Ambulance waiting times

[Craig the cyclist]

The examples you quoted involved four cases.

Two were care homes, presumably in the private sector, being choosy about their clients.

You are ok with people being evicted from their homes with no knowledge that it was going to happen now then? That is a bit of a turnaround from your usual stance on landlords evicting people isn't it? I assume you are happy to accept that other landlords can be picky about their clients at a moments notice? Imagine if someone went to work and came back to the locks changed, you would be all over that like a rash.

None illustrate your original 'no earthly reason' assertion.

Traditionally patients are admitted to, or remain in, hospital because they are ill or injured. If someone is neither of those things then there is no earthly reason for them to be in a hospital. Social issues are not an illness.

What should a hospital do with a patient who the care homes don't want to accept or where families cannot or will not cope?

You tell me, that is pretty much what the question is.

 

[Bromptonaut]

You are ok with people being evicted from their homes with no knowledge that it was going to happen now then? That is a bit of a turnaround from your usual stance on landlords evicting people isn't it? I assume you are happy to accept that other landlords can be picky about their clients at a moments notice? Imagine if someone went to work and came back to the locks changed, you would be all over that like a rash.

Where did I say I was OK with people being evicted from care homes?

For the record, I'm not. But the reality is that it happens. It may be about paying bills but on the other hand if the home's approvals only cover certain conditions or age groups what do they do? If a client is engaging in behaviours the home cannot cope with but they struggle on and it ends up with a client or a staff member injured guess who will be facing the music.

It's all a symptom of dysfunctional social care developed over 40+ years and ignored/kicked down the road by governments of all stripes.

The latest wheeze isn't actually about improving the system but rather making the 'sell your house for care' thing go away. On the one hand its a lottery whether you end up in a home but on the other hand why should the taxpayer backfill people's inheritances?

 

[Bromptonaut]

You are ok with people being evicted from their homes with no knowledge that it was going to happen now then? That is a bit of a turnaround from your usual stance on landlords evicting people isn't it? I assume you are happy to accept that other landlords can be picky about their clients at a moments notice? Imagine if someone went to work and came back to the locks changed, you would be all over that like a rash.

This is the sort of posting that gets you a reputation for trolling. A complete diversion from the thread's theme linked with an attack on the poster's sincerity.

 

[Craig the cyclist]

Where did I say I was OK with people being evicted from care homes?

For the record, I'm not. But the reality is that it happens. It may be about paying bills but on the other hand if the home's approvals only cover certain conditions or age groups what do they do? If a client is engaging in behaviours the home cannot cope with but they struggle on and it ends up with a client or a staff member injured guess who will be facing the music.

It's all a symptom of dysfunctional social care developed over 40+ years and ignored/kicked down the road by governments of all stripes.

The latest wheeze isn't actually about improving the system but rather making the 'sell your house for care' thing go away. On the one hand its a lottery whether you end up in a home but on the other hand why should the taxpayer backfill people's inheritances?

Which is all very confused isn't it? If a tenant doesn't pay their bills, should they be simply kicked out of their house while they are out? I seem to remember that you work/volunteer in that area and have consistently said no they should not. But when it happens in care you are happy to say they can be.

The question was about why ambulances can't offload, the reason is because the hospitals are full. They have large amounts of people with no need to be there.

What do you suggest we do with those patients? Try and stay on the question this time.

 

[Craig the cyclist]

This is the sort of posting that gets you a reputation for trolling. A complete diversion from the thread's theme linked with an attack on the poster's sincerity.

It seems we posted our last replies at the same time.

Yes, I believe your thinking is confused as I have said. Pointing that out is not trolling, but that is an easy accusation as it works to shut down the argument.

 

[Bromptonaut]

Which is all very confused isn't it? If a tenant doesn't pay their bills, should they be simply kicked out of their house while they are out? I seem to remember that you work/volunteer in that area and have consistently said no they should not. But when it happens in care you are happy to say they can be.

The question was about why ambulances can't offload, the reason is because the hospitals are full. They have large amounts of people with no need to be there.

What do you suggest we do with those patients? Try and stay on the question this time.

Perhaps YOU could try and stay on the question which is about how people fetch up staying in hospital.

You're comparing apples with oranges. A Care Home is not comparable to a private residential tenancy. In fact I'd say it's closer to a hospital. If the care/treatment is no longer appropriate for the resident's needs then they may need to move elsewhere.

As I've already stated I don't support the way in which care homes appear to be cavalier about offloading their difficult cases onto the NHS. Equally, if a resident with dementia has become unmanageable and is a danger to themselves and others then you cannot expect a Care Home to go through the sort of processes that are (rightly) required to remove a residential tenancy.

The issue is the chaotic nature of social care which will only improve if it's properly funded.

 

[Craig the cyclist]

Equally, if a resident with dementia has become unmanageable and is a danger to themselves and others

But then they would have a medical need to be in a hospital wouldn't they?

I have been quite clear, the patients with no medical need to be in a hospital are the issue. What do we do with them?

We do agree though that social care is in a mess, but as ever with health, it is not just a case of 'it's the Conservatives', successive governments of blue, red, blue/orange have all fucked about with it, each one making the situation worse.

 

[Rusty Nails]

.

But then they would have a medical need to be in a hospital wouldn't they?

I have been quite clear, the patients with no medical need to be in a hospital are the issue. What do we do with them?

We do agree though that social care is in a mess, but as ever with health, it is not just a case of 'it's the Conservatives', successive governments of blue, red, blue/orange have all fucked about with it, each one making the situation worse.

Do hospitals take in patients because they have dementia and behavioural problems that cause a danger to themselves or others? Is that classed as an acceptable medical need for admission to hospital? That would certainly save sufferers and their families the expense of having to pay for care homes.

Has each successive government really made the problem of health and social care worse than the last one? If so then every single one of them is incompetent and should never have been voted into power. Is there a timeline that details the worsening effects on social care after each change of government?

You are right, to an extent, that this goes beyond just a party political solution as parties have shown that they will kick the can down the road as long as they can get away with it, but this Tory government have had a very long time to improve the situation, and to promise that they would without actually doing so. ( Boris said in 2019 that he already had a clear plan prepared...one could say oven-ready “And so I am announcing now – on the steps of Downing Street – that we will fix the crisis in social care once and for all, and with a clear plan we have prepared to give every older person the dignity and security they deserve.” ). What is most worrying is that these recent tax cuts and NI increase reversal, on top of the extra costs of energy subsidies and the Covid pandemic look likely to lead to reductions in public spending over the foreseeable future and I suspect that social care will end up being the Cinderella service for a long time yet.

I look forward to seeing Coffey's plans, or more pertinently, their implementation to cure the bed-blocking problem.

 

[Bromptonaut]

But then they would have a medical need to be in a hospital wouldn't they?

I have been quite clear, the patients with no medical need to be in a hospital are the issue. What do we do with them?

We do agree though that social care is in a mess, but as ever with health, it is not just a case of 'it's the Conservatives', successive governments of blue, red, blue/orange have all fucked about with it, each one making the situation worse.

I honestly don't know whether somebody who has dementia and shows (say) violent and/or sexually disinhibited behaviour would have a medical need to be in hospital. Might it equally be an issue for a more specialised Care Home and Deprivation of Liberty Safeguards?

The examples you originally quoted had, with one possible exception, no medical need to be in hospital. Exception might be the one where relatives 'demanded a cure'. Could they have been a ping pong discharge/admission where a recurrent condition was seen as not being properly treated?

As to what we do there's a need for either new legislation or proper use of what already exists allied with properly resourced care whether delivered at home or in an institution providing care or nursing.

Governments pre 2010 didn't move the issue on. Legislation in the nineties moving funding from Social Security to Councils together with an assessment framework seemed to give a lift but Labour didn't do much between 1997 and 2010.

The Conservatives have been in power for 12 years and not dealt with the issue either. May at least tried only to be kebabbed by her own side over 'dementia tax'.

 

[Craig the cyclist]

Do hospitals take in patients because they have dementia and behavioural problems that cause a danger to themselves or others? Is that classed as an acceptable medical need for admission to hospital?

Depends what sort of hospital. The patient you have described would probably need an EMI bed, unless they had a concurrent physical need better treated in a Gen hospital.

Has each successive government really made the problem of health and social care worse than the last one?

Yep. Each successive government has had, and implemented A Big Plan. These Big Plans have always involved some change to how the NHS operates and so has caused upheaval. How long do you think these Big Plans are for?
NHS Plan, 2000
Five Year Forward view
The NHS 10 year plan
The Lansley Reforms, 2012
NHS People Plan
There are lots and lots more.
Now what do they all have in common (possibly with the exception of Lansley)?

but this Tory government have had a very long time to improve the situation, and to promise that they would without actually doing so.

It has had 12 years, about the same time that Labour had to not do what they said they would do.

I look forward to seeing Coffey's plans, or more pertinently, their implementation to cure the bed-blocking problem.

So do I.

I honestly don't know whether somebody who has dementia and shows (say) violent and/or sexually disinhibited behaviour would have a medical need to be in hospital. Might it equally be an issue for a more specialised Care Home and Deprivation of Liberty Safeguards?

It may be an issue for several options. Probably the least sensible one would be the back of an ambulance or a cubicle in ED.

Exception might be the one where relatives 'demanded a cure'.

Demanded that they be guaranteed she would never be ill again. That is significantly above 'wanting a cure'.

 

[Rusty Nails]

It has had 12 years, about the same time that Labour had to not do what they said they would do.

Have you seen me praising the Labour Government for their sterling work on health and social care? They did not do as much as they claimed they would to improve the situation they inherited.

But we are now in 2022 after more than 12 years of a Tory government. It is futile, and also deflecting from the current government's faults, blaming parties from the past, whether Tory or Labour, when this is the government we have now.

Should we sit back and not blame them for current problems or carry on as if everything is fine, or soon will be?

 

[classic33]

Depends what sort of hospital. The patient you have described would probably need an EMI bed, unless they had a concurrent physical need better treated in a Gen hospital.


Yep. Each successive government has had, and implemented A Big Plan. These Big Plans have always involved some change to how the NHS operates and so has caused upheaval. How long do you think these Big Plans are for?
NHS Plan, 2000
Five Year Forward view
The NHS 10 year plan
The Lansley Reforms, 2012
NHS People Plan
There are lots and lots more.
Now what do they all have in common (possibly with the exception of Lansley)?


It has had 12 years, about the same time that Labour had to not do what they said they would do.


So do I.


It may be an issue for several options. Probably the least sensible one would be the back of an ambulance or a cubicle in ED.


Demanded that they be guaranteed she would never be ill again. That is significantly above 'wanting a cure'.

Regarding the two bits in bold.
Type of hospital isn't a choice that many patients can make. They seem to be a one sort does all nowadays, and at the same time do less than before.
We'd three local hospitals 23 years ago, then three were made into two then one. The one remaining is supposed to be doing the jobs of all three previous hospitals. The junior staff are run ragged, the paper pushers who sit watching screens don't have to bother about actually treating anyone. They just sit there, their screens showing them them what they "need to know". How their customers for that day, not much more.

I'd an operation in November '95, but that's not what I went in for. I entered via the A&E, then there was a problem shortly after being transferred to the ward. The operation was carried out to try and cure the problem that arose in the hospital. As a result of the problem reoccurring while in the operating theatre, I ended up staying and taking a bed up for just under six months. I could see no need, the nurses on the ward could see no need, nor the doctors, for being there so long. But it turned out that someone higher, possibly due to the problems that occurred, felt I should be there.* I ended up signing myself out. Finishing treatment as an outpatient at the other hospital.

He never said demanded they never be ill again. You can cure an infection with a course of treatment. The thing is, it needs to be the correct treatment. And treatment once, "wanting a cure", doesn't mean that that person will never get ill again. You're stretching it to it's limits, possibly beyond, in trying to make a point.

*Found out years later at the one remaining hospital, after the person named had left their position when the hospital was closed. It wasn't even a medical decision on their part.

 

[PK99]

As I've already stated I don't support the way in which care homes appear to be cavalier about offloading their difficult cases onto the NHS. Equally, if a resident with dementia has become unmanageable and is a danger to themselves and others then you cannot expect a Care Home to go through the sort of processes that are (rightly) required to remove a residential tenancy.

When that happened to my mum, we moved her from her Rest Home to a Psychiatric Care Home and continued to pay for her care from the funds released by selling her house using Lasting Power of Attorney. There was very little left when she eventually popped her clogs.

Too many people, it seems to me, want the state to pick up the bill so that they can inherit the parents' assets, hence hospital beds blocked by people who no longer heed hospital care.

 

[Julia9054]

When that happened to my mum, we moved her from her Rest Home to a Psychiatric Care Home and continued to pay for her care from the funds released by selling her house using Lasting Power of Attorney. There was very little left when she eventually popped her clogs.

Too many people, it seems to me, want the state to pick up the bill so that they can inherit the parents' assets, hence hospital beds blocked by people who no longer heed hospital care.

Are psychiatric care homes available to those without houses to sell?

 

[Rusty Nails]

When that happened to my mum, we moved her from her Rest Home to a Psychiatric Care Home and continued to pay for her care from the funds released by selling her house using Lasting Power of Attorney. There was very little left when she eventually popped her clogs.

Too many people, it seems to me, want the state to pick up the bill so that they can inherit the parents' assets, hence hospital beds blocked by people who no longer heed hospital care.

Very sad, and far too common.

Not sure if it is still the case, but not so long ago the government did not count that sort of dementia as an illness that warrants care/nursing home costs to be met.