social care are hard to deal with, within reduced budget paradigm
- Summer holiday cover becomes near impossible
- Medications not administered, simply given to customer (perhaps NOT taken)
- Times between medications…. Far too long, followed by far too close
- Under-dose followed by overdose every day ….
- Some appointments failed to carry out ….
- Medication irregularities leads to swallowing / hydration problem
- Hydration problem causes confusion and falls
- Confusion and falls leads to A&E admittance
- Austerity budget reductions create greater pressure to save costs
- Four-hour target destroys sensibility in A&E
- Diagnosis backwards from worst case
- Tested, X-Rayed and Scanned for various problems
- Drip eventually administered to address dehydration
- Meds administered eventually to reduce Parkinson’s impact
- Passed through to next ward
- Need for hydration ignored
- Food offered, virtually unable to eat
- New drip inserted, agreed for 24 hours for full hydration
- Being kept in over-night, for observation
- Passed through to next ward
- Drip not retained
- Noisy ward, virtually impossible to sleep or rest
- One quarter of meds not given due administration error (for three days)
- Unable to eat or drink much, due to lack of meds
- Gammon so tough, an ‘Iron-man’ would struggle to eat it
- Lovely patient staff, seem very caring
- No day lounge, Pay TV system no use for elderly confused. Thus zero mental stimulus
- Low level lighting impossible to read in for poor sighted
- Parkinson’s meds administered after given food, thus chew swallow action NOT helped
- ¾ of all food not eaten due to lack of help, wrong set up!
- Insufficient fluids taken … Thus poor sleep, low hydration, poor nutrition …
- Declared fit, BUT needing 24/7 social care for discharge
- Walking about frowned on due to risks (Thus mobility reduces)
- Impossible to sort 24/7 care,
- Reviewed health position….
- Hasn’t got COPD, A&E theory in error!
- Thus 24/7 care NOT needed, was a staff nurse mistake
- Release arranged on Wednesday for the following Monday…. Staff nurse sees this as OK!
- Staff nurse states that hospital exit team go home at 17:00 and anyway not in today!
- Staff nurse reluctantly arranges meet with exit team
- Exit team carry out basic fitness to be discharged assessment (agreed for next day)
- Sort out care in the community package (until noon Monday)
- Next day relapse, thus has to stay in longer
- Checking charts, virtually ate no breakfast or lunch!
- No diagnosis of medical issues, simply confused and slightly hot
- Relatives provide 1:1 care in the ward to help eat, drink, meds etc.
- Some hospital food provided clearly after consume by dates!
- Next day release arranged and achieved
- Goes home, under nourished and dehydrated, still a little confused!
- Slips out of bed the next morning paramedics called in by NHS carers
- Paramedics spend ages trying to stabilise and enable supported living
- Arrange community nurses
- Arrange Occupational Therapy support
- Arrange Physical Therapy support
- Next night refuses to be undressed by black man, sleeps in chair in day clothes.
- Still not drinking enough
- Care team fail to arrive at Noon on Monday
- NHS carers continue to deal with interim care
- Care team swear that Hospital never called them
- Care team fail to advise when care will resume (as had been agreed)
- Social Care fail to answer phone
- Social Care fail to answer Emails
- Social Care fail to reply to voice-mails
The system makes the old and frail less capable, for-ever dependant on more care with less independence, the hospital is more like Commando training: Wrong meds, sleep deprivation, poor food and drink, while trying to get better! Every phase erodes the ability to be self-sufficient, locking in failure and greater costs!