Cognitive dissonance, the NHS, Virtual Wards, and the rest of the shit that is going down

I attended an online NHS England conference on Thursday afternoon.

The conference focused on the development of Virtual Wards.

Virtual Wards are a newish concept in the UK, providing hospital-level care for people in their own homes.

There is a lot to this, and I don’t want to get too much into the nitty-gritty as that will take me on a tangent away from my topic – my cognitive dissonance.

So, Virtual Wards are scheduled to start-up across the UK this year. Some wards have been running for years.

Essentially, if you are old and frail or have a chronic chest condition and experience an exacerbation (a worsening) you should have the option (in certain circumstances – there is always small print), to receive your care at home rather than hospital.

I’ll focus on frailty as that is my area.

If, for example, you are 90 and you fall at home and perhaps have a chest infection, you will have two options; A&E = 5 hours waiting for ambulance, 2 hours outside A&E waiting to get into the department, 8 hours waiting to be seen by a doctor, 12 hours waiting to move to a hospital bed, 3 to 21 days receiving treatment with associated hazards – hospital acquired infection, deconditioning, falls, institutionalisation and perhaps never getting home again as you are too worn-out from the experience to live alone again or:

You fall, a nurse arrives within 2 hours at your home, you are assessed, I review you either virtually or in person in your home, therapists, social workers, pharmacists, and others come to you; treatment is initiated, and you are back on your feet in a few days.

Yes, the choice is obvious.

The NHS has put lots of money into kick-starting these wards. (For this year).

The idea is that people will receive care in their homes, with better outcomes and associated reductions in pressure on the ambulances, hospitals, and social care.

All of this is good. Some of it is great. There’s a risk people will lose the opportunity of receiving specialist hospital care – things might get missed, although if you are 90, you possibly want things missed (you don’t want that unnecessary MRI scan or colonoscopy).

At the conference there was much positivity.

Indeed, lots of this is moving towards my dream-state of providing high-quality care for older people that doesn’t require the precarious process of hospitalisation. (If you want to know what is bad about hospitals, search ‘hospitalisation’ on my blog site or Google, ‘almondemotion’ and ‘hospitalisation’. You will soon see.

So, many people were upbeat. There was an enthusiasm, an exuberance. Excited tweets were liked and shared, the whole social media shebang.

And, yes, it is genuine, there are good things.

And this is my point.

This is the dissonance.

Cognitive dissonance is the tension associated with holding two conflicting concepts or ideas in your mind.

You see, for all this modicum of good, there is so much bad.

Setting aside the waits I described above (which one of my patients experienced recently), there is the medicalisation or specialisation within healthcare, there is the sleepwalking towards a computerised system, where, for example, the pressure on GPs to ‘sort’ patients is so great, they are forced into shortcuts, which translates in many instances as, my 90 year old woman not getting to see a doctor in her home.

I heard last week that many older people have given up calling their doctor as they can’t cope with the telephone conversations, the lack of a person, struggles to hear, catch or recall what is being said, the sense that they are not important enough to get to see their doctor or nurse in person.

The processes that started during Covid have continued. Most patients haven’t seen a doctor in two years.

The hospital clinics for older people, those living with frailty and cognitive impairment are still run on the phone.

Doctor A calls patient B.

‘Hello, it is doctor A, how is your pain/breathing/stomach/bowel/etc?’

‘Oh, everything is fine.’

‘I will see* you in six months’            

*Speak to you again in six months and have an equally superficial/transactional interaction.

I even recently read in a patient’s notes the following:

‘Called patient for telephone appointment. There was no answer. Patient has not attended the appointment. See again in six months.’

This attitude will ruin us all.

And outside the NHS, beyond the ambulances that take 20 minutes to reach someone experiencing a cardiac arrest (too late) or the 18 month waits for surgical procedures – hip and knee replacements, the day of the operation cancellations (‘Sorry, we don’t have any beds’), or the associated issues with social care, where people do not want to work in the field as the pay and working conditions are so poor, beyond this, is the knowledge that today, somewhere in the UK an old person will die as they can’t or won’t turn on the heating for fear of not being able to pay the bill.

Those in government function in a cesspit of lies, deceit, manipulation, and self-interest.

The planet is failing. Forget 1- or 3-degrees global temperature rises; we are facing a run-away state of global collapse where the only people who will be OK are the billionaires building secure complexes in New Zealand for the end of times.

The polluted seas and beaches, the inability of younger people to rent or buy houses – living with their parents into their 30’s as the property market is a mess of profiteering.

The starving Polar Bears.

The disappearing insects.

The desertification.

Loss of soil.

Covid.

Hyperinflation.

Inequality.

Putin.

Yes, the list is long.

It is easy to become carried-away with negativity.

And this is my point.

How do I balance some of the good things with all the bad?

How do I carry these conflicting thoughts in my mind?

The term Schizophrenia literally means ‘split-mind’ – is that the only way to remain sane?

(See, ‘Mad to be Normal’ by RD Laing).

Perhaps sequestering my emotions, to allow myself some capacity to appreciate what I have.

Any thoughts?

Positive mental attitude?

Self-help books or groups?

Cocaine/Cannabis/Alcohol/Amazon/Netflix?

My current remedy is to run and swim (first winter swim of the season for me today, picture), blog, read fiction and focus on my patients, doing my best for them at the moment of my encounter without considering the x10,000 others who are not getting the care, treatment or support they require and deserve.

Funnel your vision.

Narrow the focus, one tweet at a time.

What a stramash.