So as a patient what's my view on this, what has my experience been? Actually it is as a family member of a patient I've realised my main experience lies, when my dad was in hospital earlier this year. He had already been in hospital a couple of times in recent years, he has Parkinsonism & Dementia but was living at home on his own with a care package in place which was working well. That is until Boxing Day 2014 when he had a double-stroke. He then spent 3 months in hospital recovering and he did indeed reach the stage where he was well enough to leave hospital but arrangements were not in place so that he could. The media would of course call this bed blocking, and I'd begin to turn the air blue!
This leads on to the other thing that I've heard a lot of recently, about certain things not being available at the weekends. One thing my dad desperately needed was physiotherapy, he did get some whilst on the stroke rehabilitation ward at the QA Hospital in Portsmouth. But he only got sessions on weekdays, if he had any at the weekend they were very few and far between. He could have also done with community physio service once discharged, but the team told me this would be very unlikely because they were so stretched and only went out to the highest need patients. We did see the same doctor frequently to catch up on exactly how my dad was progressing and we did see that doctor at the weekend sometimes (there was always a doctor around at the weekend). Seeing the same nursing staff frequently didn't seem to be an issue, they seemed to always be there!
When it came to discharge planning, it became clear that my dad could not go back home and would have to be discharged to a care home. The family meeting we went to (very well organised with nursing staff, physio's and social services) said in no uncertain terms that dad could not be discharged back home. So social services gave us a big pack of information on homes available in our area and which ones had vacancies. But the process of us going out to visit these homes, places being available and then those homes coming into hospital to assess dad to check they could provide the care he needed took time and planning. Unfortunately the advice given by the discharge team that dad needed a "care home" proved incorrect, because dads mobility was so variable on his good days he was a "care home" but on his bad days he was a "nursing home". So having gone through the process of finding a care home, we had to start again and find a nursing home. This all took time and although the team we dealt with on the ward did make it clear he was well enough to go home, they never once used the term "bed blocking", in fact quite the opposite - they said they would not expect dad to leave hospital until arrangements were in place that we were all happy with. The pressure they were under was evident, they didn't have to say the words, but I knew they wanted dads bed....it was a kind of unspoken understanding.
The other service that was not 7 days was the social services element, a couple of times we visited a home at a weekend, and we could have done with speaking to social services, but had to wait until Monday. Of all the services we dealt with during my dads time in hospital, this surely should be a 7 day service, I know the person we dealt with visited her patients regularly, spoke to care homes, reviewed cases etc. The whole process would surely benefit from more cover.
What this means of course is that for me as a family member, with no experience of how everything worked, the system is very difficult to navigate and very time consuming. The thing to bear in mind is that the NHS is an inherently compassionate system. If it wasn't then when they needed the bed they would have discharged dad to my care whether I could cope or not....but I don't believe they would ever do that. So with that compassion in the forefront of how the NHS works, it means if they wait until everything is in place before they discharge then there will be periods when that patient is in hospital longer than medically necessary. But what system would you rather have? Of course it would help to have more physio's (both at the weekends and for post hospital care), to have social services available 7 days a week to have more care homes available with more spaces. But where does all this extra money come from (well, not the care home bit because a lot of them are privately run), I'm only looking at a tiny fraction of the spectrum of a wider 7 day service the government are talking about.
The NHS annual budget is what, £115billion? So even if you said a 7 day service would cost another 15% on top, that is £17billion every year. I've no idea, that figure is completely made up, but even small percentages of such a massive figure is soon going to add up. So now it makes more sense why experts get worried by how much these plans could cost. That is even assuming you can find all these additional speciality people you'd need to recruit and train (this element frequently questioned by those in the NHS).
- So, would my dad have benefited from certain things being a full 7 days, yes.
- Under the circumstances, despite him being in hospital longer than he needed to be, was he treated with compassion, yes.
- If everything was in place for a full 7 days, would dad have spent less time in hospital, probably.
- To literally just extend the things it does now over 5 days to a full 7 days, can the NHS afford that, no I don't see how. (not without increasing National Insurance contributions)
Of course efficiencies could be made, things could be stopped to help pay for it.....but how you work out what that is going to be? We need a Royal Commission to work that out, we really do.
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