Friday, 13 April 2012

The Fragmenting Of England's NHS

"Wakey wakey Mr Beasly. Two o'clock in the morning
and we think you're well enough to go home now."

UK plc's chief salesman is touring overseas accompanied by his back up team of weapons salesmen. Every media clip shows him looking more and more uncomfortable in formal situations and his speeches are lack lustred and robotically delivered.

Shouldn't he be back in England sorting out their NHS rather than selling arms abroad?

English NHS Trusts have reportedly sent home 239,233 patients between 11pm and 6am last year. The Mail is up in arms about the numbers, although it does mention that senior doctors say the numbers will be far smaller, as the statistics include patients who want to go home as test results come back with the 'all clear', as well as women who have just given birth. Also included are drunks sent home after being admitted earlier to A & E to sober up and some Trusts also count patients as being'discharged' if they have died.

The most worrying excuse given by senior Trust officials is:


'...  nursing staff may only get round to recording patients as being ‘discharged’ on computer systems late at night even though they left earlier on that evening.'


If nursing staff can't accurately record a patient's discharge time what trust can a patient have in other medical records?

I'm all for escaping from a hospital ward at any time of the day or night and if I was told at 3am that I was fit enough to leave I would do so - as long as was able to make the necessary arrangements for a safe journey home. To send anyone home at any time of day or night without verifying the patient's safety is irresponsible.

What would be interesting is to know how many of those discharged were admitted drunk. Many times I've said the NHS should not be used as a depot for drunks and they should be put in police cells until they are able to stand on their own two feet.  If that happened the number of drunks on the streets may well diminish rapidly.  There's nothing glamourous about staggering out of a police station into the street early in the morning, clutching possessions in a plastic bag and being aware that the previous night's attire doesn't look so alluring in the cold light of day.

I remember some years ago being desperate to leave hospital after a minor operation. The medical staff refused to allow it until a relative or friend presented themselves to the ward sister and gave her their assurance that 'her' patient would be in safe hands.  This patient safety net has since been removed from hospital discharge procedure.

Of course, if a patient wants to go home, they are free to discharge themselves. But if hospitals are discharging patients in the middle of the night without ensuring adequate arrangements are in place for their return home, they are breaking one of the basic rules of medical care.

The Patients Association receives several calls a week from distressed relatives whose loved ones have been sent home in the middle of the night. How many friends or relatives don't contact the PA?

When I read this earlier in the week I shook my head in disbelief at how the English health service is fragmenting. Irresponsible night discharges are possibly all part of 'the plan'.

16 comments:

RMcGeddon said...

It was scary seeing Dave tell the people of Indonesia that they had 'shared values' with the UK.
Brutal intervention in East Timor where thousands were massacred ( including 250 at a cemetery in Santa Cruz in 1991).
Murderous attacks on religious minorities, including muslims who aren't the right kind of muslims.
We should be afraid if this is what Dave aspires to.
He's off to Burma soon to witness more 'shared values'.

English Pensioner said...

I put it down to general incompetence which is endemic in most state run organisations.
When my wife was in the local hospital, she was told she would be discharged at 9.00 the following morning once the doctor had seen her. So I went in the car to collect her getting there at about 10.00, parking in the hospital car park at £1 per hour. Getting to her ward, I discovered that the doctor had not yet got round to seeing her, which happened at about 11.00. This was followed by "we've just got to get the papers for you to take to your GP" took us to about 1.00 pm. Then someone had forgotten to order her medication from the pharmacy, but they were at lunch, so no one could deliver the prescription till they were back. More delays here, then we had to wait for a porter to push the wheelchair, I couldn't do it for "Health & Safety" reasons!
We finally got home at about 7.30 in the evening.
All simple incompetence, nothing else.

tris said...

I imagine RMc, that he must have been thinking of northern Ireland (and some parts of Glasgow, and for all I know, Liverpool) where being the wrong kind of Christian can get you killed too.

But Call Me will sell arms to anyone who will buy them pretty much regardless of what they have done, and the Queen is no better inviting despots and murderers to her luncheon for which we will pick up the tab.

I wonder what he's peddling to the Generals in Republic of the Union of Myanmar today.

Thank goodness, SR, the NHS was one of the devolved areas of government. All my English friends are shuddering at the thought of the creep to privatisation, with Lansley at its head. The way he dismisses criticism and fears is truly frightful.

I heard about one old dear deposited at her door but with no key, she couldn't get in.

I know old people are a bit of a pain to Cameron. Without them he could cut the top tax rate to 35%, but killing them off like that is a bit obvious even for him.

No matter how useless Millipede is, this should bring down Cameron's government if nothing else does.

JRB said...

What this item shows are a couple of unequivocal truths –

[1] The NHS in England is rapidly ‘going to hell in a hand basket’.
( Ms Sturgeon please take note, and avoid any or all of the changes happening down south. )

[2] That for far too long skilled and professional nursing staff are being diverted from their core duties by a bureaucratic management to fill out meaningless statistics, which, until now, no member of management has read, far less acted upon.
If you die – you’re a discharge
If you visit A&E but not admitted - you’re a discharge
If you want to go home - you’re a discharge
If you left earlier, but not noted - you’re a discharge
If you were drunk and just sobered up - you’re a discharge
And if you are a new mum and child – then you’re a double discharge

But how many of these ‘discharges’ should be quantified as ‘irresponsible – despite all the statistics we cannot actually say.

‘Discharges’ are but one of the many administrative and statistical returns heaped upon our overworked nursing staff by a bureaucratic management.

If anyone is acting irresponsibly it must surely be hospital management, who no doubt will argue that they are simply bowing to irresponsible political pressures.

Furor Teutonicus said...

XX
'... nursing staff may only get round to recording patients as being ‘discharged’ on computer systems late at night even though they left earlier on that evening.' XX

Apart from the medical side, these lists are invaluble when it comes to an emergency.

I would like to see the video of what happens when Bill Bloggs, fireman, finds whoever could not be bothered filling in these details, after crawling around a burning hospital ward full of smoke, looking for a "patient" wh is cosily wrapped up in bed AT HOME!

Crinkly & Ragged Arsed Philosophers said...

If any of this statistical analysis is distorted by the mere recording of times when the information has been transferred to the data base, I see no reason for alarm or criticism. It simply makes sense for night shift staff to catch up with the paperwork during the quiet times.

While English Pensioner raises an issue I can sympathise with, I've neither experienced or heard of any in patient being tipped out either late evening or early morning under the NHS.

But with the efficiencies being claimed by the private sector it wouldn't surprise me to see this maxim adopted under the guise of maximising throughput and bed utilisation.

Perhaps the whistle-blower in this instance is Mr Lansley himself?

Edward Spalton said...

I have to say that my recent experience of the English NHS for a small bit of day surgery in the Derby Royal was excellent. From receptionist to anaesthetist, to surgeon, to theatre staff and ward staff , to the people who brought the cups of tea round, they were uniformly first class. If it had been private treatment, I would have rated it real value for money. A few days ago I visited a friend who was in for a much more serious operation and he and his wife were of the same opinion.

Yet just over the county boundary in Staffordshire a few years ago , a hospital was reckoned to have caused the early deaths of up to 1200 people by neglect in the most distressing circumstances. Patients were drinking water out of flower vases and being left in their own filth. At the same time the hospital was ticking all the official boxes to achieve foundation status. Doctors and nursing staff later said they were afraid for their jobs to speak out.

So I don't think the variability is anything to do with Mr. Salmond or Nichola Sturgeon. Although I would also say that my sister's recent treatment in her last illness in Argyll was also about as good as it gets.

I think a great deal depends on leadership within the individual hospitals. Some years ago I visited my sister in the Glasgow Western infirmary and was appalled at the treatment and general atmosphere of slapdash chaos and nobody knowing anything.

Yet the calm, caring competence in the Southern General where my brother in law was looked after in his last days a little later was exemplary.

More recently I paid a return visit to the Western where my wife's sister in law was making a very good recovery from a stroke and, having feared the worst, was mightily reassured by the standard of care.

So I think the NHS suffers from being a producer monopoly but is rather like the curate's egg, probably mostly good and frequently excellent - but desperate in parts - with very little of the variation to do with actual funding.

Of course, PFI (Private Finance Initiatives) etc are an appalling extra cost and complication but Labour was the great promoter of these and the present Con/Lab arguments in England are mostly posturing. Labour would be doing something very similar in power, working towards what the EU calls "the market in health services" - as will be the case in Scotland whilst it is in the EU. The process is sometimes called "the enabling state" whereby most government functions are farmed out to contractors in an EU-wide market.

It is loved by politicians of all parties because of the "revolving door" whereby the ministers and civil servants who award large contracts get second careers and reappear as directors and consultants of the firms which to which they awarded contracts whilst in office..

subrosa said...

That's his 'arms salesman speech' RM - shared values.

He's now done Burma and looked like the second class salesman he is next to Aung San Suu Kyi.

subrosa said...

It is incompetence EP and expensive too. With your wife still being on the ward her bed would not be classed as empty so the incompetence affected more than yourselves.

subrosa said...

The problem is Tris that Labour wouldn't do any better and neither would the libdums. England has little or no choice.

subrosa said...

Of course it's irresponsible management JRB, but where are the nursing unions to stop it?

Surely the likes of the Patients Association and others must be able to break through the NHS Trust kingdoms or is that now impossible?

subrosa said...

FT, the point there is that if someone is discharged at 8pm yet it is registered as 1am then that's a useless record surely.

Why have records if they're not accurate?

subrosa said...

Of course it makes sense for staff to update records during quiet night periods Crinkly, but they must be accurate.

It could be him Crinkly. Because his decisions do not affect the Scottish NHS, I'm afraid I take a shallow interest in his mutterings.

subrosa said...

That's the way it should be for everyone Edward, however Staffordshire was allowed to continue their dreadful behaviour for years. Just why that happened I don't know, yet didn't the Trust head move up to a quango job?

I would agree the variations have little to do with funding but all to do with management as JRB points out.

It will be interesting to see how the NHS operates in 10 year's time.

Brian said...

Rosie,

Has a similar FOI request been made to the Scottish NHS regarding nocturnal discharges or is a strict rule that nobody can leave before having breakfast enforced up north?
I think part of the problem is the tick box target culture that sets time limits on treatment waits and the hotelisalisation of wards with minimal spare capacity. The latter trend means that beds are often smptied, cleaned down, remade and refilled before junior doctors have a chance to browse the contents of the patient's fruitbowl.

subrosa said...

Not that I know of Brian, but I may do one myself.

As I say I've no problem with anyone leaving a hospital day or night, but to insist some do - without ensuring they have support and will be safe - is dreadful in a so-called caring society.

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