Beds (or bust)

The theme at work for this week was beds. Beds in the hospital. The pressure to empty them of well (‘medically-fit’) patients and fill them with unwell (sick) patients.

This happens across the UK, every day of the week. Indeed, it is probably taking place now (7am, Saturday morning) at your local hospital, large or small.

A constant, incessant, remorseless pressure to move patients – aka people, through the health and social care system.

You couldn’t imagine a more difficult ask.

You can keep traffic flowing on the M1 by adjusting the speed, number of lanes and rapidly addressing any blockages or breakdowns. In hospital it is a little different. In hospital we aspire to person-centred care, this means regarding each patient as an individual with one-on-one needs, demands, hopes, aspirations.

You can’t bulk-up the patients into ‘the traffic between junction 30 and 33’ type thing, imagine you had to look at each car, each motorist and adapt the conditions because of them.

Sometimes, to help people cope, the patients are substituted not with people but beds; move this bed here and that one there and create capacity to accommodate another. This is a little like the depersonalisation that happens with the traffic. I am not being critical of those who do this – it is out of necessity – it is cognitive dissonance generated to preserve their humanity. Objectification.

I have written before about bed capacity – the need for the system to have slack to operate – this is somewhere about 80% bed occupancy; the NHS over this winter has been running at 95 per cent – and, when you consider that is an average taking into account day-case and paediatric beds, the true number is something like 110% – that is, more than one person occupying one bed each day.

They call this hot-beds on submarines, where three different people sleep in one bed, in shifts.

The next stage is bunking-up; sleeping head to toe.

Within the maelstrom, this craziness are the patients, their carers, family and friends and the staff.

The staff are run ragged. Torn apart by unremitting pressure and demands; compassion fatigue; you’ve all heard of that, no? That is when you start with a kind, loving, caring, considerate person and take and take and take, you knock the compassionate stuffing out of them, you allow no time to recover, shift after additional 12 hour shift, combined with physical and psychological exhaustion and, you have a person who is just concerned with getting to the end of the day, not necessarily holding the hand of Enid in bed 13. Anyone can be affected. I have been. It isn’t pleasant.

Well, Rod, how do we remedy this pressure? There must be an answer, a solution, a way-out that we haven’t considered?

Again, across the UK groups of people are coming together to establish ways to understand the movement of patients, thinking-up ways in which we might work together collaborate (as Don says) – create a Team (the only way individuals can meaningfully increase productivity).

Folk are left scratching their heads.

For some the answer is straightforward.

Stop medicalising. Keep loneliness separate from medicine, co-locate, concentrate the super-specialists, up-skill the unskilled, patchwork cover, stretch the hand-towel in an attempt to maintain your dignity. Contort, make yourself small.

None of this is working.

You hear of centres of excellence. Places where is it going just fine. Many of those are a sham. An attempt by people to construct a picture of success, ever hoping for progress, a better tomorrow; and, for every Salford or UCL there are multiple locations where people are not even aspiring to talk positive.

The government is screwing the NHS through mismanagement at every level and this is left as the elephant in the room. Think of a grey animal. Yes, think of a struggling system.

It’s not that people haven’t tried to say there is a problem, to challenge the direction; heck, last year, junior doctors were on strike, picketing hospitals. That seems to now have been forgotten. Now, we are caught-up with a deterioration in the system where too few doctors are trying to care for too many patients, the same with nursing and therapy. And, instead of spitting on the health secretary’s polished patent leather shoes, we harangue the managers, who in turn sigh.

I hadn’t intended this to be negative.

It is hard to talk about the NHS, patients and hospital beds without this being a theme.

I guess, my aspiration was to bring the conversation round to the problem; the collective challenge. No one is sitting pretty. This affects us all. You, your children and parents. It will affect them at the least expected moment. We are all in the game. We can all, at the flick of a switch (of metaphorical fate) become a bed, appendix in bay three bed four.

None of us want this, none of us aspire to this, yet, it is the direction of travel.

Any answers?

Elephant-in-the-Room_art

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