Introduction: This is a simple ‘bullet point’ blog, not criticising anyone in the ‘perfect system’ they have the misfortune to work in. There are many ‘heroes’ within the NHS and Social Care world, governed by well-meaning managers, board members and politicians, who between them have systemically destroyed most that was good.
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.
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.
Figure 1. Taken from the VT-CAUSAL training programme.
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!
- 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!
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