Crisis, alert, no beds!

Many are unaware of the pain and sometimes indignity facing the patients (as Old Adam waits on that stretcher, in hospital gown, bottom or testicle peeking-out, he needs the toilet, ‘Just go in your pad,’ he is told.)

Thirty years ago and counting. 90’s reminiscence.

He has a glass that is so half-full that the Kool-Aid is spilling over the rim.

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

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.’

The cost of loneliness (Roubles, dollars or robots?)

One patient recently attempted to resuscitate her (toy) baby when the batteries ran-out.

Three days, 15 points and just starting to recover from the British Geriatric Society Autumn Conference

For the most, this was people showing-off their successes, how many older people they had saved from peril (mostly keeping them out of hospital), how many standard deviations from the mean their intervention had generated and so on.

Broken hearts, or why telephone consultations are less than 35% effective (homage to Heathcote)

Although doctors are being battered over the head for not enough F2F appointments, in reality, telephone reviews are much harder than seeing a person in the surgery.

Take away, facial expression, eye contact and body-language and it is far more difficult to know or understand what is going-on.

It’s worse than it’s ever been. Just kidding… Not.

‘When will I receive my Covid booster?’ Asks patient Annie, 98, unable to leave her house for the past three years.

‘We are working-our way round,’ Says the doctor.

Shady Towers, Social Care, Nora and Whitey on the Moon.

The PM announced a rise in NI tax this week. I understand this is to offset some of the damage they have done to the NHS over the past decade. Fantastic. (And yes, Whitey is still on the moon).

To stop or not? (Jerzy Kosinski, Oliver Sacks & other ideas)

If you watch the Robin Williams / Oliver Sacks movie/book Awakenings you will see what dopamine can and cannot do to the brain.

You get what you pay for. (this is not a happy one)

No, not the climate, not the uncollected bins, the zero hours, no, not the Shitty White Men travelling on purpose-built spaceships that fly over the filth and poverty of a world falling apart, all of it together.

daydream believer, this can’t be a second-wave; i haven’t had my summer holiday yet.

And, yes, those bureaucrats, the apparatchiks who felt things were returning to normal will be once again on the back-foot and find themselves redundant, scraping the earth with their over-long arms, their Neanderthal gait giving it all away.

Lockdown, solitary confinement and loneliness

Imagine the harm done to those people previously ‘living well’ with dementia who for six weeks have had a dramatic reduction in visitors and day-centre attendances; even the bitter-sweet routine trips to GP surgeries or hospitals have been done away with.

Infection then and now, the Great Influenza and Covid… lessons from the past, reflections on the present.

You wouldn’t send someone into the centre of Fukushima wearing a plastic flimsy? Well, the UK has allowed that to happen.

Too negative, too positive, or should I just be quiet? (thoughts on the experiences of people living with dementia in the UK)

Ensure independence, autonomy and the right care and support for people living with dementia (and, yes, older people in general) and the NHS will be fine.

Catch-22, doctors, leaders and the NHS (healthcare, military and other absurdities)

What struck me was the similarity between bad leadership as described in the 256th US Army Air Squadron and… you guessed it, the NHS.

(Admittedly there are no bombing runs in most UK hospitals)

Doctor, my husband will see you now. Home visits, and why we should fight for them.

For today, I hope to keep popping out, spending quality time with patients, understanding what is important to them, their preferences, hopes, fears and aspirations, and supporting them to stay outside acute care.

Why I have been depressed for the past nine years (and how to save the NHS)

..when you see society deteriorating, when there is so much potential for improvement, that is surely depressing; when you see vibrant doctors and nurses forced into early retirement because the work has become too much, that is bad; when you know that people have and will die because of cuts, what could be worse?

Hospital

You see, The Plan says that more will be invested into community care, yet, the cumbersome nature of the NHS, again, the upside-down system of health and social care has resulted in lots or organisation and reorganisation but little transformational thought, little concept of how we can do things differently.

Medically Fit – 2020

Maybe we should call it ‘hospital check-out’, to get away from the nonsense of fitness, when many of the people described are actually quite sick and are often even dying, it is just that their death need not require a bed on a hospital ward.

My Job

Mostly, my approach is to consider that we, that is the community services (those outside the acute hospital) can and do support a far broader range of patients than people realise and, when working well together, can care for a significant proportion of the people who otherwise arrive at the door of A&E.

Doctoring, fast and slow.

In life, there are those who work and act quickly; my mum would say, ‘chick-chak’ which I think is a derivation of Hebrew meaning, ‘promptly, without messing about,’ and, those who tend to dilly-dally.

Manor Field Blog number 6. Doctor, how much should I drink?

Well, most of us – adults that is, have been drinking for many years, and, if you have made it into your 50’s, 60’s or older and are in reasonable health, you are probably close to the sweet spot.

Humanity differing.

When a surgeon is poised over my broken hip I would like that clinical sterility, that void of softness; yet, for that surgeon to function in a team, with people, peers, they need the kindness, caring and empathy of the group, the ability to be told-off for a silly mistake or mis-perception; ego can’t be allowed in.

I veered into Yellow

…you see your destination and intuitively perceive that the way to arrive at that goal is not straightforward, indeed, you might learn that it is only a stepping-stone towards something else.

Spiral

…all the way from human genome project, face transplants, over-the-counter Viagra, genomics and gene therapy to long-length of stay, delayed discharges and workforce crises.

Leaders and Commanders

I am not a military guy. Anyone who knows me likely would agree with this statement – in fact, if you have met me, you would almost certainly wonder why a) I have even said it and b) Why ‘Commanders’ is in my title. Well, I’ll try to explain. It was an unusual Bank HolidayContinue reading “Leaders and Commanders”

Flow; best left to plumbers.

It perhaps has something to do with my internet settings or preferences, I don’t know; you see, I get a number of emails from different national and international health organisations informing me of conferences and award ceremonies taking place in the realm of Quality Improvement. This is the science of doing things better in healthContinue reading “Flow; best left to plumbers.”

Adaptive Intelligence

Their eyes were dull, tired, their postured stooped; they emanated nothing more than a faint flicker of a need to keep going, to survive today in order to continue the next.

What would you like to be called?

It means, I am your doctor, I am here to help, I will do whatever I can to support, and, with this the clinical contract – first, I will do no harm, second, this is confidential and, third, well, If I don’t know, I’ll find someone who does.

Watch it…

(When was the last time anyone checked the dirt level of an NHS keyboard)(Oops, should have said that – the snap response there is sometimes keyboard-condom rather than ‘clean the thing’ the former making touch-typing a nightmare)(when you do get to type, rather than write, which is a mixed-methods form of data collection, common in the health service).

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 areContinue reading “Super-stranded”

Being Jeremy Hunt

In the past when I have written about Mr Hunt I have struggled to use his name, generally preferring the abbreviation ‘JH’ or just that man. As if, by not naming him he is less real, more likely to be the product of a too-vivid nightmare. But, alas, he is real. This leads me toContinue reading “Being Jeremy Hunt”

Daddy, what did you do?

This was a recruitment poster from WWI – designed to create a feeling of guilt in young men, chivvying them to volunteer, head-off to Flanders, Ypres or somewhere on the Western Front and, likely die. At least they wouldn’t have to face their children… ‘I stayed at home, because I didn’t want to participate inContinue reading “Daddy, what did you do?”

Medically fit – today and tomorrow (3)

You hear this term all the time nowadays, at least, if you work in an NHS hospital, are an inpatient or carer or relative of someone who is occupying a hospital bed. Most often… Are they medically fit? When will they be medically fit? If they are medically fit, have you done the take-home medicines?Continue reading “Medically fit – today and tomorrow (3)”

Acute

You can’t lie in the same hospital bed for more than the average length of stay which in your case, for your disease, disorder or condition is 3.76 days.

DToC

Most readers of my blog will not have heard of this term. I suspect most of those working inside the NHS don’t know of its existence either… DToC – Delayed Transfer of Care. This is how groups of mostly older people are categorised once they are deemed medically fit – (another NHS neologism which tooContinue reading “DToC”

The Death of Stalin

I thought it an odd way for someone to explain, ‘This is how we do it,’ but, there you go – within a short few years that person had become a victim of the system themselves.

(299 792 458) The Speed of Light

Yesterday I received a letter from a GP. How many of you (patients, that is), realise that within our health and care system, on which at times your life, or the life of your family depends, and, despite 21st century technology that can take us to Mars and back, doctors are writing each other letters.Continue reading “(299 792 458) The Speed of Light”

Values

Thank you, Wendy for the comment to yesterday’s blog. You mentioned the close-shave in my awakening to the values. And, you are one hundred per cent correct. If the values are at odds, you can’t go anywhere. It is ironic, for within the NHS, values are so pivotal to everything that happens – the goodContinue reading “Values”

York – somewhere else;

I spent a few hours in York yesterday. I travelled up to present some of the work we have done in Doncaster in relation to Quality Improvement, dementia and delirium (signing, dancing, dog-visits – that sort of thing). Recently, I have been talking about the perpetual Narnia which the government has foisted on the NHS;Continue reading “York – somewhere else;”