The Christmas and New Year period saw the NHS at almost breaking point with record numbers of people accessing ambulance and A&E services – a lot, in fact a third of those patients according to NHS England went to A&E inappropriately! And yes my grandma was one of those - she was part of the NHS’s problem, but not through any fault of her own!
By the New Year the national media were reporting just how bad the situation was amongst the emergency services, as they struggled to cope with the often unnecessary demand put on them. The local Manchester Evening News also ran a piece highlighting the very high demand that was placed on the North West Ambulance Services over the festive period, with category ‘red’ calls up by 20 percent from the same time last year. So you can understand then the anger, frustration, disappointment and disbelief that my family had over that same period.
Part of the problem
My grandma has dementia and as such she has to have full time care delivered from a care home – self funded from the rent of her own house and from additional top-up funding from the family. She pays to be looked after by carers who are supposed to be trained in everything from moving and handling, health and safety, nutrition, nursing, caring, communication etc etc. Carers and a care home that are inspected regularly by the CQC, and who are supposed to have qualifications and training to undertake their job appropriately. So why then is my family so frustrated with them?!
In the middle of the night on the New Year bank holiday Monday my grandma had bad stomach pains. At 12.50am my parents were called by the care home to say that she was on her way to the local hospital by ambulance and that they should follow her to the hospital. So yes you heard right, stomach pain, ambulance and A&E in the early hours of a bank holiday – the worst time of the year possible!
My parents were met at the hospital by the ambulance crew who questioned why they had been called as it wasn’t an emergency and therefore they shouldn’t have been called. If it wasn’t an emergency – then nor should they!! My grandma then smiled at my parents and asked them what they were doing there – that to me doesn’t sound like someone with life threatening conditions!
By 7.50am the following morning my grandma was discharged from the hospital after a night awake in a busy A&E department – a person with dementia, getting more and more frustrated, confused, angry and tired with every passing hour. The medical team were brilliant though. Clearly under pressure from the enormous amount of patients that they were dealing with that night, they did every test under the sun to see if there was anything wrong with my grandma (including ECGs and all sort of other expensive tests), but nothing could be diagnosed. At best they decided that it must be constipation!
So yes you heard right, for the grand total of about two thousand pounds and seven hours of time, my grandma was diagnosed as having a condition that should have been dealt with by an out of hours GP, or the NHS111 team at a fraction of the cost! A cost that the NHS just cannot afford to keep having to pay!
So why then do care homes just seem to take the easy option and just ring for an ambulance (as though it was a taxi service) and almost ‘offload the problem’ onto the various emergency services to deal with - services that are already stretched.
But even more worrying – my grandma was not the only patient in the hospital that night from the same care home – there was another female patient, again with dementia that spent the night being chased around by the nursing team instead of them being able to do the actual job that they are paid to do.
Education and communication
Do care home staff really have the right level of medical training to care for their residents? Do they understand how to appropriately access medical services from professionals if they are unable to deal with certain circumstances themselves? At the moment, when talking about this particular care home, I would have to say no.
Why is more not being done to up-skill care home staff to be able to cope with basic ‘emergencies’ themselves? Yes it all comes at a cost but surely putting money into training such as this would ultimately save the NHS a small fortune – don’t forget – two female patients in one night accessing both A&E and ambulance services from the same home. How many other patients were inappropriately sent that week at the same cost?
The same question can also be asked of communication skills. When my grandma arrived back at the home the next morning my parents were met with a sarcastic retort about the constipation diagnosis. Suggesting that she had in fact had diarrhoea that night, so how could it be diarrhoea? Diarrhoea? That symptom information was never passed on to the ambulance crew, my parents, nor then subsequently was it passed on to the A&E staff. So for seven hours the hospital teams were dealing with a patient whom they were unclear about her actual symptoms!
How can the care system be failing in so many ways? Surely communication skills are critical to such care roles? Surely it is common sense to tell ambulance crews or any medical teams what the symptoms are of a patient?! If the care home staff had dialled the NHS111 service they would have asked for all about the symptoms over the phone as they went through their algorithms.
Changing behaviours are drastically needed
The NHS has spent hundreds of thousands if not millions of pounds undertaking national campaigns to educate people on the appropriate use of emergency services. Highlighting that ambulances and A&E services are for life threatening emergencies. If not, that there is a range of more appropriate services available to people during the day and night.
Why then are people or care home staff choosing not to do as requested? Why do they just opt for the easy solution? And why do they not even bother to talk to the medical staff properly as peer care professionals? Why do they not bother, or think to advice of all a patient’s symptoms? Is it complacency, ignorance, or worse?
Behaviours and communications in and around the NHS is what I spend every day trying to improve. It then smacks me even harder in the face when I hear of such experiences/ situations so close to my home. It makes me question everything about the various aspects of the care system and how they choose to interact with each other. Almost with no regard for the inappropriate impact that it will cause on the other.
Surely there are huge lessons to be learnt just from this one episode? The NHS is on its knees. It is both financially and time strapped – both of which are inextricably linked. Why then are we not looking harder at the causes? Why are we not putting resources into improving what might be seen as small/ quick wins in terms of up-skilling care home staff on communication and basic nursing skills, as well as educating them on how to access timely appropriate additional medical support? Surely there has got to be a significant cost benefit to undertaking such activities?!
I apologise for graphically describing my grandma’s symptoms and the inappropriate care that she was subjected to. But it just galls me to experience almost first hand so many systematic failures that, from my perspective anyway, could so easily be turned around and hopefully, done before the NHS really does collapse under the strain – forever!