Loopy knife edged NHS Treatment Model ?

[Clunkclick]

I had cause earlier this week to experience what I presume is the new schema for treatment of some Orthopaedic injuries in my health district after falling at home and breaking a bone in one of my fingers.

 

I fell over in the house late Sunday evening (23:30)  whilst putting out the bins for collection and did so very awkwardly, colliding with bits of domestic kit before coming to rest. When I got up, its was evident that something was wrong with the ring finger of my right hand - its was splayed a good 35 degrees to the right of normal position and was painful to touch. It was clearly broken and needed attention - couldn't go to bed with it in that state.

 

So, I drove myself in to the local Accident and Emergency (2.5 miles away) and within 2 hours (2 O'clock in the morning) had been recepted, x-rayed and consulted by an A & E Nurse  specialist who told me that I had a spiral fracture of the proximal phalanx (The bit of bone between the knuckle joint and the mid-finger joint) and who further told me, after a phone consultation with a doctor, that I might need surgery and couldn't be treated at this hospital.

 

I found the last bit of this advice a bit strange as the hospital (Northwick Park) I was attending was a District General Hospital, which, when it was built in 1970 , was designed to deal with 85-90% of all the treatment needs of people within a five mile radius. But I am aware that the health care set-up in North-West London is in the process of being re-modelled and chunked-up into larger catchment areas, for whatever reason, and being in a bit of pain, I really wasn't in a position to debate this advice. However, I didn't realise how far I would have to go to get treatment.

 

So, I was sent home, without being checked for stroke,  with one of those aluminium strip peg-type splints over the end of the finger, verbal advice to use paracetemol as needed drawn from my own resources and a referral letter to a hospital  plastic surgery clinic to be held at 14:00 the following day at a hospital in inner London 14 miles away !!!! - The electronic records, including X-Ray, were transferred electronically to Royal Free.

 

On investigation of possible travel arrangements I found that the destination hospital (Royal Free) has even less patient car parking facilties than Northwick Park and decided it wouldn't be a good idea to drive through heavy inner London traffic with a splinted finger.

 

So, on Monday, I made my way by tube and bus to the Royal Free - a journey that  took only one hour forty minutes, due, uncharacteristically, to all the  transport connections working flawlessly, arriving at 12:20 for the 14:00 - appointment. Luckily for me, the crowds on the tube were less than usual and I did the whole journey for free on my 60+ Oyster card.

 

 Eventually was seen at 16:00 (Missed lunch) and was advised by this gentleman that in his opinion surgery was in appropriate and that the injury could be re-splinted and that I would have to attend outpatients Hand Therapy for periodic exercising. I'm also told that I will be left with a residual twist/tilt on my finger - little did I appreciate then, how extensive that would be ("You are not going to play the piano, are you ?- I should have said "Yes")

 
So that's  a 14 mile, 2 hour journey, at hazard in London, by an unescorted OAP (I live on my jack and recovering Lymphatic cancer, who was still slightly in shock, who  hasn't ever visited this part of London before and who could have had the fall on Sunday due to a minor TIA (stroke) to be told that the treatment will be the same as could have been administered at my local hospital - this really  takes the biscuit - the  take it or leave NHS designed for the convenience of the providers.

Where did whoever designed this "System" get his ideas from ? Chairman Mao's accounts of the "Long March" or those of the Allied POWS at the end of WW2 ?

 

In the end, I get released from clinic 16:30, with a plaster cast on my hand/fore part of forearm and told to report to the on-site Hand Therapy unit for an appointment. They were clearly under pressure. They  then went on to tell me that I could get these Outpatients hand exercise sessions at a hospital nearer to me, Mount Vernon (7 miles away) So, I opted for that. Told to wait home Tuesday for a phone call from Mount Vernon Hand Therapy Unit.  Eventually, got out the Royal Free at 17:00 and battled my way through rush-hour tube and bus crowd, arriving home after an hour and twenty minutes.

 

Following day (Tuesday) j- rest day ? No. Incoming, Phone call from Mount Vernon, "Please attend clinic 10:30 Wednesday".

 

**** a Fitbit.

 

Attended Mount Vernon as instructed - that's another 40 minutes each way, with all the connections working uncharacteristically well (Bus-train-Bus). Into Clinic bang on time, into a room where other patients were getting hand treatment on a series of what appeared to be  2.5 feet square office tables pressed into service, no screening or anything. Asked, within earshot of other patients, to provide therapist with brief details of my current medical conditions - patient confidentiality ? . . . out the window ! The cast was removed and replaced by one of those  personally molded thermoplastic hand support, lashed-up with a coloured tape which I was invited to chose, from a selection (Talk about taking the Michael) and then given an appointment for a weeks time.

 

With the cast off, I can now see that the finger, although no longer splayed out at 35 degrees is now tilted over at 45 degrees to the plain of my hand and, on researching this matter, I find it can be treated simply by a minor surgical procedure, which isn't even an "Open" procedure using "K-wires", sometimes being done on an outpatient basis under a local anaesthetic.

 

Honestly, what a complete lash-up.

 

All due to under funding.

 

When I broke the Schaphoid bone in my wrist in 1979 the full treatment was done at Northwick Park - the value of the UK economy was then, half the size it is today.

 

Lewis Carroll couldn't have written this.

 

Definitely, not a one stop shop. Coming to a place near you soon, if its not there already

 

And remember that these arrangements are only a stepping stone to full contractorisation.

 

Whilst the hospitals involved at each point are still part of the NHS, at the moment, I suspect that  many of the staff employed as therapists etc are employed like Uber drivers.

 

So, there you go, granny's xmas presents for the next 2 years sorted - year one, jet pack (As used by the Swiss flyer) + Tom-Tom, year two a subscription to the All England Law Reports and a copy of Salmond on Torts.

 

 

Nick

 

 

 

 

 

 

 

Edited 11 May, 2017 by Clunkclick

[YS53]

Not sure it was completely caused by underfunding CC,the NHS is a bit of a disaster area for many reasons and needs sorting out in many ways.

If you are unlucky the NHS has always been chaotic,by that I mean it is a complete lottery as to how you are handled/treated - sometimes extremely well and sometimes it is bizarre.

Many years ago I started to feel very tired and my GP wanted to treat me for depression (take the pills and go away LOL) - however I did not believe the 'diagnosis' for a minute and got a private blood test - this showed that my RBC (red blood count) was right on the lower limit.I took the result to my GP and he said ''its ok - its within limits'' so it was totally ignored for years.

I ended up having to travel up to London for years  to see specialists because I absolutely refused to return to the consultant mentioned below.

Some years later I developed some other problems which 'might' have been exacerbated by low RBC but when I 'presented' with these problems I became a 'Health Anxiety Disorder' patient,that was due to me being very unlucky in seeing a particular specialist consultant (consultant x).

Some years later I got a phone call from a friend who's daughter had some severe and  specific (area) head/ear pain and she asked me the name of  consultant x,he had seen her daughter and had said that her ear/head pain was no problem - I confirmed it was the same guy and added not to trust him and to  'get a second opinion at Soufhampton' 

This she did and her daughter was operated on the very next day.By that time I was an 'experienced' patient and knew a bit about how things happened with the NHS

[Clunkclick]

This isn't just the action of random consultants.

 

This system has been devised, planned (Albeit ok on the back of a fag packet) and various parties agreement has to be obtained across previously geographically and organisationally separate hospital entities before it can all kick off. And it has probably been set-up in this way to favour contractorisation - making simple one process added value that can be easily tendered for contract.

 

Its definitely not for the comvenience of patients, as I found out.

 

Having worked in the NHS in the 1980s, I know that what is now essentially one health authority serving the whole population of NW London (2 million in 100 square miles) was previously a collection 6 District Health Authorities each serving on average 300,00 in a 25 square mile area. And most of the hospitals that are currently serving in the new bigger unified larger authority were originally designed and built to operate against the smaller model or even earlier versions.

 

Given that, unavoidably you have a process, which for sake of argument is called process one, or "Detect, align and re-set broken bones" , do you, in the face of reduced resources, add another process on the end called "Hand Therapy" - and then geographically disperse the delivery of that output. Of course not,  not unless the purpose of the add-on process to hide the effects of not doing process one properly. That's where the expertise at Richmond House appears to lie - organisational bull****.

 

Does the Foreign office organise a mercy mission to country X and then require those supposedly in receipt of the mercfy to visit Whitehall plus every regional government office in the Uk for the handouts ? Nah !

 

And . . if you want to go  Stasi and code me an "Anxious patient", . . . can I introduce you to my lawyer who may well dispute that assertion, in the context of these facts.

 

Nick

Edited 11 May, 2017 by Clunkclick

[Ttaskmaster]

I worked at Northwick Park NWLH NHS back when this sort of thing started.

Not so much underfunding as mis-funding. Pouring money into the NHS has always been a big, easy win for politicians, but people forget that it has to be applied correctly. We watched as ever more layers of expensive management consultants were bought in to run things, while medical Consultants were ousted, Domestics were replaced by the cheapest labour possible, and ward nurses were cut from 3 per ward at all times to just one covering two wards...

 

I once witnessed a patient collapse in the main corridor and some nearby nurses attend him. One called to the nearest ward nurse, for some quantity of somethingorotherazine and a medicalthingdoer. The ward nurse declined, stating that if they wanted it they must use it from their own ward budget.

I left the NHS shortly after seeing that...

[P6bJOHN]

I'm glad I live in the North West, we seem, so far, to get excellent hospital treatment. I've seen two different consultants and had two operations for separate complaints in the last year. Both procedures have been done professionally and swiftly.

[CWARD]

2 hours ago, Ttaskmaster said:

I worked at Northwick Park NWLH NHS back when this sort of thing started.

Not so much underfunding as mis-funding. Pouring money into the NHS has always been a big, easy win for politicians, but people forget that it has to be applied correctly. We watched as ever more layers of expensive management consultants were bought in to run things, while medical Consultants were ousted, Domestics were replaced by the cheapest labour possible, and ward nurses were cut from 3 per ward at all times to just one covering two wards...

 

I once witnessed a patient collapse in the main corridor and some nearby nurses attend him. One called to the nearest ward nurse, for some quantity of somethingorotherazine and a medicalthingdoer. The ward nurse declined, stating that if they wanted it they must use it from their own ward budget.

I left the NHS shortly after seeing that...

 

My brother works as a lowly porter for the NHS. On one of his previous roles as a porter was putting the rubbish in the skips. They were filling a huge skip every day with mainly with unused stock such latex gloves, syringes and other such small items that had either gone out date or more often not that popular with the staff. We are not talking the odd box of gloves but the large box of boxes of gloves. Some of the other stuff that went in included a huge Karcher diesel powered heated hot jet wash, nothing wrong with it. Various Stainless steel tables and cupboards all serviceable. It seems to be very easy to spend money when it's not yours.

Bizarrely the staff weren't allowed to take any of it home either or they would be dismissed for theft, nor could they buy it. 

This was at the same hospital that had my Grandma passed from one waiting list to the next so that she was never on one for longer than target time. She never managed to get the operation before she died. 

 

[Clunkclick]

Meanwhile, the important things, like getting Theresa, Dave and George and their friends and associates to Birmingham 15 minutes ahead of conventional rail goes ahead unrestricted - witness the cut through back roads of Ruslip which are currently being trashed by a stream of 10 tonne dumper trucks.

 

N

[CWARD]

HS2 is a waste of money but throwing more money at NHS isn't the answer. You could double their budget and in a few years they would be asking for more. It's the same as pouring more water into a leaky bucket without fixing the holes first. 

[gadgetman]

Is there a bulleted to the point version of post 1?

 

Kind of fell asleep after paragraph 6

[Breezy_Pete]

• I broke my finger
• Waaaaah!
• It's NOT FAIR!

 

 

[VWD]

What a lot of folks do not realise is the terminology used to describe those needing treatment ,i'e. PATIENT, which means nowadays that you have to be very patient to get treatment.

As for checking for stroke liability- familial tale. Late dad fell at home ,due to eye problems. He managed to attract attention from a neighbour and was taken to hospital to be stitched up. He was discharged to end up having a stroke at home. Excuse from hospital was that no one realised he was 86. Even though the hospital had his records ( and eye test results) for a lot of of years past.

Throwing money at the NHS is not a solution. Waste of time with the organ grinders being paid obscene sums ,whilst the Monkeys get that many peanuts, that they decide to up sticks and move abroad .

[Clunkclick]

Just now, Wino said:

• I broke my finger
• Waaaaah!
• It's NOT FAIR!

 

 

Usually most of you comments you make are insightful, why are you attempting to lower the standard of debate  on this occasion ?

 

Be assured this post was not intended to be a "Poor me" post, but a lament, yet again about the declining standards of some public services and the substitution of poor ersatz commercial or commercial precursor replacement services.

 

If you haven't experienced that recently you must be one amongst a privileged few.

 

Nick

Edited 11 May, 2017 by Clunkclick

[Clunkclick]

Just now, gadgetman said:

Is there a bulleted to the point version of post 1?

 

Kind of fell asleep after paragraph 6

No endurance these young people . . . hows that for mildly inflammatory - no doubt beaky moderator will be round shortly to enforce the will of comrade Kim and to close down an further comment on failing government systems or ones that were designed to fail.So predictable its worn a hole in the record.

 

Nick

Edited 11 May, 2017 by Clunkclick

[Titanium_Man]

I've always had amazing service when I've needed the NHS. Two years ago it took them 4 days from deciding I needed an operation to actually getting it. But then I actually needed the emergency treatment. 

 

Is anyone else thinking that it sounds  like someone went to A&E with a broken finger and the staff decided to waste their time like theirs had been wasted and sent them on a wild goose chase?, or is it just me? 

Edited 11 May, 2017 by jars

[Clunkclick]

I don't think so mate for the following reasons:-

 

The X-ray I saw showed a wide, spiral fracture going the full length of the bone barring about 5 mms at the knuckle end.

The surgeon I saw  later at the Royal Free said if it had split all the way, he'd have intervened surgically. And the click it made when he reset (Sans anaesthetic) the position prior to plastering could probably have been heard by National Theatre Box Office staff on the South Bank.

 

What I was saying was why wasn't there the expertise available at that time, even over a digital link, to have made the surgey/

no surgery decision there and then thus avoiding my nugatory journey.

 

I suppose with today's eye for income generation, if my local council is  now trying to sell  me stuff every week (They have "Deals"by e-mail) then what's to stop the hospitals turning into a Tourist draw . . . "Roll-up, roll-up, see NW London's A & Es and clinics son et lumiere.

 

However that's not to say that there are not other issues there including ethnic and staff morale issues.

 

 The first comment to me from the South-East Asian -Nurse specialist was that "I've been on shift" for the last 12 hours. Well, sorry mate, I do msympathsize, but what's new, I've done 12 hour shifts (Not of my choosing) in the NHS, 30 years ago when doing studies in anything from hospital kitchens, laundry to night standby posts - that's the name of the game, man-up. We certainly didn't take it out patients. 

 

Just to give you a  further flavour, of the other divertissement, whilst I was waiting there to be treated a black bloke came into A & E with an outside jacket on which was emblazoned in six inch white lettering on nthe back "If you think this coat is black I was looking for one two shades darker". Nothing Extra ordinary round here.

 

The pains in the fanny will be coming on now.

 

Nick

Edited 11 May, 2017 by Clunkclick

[KenONeill]

10 hours ago, Clunkclick said:

 The first comment to me from the South-East Asian -Nurse specialist was that "I've been on shift" for the last 12 hours. Well, sorry mate, I do msympathsize, but what's new, I've done 12 hour shifts (Not of my choosing) in the NHS, 30 years ago when doing studies in anything from hospital kitchens, laundry to night standby posts - that's the name of the game, man-up. We certainly didn't take it out patients. 

 

Nick

And his point is? When I started this job we used to do occasional 16 hour shifts, and then start another 8 hour shift after 8 hours break.

[philbes]

At 3am on a below zero degrees icy morning my wife drove me to the nearest A&E in Stroud (3 miles) with a nose bleed (first every in my 68 years) that just would not stop.  Was told I couldn't be treated there and would have to travel to Gloucester A&E - another 11 miles on icy roads.  So what could the Stroud A&E treat?  At least parking in Gloucester hospital was easy at 3.30am!

[Clunkclick]

Just now, KenONeill said:

And his point is? When I started this job we used to do occasional 16 hour shifts, and then start another 8 hour shift after 8 hours break.

That's the second time, I've been within earshot, when this has been said to me in this hospital.

 

Many of the staff are from abroad and, I think, suffer a bit of culture shock when they come across here and do these sort of jobs.

 

I think, when viewing UK from afar and reading the recruiters literature (No doubt, per the Army - All adventure holidays, water-skiing, table tennis and rock concerts) they see developed countries as easy street and then get a rude awakening when they pitch-up. But that's not to say, that staff conditions in the NHS haven't tightened considerably in the last few years. as they have for everybody (Barring the top 2%) in the UK in response to the changing World economic conditions.

 

When I was working in the NHS most of the nursing staff I came across  were doing 8 hour shifts and only a few voluntarily did 12 hours with a rotating pattern. Whereas the chaps I spoke to when last an inpatient (2 years ago) said they were all doing 12 hour shifts on a earlies/lates rotating pattern - no choice, take it or leave it and were indicating it was a bit tough.

 

But, its pretty unprofessional, as the opening "Meet and Greet" to the patient to say this.

 

And the A & E wasn't busy (I've studied a few in a professional capacity), just a slight trickle of patients (I guessa about 6- 10 patients an hour).

 

Nick

 

 

Edited 12 May, 2017 by Clunkclick

[Clunkclick]

Just now, KenONeill said:

And his point is? When I started this job we used to do occasional 16 hour shifts, and then start another 8 hour shift after 8 hours break.

I've spoken to WS professionals who've had no choice because they had no support staff and had to do lengthy studies of departments on their own. I remember. in the late 1980s, one bloke telling me, at job interview, he done a continuous 36 hour study of Computer Ops at BACS, on his feet, and after, had virtually crawled out of the Ops Room on his hands and knees.

 

Horses for Courses.

 

N

[Breezy_Pete]

14 hours ago, Clunkclick said:

Usually most of you comments you make are insightful, why are you attempting to lower the standard of debate  on this occasion ?

 

Be assured this post was not intended to be a "Poor me" post, but a lament, yet again about the declining standards of some public services and the substitution of poor ersatz commercial or commercial precursor replacement services.

 

If you haven't experienced that recently you must be one amongst a privileged few.

 

Nick

 

Just thought it made an amusing antidote to excess verbosity about not much.

I'm extremely happy with my treatment at the NHS lately, just this morning I was offered a GP appointment 20 minutes after calling, with no questions about how urgent or otherwise.

A month ago I had a weird falling-down-vomiting thing suddenly at work. My partner called for an emergency appointment and we were offered one 15 mins later. Vestibular neuritis diagnosed within seconds of arrival.

Maybe I'm lucky with my local GP surgery.

[KenONeill]

2 hours ago, philbes said:

At 3am on a below zero degrees icy morning my wife drove me to the nearest A&E in Stroud (3 miles) with a nose bleed (first every in my 68 years) that just would not stop.  Was told I couldn't be treated there and would have to travel to Gloucester A&E - another 11 miles on icy roads.  So what could the Stroud A&E treat?  At least parking in Gloucester hospital was easy at 3.30am!

Different trust (in fact for NHS purposes maybe different country) but my Mum had a similar experience, because the A&E consultant wanted to pass treatment on to an Ear, Nose and Throat specialist.

[KenONeill]

57 minutes ago, Clunkclick said:

I've spoken to WS professionals who've had no choice because they had no support staff and had to do lengthy studies of departments on their own. I remember. in the late 1980s, one bloke telling me, at job interview, he done a continuous 36 hour study of Computer Ops at BACS, on his feet, and after, had virtually crawled out of the Ops Room on his hands and knees.

 

Horses for Courses.

 

N

TBF the 16 hour day followed by another 8 was unusual (maybe once a quarter) but the point stands that some people have done significantly longer shifts with less rest than 12 on 12 off, day off after 4 shifts rotating days and nights.

[Ootohere]

NHS England has a major headache right now with a rather leaky IT System.

Delays of appointments and treatments can be expected.

[gadgetman]

5 hours ago, Clunkclick said:

Many of the staff are from abroad and, I think, suffer a bit of culture shock when they come across here and do these sort of jobs.

 

I think, when viewing UK from afar and reading the recruiters literature (No doubt, per the Army - All adventure holidays, water-skiing, table tennis and rock concerts) they see developed countries as easy street and then get a rude awakening when they pitch-up. But that's not to say, that staff conditions in the NHS haven't tightened considerably in the last few years. as they have for everybody (Barring the top 2%) in the UK in response to the changing World economic conditions.

Just because a nurse or doctor isn't from the UK doesn't mean they are bad at their job. 

 

In fact most of the best service I've seen has been from non UK staff as they generally work harder. Especially the Philippino and eastern EU staff. 

 

Don't judge your own trusts failings as some kind of UK wide issue. 

[Clunkclick]

Totally agree GM.

The bloke I saw at Royal Free was cracking -literally.

 

As one of the previous posters said NPH had started to develop problems long ago.

 

Many of the areas you go into there now, you find individuals with attitude and its like treading on eggshells the whole time.

 

Another example was when I went to my last 3 monthly Lymphoma follow-up clinical. After I'd seen my doc (An Asian) who was brilliant, I came out to the reception desk to book my next appointment (Letter issued there and then) only to be greeted by the clinic nurse moaning on about the overload of follow-up Haematology appointments. This was in front of a seated mass of patients waiting to see their Haematology doc.

 

Most people would realise that is something that you shouldn't do except in extremis. Does one charitably assume that these professionals are giving vent to their feelings in this way because they are being confronted by what they perceive to be insurmountable problems caused by a system in crisis, or are they just having a bad day ? I think its the former because I received letters in respect of each of the 3 previous Lymphoma clinic appointments revising the dates of all these appointments to the right.

 

The impression I get is that a system overloaded.

 

Under current protocols, Blood cancer patients like me are called back at increasingly elongated intervals over 5 years to check whether they are still in remission. So, in any year the clinic has to see not only all the new cases arising in that year, but, additionally,  all the patients (In good or bad health) from the previous 5 year period. So in a period when we are getting a demographic bulge in the older population (Where there are the largest number of cancers) the numbers to be seen are rising like billy oh. Management, NICE, NHS England, need to get a grip and reduce the call-back schedule frequency (With reference to patients in remission) and/or work out some schema for SOME call-back patients to be seen by GPs - if that was technically feasible

 

My feeling is that this bad attitude manifests itself more than it used to at this hospital (Having lived in the area for the last 60 years) and across the NHS. Equally, I understand patients very often don't see the prior events that cause staff to react like this - the stimulus may be anything from difficult home life, to awkward patients to bad management and bad policy.

 

Nick

 

 

Edited 12 May, 2017 by Clunkclick