Super-stranded

I wrote a few months ago about one of the NHS terms that cause me feelings of anxiety – DToC, in other words, the acronym used to describe people who are deemed by the ‘system’ to be ‘delayed transfers of care’ – this being, people, mostly older, often frail, frequently living with dementia who are trapped in acute hospital care because of deficiencies in health and social care.

Again, I don’t like the acronym or the term, it sort of takes the person out of the equation and turns someone into a problem, a number that can be counted, manipulated and moved-around to accommodate ever-increasing demands.

More recently I was introduced to another term. Admittedly this is not an acronym (I am sure one will be found), super-stranded – this is now an accepted NHS term which means people who are trapped inside the acute hospital system in the UK for more than 21 days (seven to 20 days, you are just ‘stranded’).

Great effort is invested in identifying this group of patients, moving them around, arranging case-conferences and best interest meetings, discussing with commissioning groups and local councils to find a way to repair the blockage (often the need to move to specialised care or rehabilitation).

I don’t really have a problem with the approach of bringing senior decision-makers together to try to fix broken systems; very often however the fix is focused on that individual and does not look at the antecedents – why the situation arose nor on ways to prevent recurrence; people are generally too busy, too consumed with the moment to look beyond. There is always another pressure, target or financial quarter to consider.

For me the issue is more the ease with which people are dehumanised. The shift from Rod, with his quirky sense of humour and pet tortoise to, RK bed 32, independently mobile. Sure, you need to know about my mobility if you are planning to help me, yet, also knowing that I like quiet, nature and bird-song might enable you to create a better environment during my period of… I was going to say, ‘detention,’ but, that would be wrong – my waiting. Let’s call it that – ‘The Waiting’ we can even imagine it is some sort of twisted existential game (ironically such a game has been invented, I think it is called ‘GridlockED’.)

Will we ever reach a point where person-centred care and the acute and emergency health and social care systems are merged into one? Where the knowledge that ‘Rodney’ makes ‘Rod’ feel uncomfortable is a thing. Yes, and I have said this many times before; I want the doctor to know my blood pressure and cholesterol level, I want them to practice the most up to date evidence-based medicine, but I want something more.

Thirty years ago (when I was a lad), folk had to learn, memorise and carry huge numbers of facts and figures in their heads; nowadays that is unnecessary – all you need is Google.

Q: What is the blood vessel that supplies the thalamus?

A: Polar, paramedian, inferolateral and posterior choroidal arteries

Q: Name the branches of the facial nerve?

A: Temporal, zygomatic, buccal, mandibular and cervical

Think of the hours I could have spent learning about people, perhaps honing my emotions (both resilience and understanding others) rather than parrot-fashioned rote.

We nowadays rely more on collective intelligence; our humility has grown. No one knows everything, most people know a little. It is working together, collaborating and co-creating that results in the magic.

So, use these terms if you really must, but remember, always, that there is a person, they have a past a present and with your good grace a future.

Namaste.

jose luis lopez galvan

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