Indulgence – Sunday morning in Waterstone’s Cafe

This is a different blog.

I am sitting in the Waterstones café in Sheffield. Laptop, Flat White and Scone. A drizzly Sunday morning, there aren’t that many people about – students likely still in bed, football supporters not arrived for the match, and, with John Lewis shut, the lure of buying a new rug or cushion gone for many.

I’m OK with this although it is a little dispiriting. All the closed shops.

Fortunately, the pandemic has done wonders for Waterstones.

Over the years I have witnessed the closure of more bookshops that I can remember. Back in the day it seemed I could spend the hours going from Books etc. to Borders to John Smith’s and popping into both the Waterstones’ (in Glasgow City Centre).

john smith

Not much else to say although I must head home later and prepare my talk for tomorrow.

I started an education group for the community staff in Rotherham, so far it has just been a mixed-group of nurses and therapists listening to me going-on about old-people related topics; I’ve done delirium, frailty and lying and standing blood pressure. Nothing you couldn’t have gleaned by reading my blogs, this format is me talking for 20 minutes followed by a chat.

Readers, you are welcome to join – link is here as well as at the end. It is 3 to 4 tomorrow (October 18, 2021).

The next session is discussion a topic close to my heart – avoidance of unnecessary hospital admission.

This is the systems I employ to keep older people from the grinder that is a hospital attendance or admission.

I read this morning about patients waiting 11 (eleven) hours outside of A&E departments.

That’s 11 hours in the back of an ambulance before they are even assessed by a doctor or nurse.

The significance of this does not appear to have reached the general public.

11 hours is a long time.

I think of the patients – a typical situation might be an 85-year-old woman who has fallen at home. They fall at mid-day, the carer finds them five hours later and calls an ambulance, the ambulance, because the patient is ‘breathing’ could take up to eight hours to arrive at their home, then 10 hours (or so waiting to get into the hospital) (actually journey to the hospital with or without red lights is a trivial part of the experience).

Older person then is assessed by doctors and nurses, blood tests and x-rays. Maybe six hours later they become a ‘DTA’ = this is NHS management-speak for decision to admit. They then might wait 10 hours to be moved from A&E to a hospital bed.

This is the situation in the NHS today.

It’s falling to pieces, distracted by the bluster of the health secretary calling for more face-to-face appointments with GPs. It’s missing the point. It’s as my former colleague used to quip, ‘moving the deckchairs on the Titanic’

Mix-in to that 30-hour gap-period a level of confusion and disorientation – perhaps Alzheimer’s, diabetes and incontinence and noise and dehydration and the picture is not great.

Back to my talk, which I promise will not have too many Book of Revelation references, this being, for although the system is like a battered rag, the staff working inside it, possessed of an eternal Dunkirk/NHS spirit, keep going, keep providing care to the best of their abilities and within those hours and minutes slowly passing there will likely be paramedics, support workers, nurses and therapists providing distraction, comfort and good cheer.

And the point is that often, when people fall-over (for example) a trip to hospital is the very last thing they need.

Yesterday I was called-out on Twitter and shortly identified by a couple of former colleagues.

Screenshot 2021-10-17 at 11.49.33

It made me feel kind of special.

Screenshot 2021-10-17 at 11.50.51

The essence of my work is doing all I can to ensure my patients are as well – mentally, physically, emotionally as possible and putting-in place systems to support them in the community.

An unnecessary trip to hospital is a very wasteful use of hospital resources. (?environmental impact too).

From yesterday’s conversation, someone mentioned their mum who had fallen and was now in hospital waiting to get home supported by carers.

Screenshot 2021-10-17 at 11.52.10

Unfortunately, there aren’t many carers available. People are waiting, waiting to go home because of another fall-out of Brexit.

I remember my brother saying to me before the referendum, ‘Britain is full’ – as if we had reached peak-population. My brother is a very clever guy, he was also very wrong.

It is a perfect mess or storm.

A bonanza of unforeseen consequences.

Anyway, there is hope. We can do more to keep people well and out of hospital.

Here is a graph representing some of the work I have done in a local care home to reduce 999 calls.

999 2

Imagine that was replicated across the UK.

(This is some of what I will discuss tomorrow).

My Flat White has gone cold.

It’s hard for me to concentrate in a café where around me people are talking; I listen-in to fragments of conversation. Tuning in and out to the accents, the Sunday morning interactions of couples and friends.

I need to be in my quite space at home.

Or perhaps get some ear-plus.

And a thermos.

&

Before I go.

Delighted at the German couple behind me.

Can’t understand a word, just picking-up their feminine staccato.

Teams Link – 18/10/21 3pm to 4pm CLICK HERE

ambulance

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