Pity poor Bert.
He's broken his arm - and not for the first time. Five weeks ago he broke is left arm, which healed nicely during rehabilitation at a cottage hospital. The day before he was about to go home, he tripped up and broke the other arm, in the same place.
"It's called the humerus", he told me. "But it's not funny."
Indeed it's not - because his fracture was not the end of his troubles.
He was sent to see me in A&E to diagnose the problem, which was the easy part. The difficult part was getting him out of our department.
1) The cottage hospital wouldn't have him back. A new injury meant that various forms needed to be filled-in, telephone calls had to be made, procedures followed. It was a Sunday. As a sop, they would "keep the bed open" - for which read "we'll get paid for not looking after him".
2) We - the A&E department - couldn't take him because our small Clinical Decisions Unit won't take patients from neighbouring counties. We work close to a border that is all but impenetrable and doing so means we lose one of our six beds, sometimes for many days.
3) The Orthopaedic team wouldn't have him - even though he had a broken bone. "There's no surgical target" (lovely word) "and we can't afford to give-up a scarce ortho bed. It's purely rehab and that's for the medics."
4) The Medical team wouldn't have him because … well, he wasn't medically unwell. And, let's face it, they don't do broken bones, or rehab, for that matter.
Eventually - or, more accurately, just before his 4-hour stay in A&E was up - diktat from someone high enough up the food chain meant the medics (chuntering about being "bottom of the pile") put him in a bed.
You won't be startled to learn, of course, that Bert wasn't consulted about any of this. He was just a problem - just another body to contend with. Another old person no one really wanted to look after. What he wanted simply didn't come into the discussion - and what was best for him wasn't much discussed either.
It's now several days later and, guess what? He's still taking-up an acute medical bed. He no longer enjoys the sociability of his new-found friends at the cottage hospital. No rehab is taking place in the frenetic atmosphere of the medical ward. And, more importantly, he is being exposed to the risks of an unnecessary hospital stay. And, of course, the hospital has to cope with yet another patient fit for the community blocking the truly sick from being cared for appropriately.
As the "winter pressure" mounts on the health service, I can cite several similar problems in my hospital alone. Multiplied throughout the NHS, this means the system is failing to manage its scarce resources properly. Anyone who works close to the NHS will have similar stories.
So why are people making decisions that are clearly against the interests of both the patient and the institution for which they work? A proportion of this may be excuses for being work-shy: "Buff and Turf" still holds true. But there are more systemic problems at play here. The whole sorry affair of Bert and all similar Kafkaesque moments smack of a bureaucracy that desperately needs taming.
Your solution may be different, but for me Bert's needs were a classic example of "Type B" healthcare. For this, we need to give patients more agency, to ensure the force of their "healthcare pound" improves the quality of the care they receive, where the money doesn't just "follow" the patient, it comes with the patient. A government-funded savings account, similar to that given to those with long-term conditions would allow patients to have their say - and perhaps make the cottage hospital, and our acute trust, try to do the right thing by Bert in the future.
He's broken his arm - and not for the first time. Five weeks ago he broke is left arm, which healed nicely during rehabilitation at a cottage hospital. The day before he was about to go home, he tripped up and broke the other arm, in the same place.
"It's called the humerus", he told me. "But it's not funny."
Indeed it's not - because his fracture was not the end of his troubles.
He was sent to see me in A&E to diagnose the problem, which was the easy part. The difficult part was getting him out of our department.
1) The cottage hospital wouldn't have him back. A new injury meant that various forms needed to be filled-in, telephone calls had to be made, procedures followed. It was a Sunday. As a sop, they would "keep the bed open" - for which read "we'll get paid for not looking after him".
2) We - the A&E department - couldn't take him because our small Clinical Decisions Unit won't take patients from neighbouring counties. We work close to a border that is all but impenetrable and doing so means we lose one of our six beds, sometimes for many days.
3) The Orthopaedic team wouldn't have him - even though he had a broken bone. "There's no surgical target" (lovely word) "and we can't afford to give-up a scarce ortho bed. It's purely rehab and that's for the medics."
4) The Medical team wouldn't have him because … well, he wasn't medically unwell. And, let's face it, they don't do broken bones, or rehab, for that matter.
Eventually - or, more accurately, just before his 4-hour stay in A&E was up - diktat from someone high enough up the food chain meant the medics (chuntering about being "bottom of the pile") put him in a bed.
You won't be startled to learn, of course, that Bert wasn't consulted about any of this. He was just a problem - just another body to contend with. Another old person no one really wanted to look after. What he wanted simply didn't come into the discussion - and what was best for him wasn't much discussed either.
It's now several days later and, guess what? He's still taking-up an acute medical bed. He no longer enjoys the sociability of his new-found friends at the cottage hospital. No rehab is taking place in the frenetic atmosphere of the medical ward. And, more importantly, he is being exposed to the risks of an unnecessary hospital stay. And, of course, the hospital has to cope with yet another patient fit for the community blocking the truly sick from being cared for appropriately.
As the "winter pressure" mounts on the health service, I can cite several similar problems in my hospital alone. Multiplied throughout the NHS, this means the system is failing to manage its scarce resources properly. Anyone who works close to the NHS will have similar stories.
So why are people making decisions that are clearly against the interests of both the patient and the institution for which they work? A proportion of this may be excuses for being work-shy: "Buff and Turf" still holds true. But there are more systemic problems at play here. The whole sorry affair of Bert and all similar Kafkaesque moments smack of a bureaucracy that desperately needs taming.
Your solution may be different, but for me Bert's needs were a classic example of "Type B" healthcare. For this, we need to give patients more agency, to ensure the force of their "healthcare pound" improves the quality of the care they receive, where the money doesn't just "follow" the patient, it comes with the patient. A government-funded savings account, similar to that given to those with long-term conditions would allow patients to have their say - and perhaps make the cottage hospital, and our acute trust, try to do the right thing by Bert in the future.
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