We need to talk about urgent care..

I told my family about my blog…. They said I should write about our recent experience of urgent care , with my Mum. I mentioned it briefly in my last blog… The urgent care experience we had really underlines all the issues that face us collectively as a system…




It was Bank Holiday Monday ( it always seems to be..) my Mother, who is 93 and frail, felt dizzy. She didn’t feel well enough to stay alone at home. She was afraid she would fall, she has done several times before. She has carers who come in three times a day. They work for an agency. They don’t get paid for travel between clients. They tell me their only training is a DVD given to them when they start. They are always in a rush. Sometimes in a week she can have 15 different carers, and the turnover is huge. My Mum has dementia and new people make her anxious. So staying at home with the care she has wasn’t an option. Mum has been failing for the past few weeks and we had had several conversations with Social care that she needed a different place to live. Extra care probably, somewhere with resident care, but it hadn’t moved fast enough and following 2 previous hospital admissions in 3 weeks we were once again in a mess. My brother called GP OOH, or at least NHS111. What followed was a wearisome 50 minutes of repetitive questioning.. and holding…. Different people reading computerised questions.. did she have chest pain? weakness? Finally we spoke to someone who offered us a GP visit… I was an out of hours GP until very recently. I could triage a phone call safely in 8 minutes max.. although I usually had a good idea what was going on within the first minute. Is it surprising more of us are simply giving up and going to A&E

So the GP came… he wasn’t local and didn’t know much about local services. He didn’t think she was “acute” but clearly wasn’t well enough to stay at home. The Acute Trust refused to see her. The GP had no idea about intermediate care ( although the Acute Trust- who also manage community care say there is 24/7 access on their website) The only phone number the GP had for district nursing went to ansaphone. So now what? After 2 hours the GP phoned 999 for an ambulance and my Mum went to A&E. WE were advised NOT to go with her because if we did they might just send her home…

We were left feeling we probably should have phoned 999 straight away but we knew she didn’t need that really.

The next day I went to the acute medical ward at 9am. I knew the doctors would be there then I was informed, a little brusquely that is wasn’t visiting time and everyone was busy. I pointed out that my Mum has dementia and therefore is both confused and frightened so I would like to sit with her for the ward round…using some medical terminology and the Dr title helped I think as I was allowed to stay. We agreed my Mum wasn’t acutely ill but needed to be in a more supportive home environment. A social services assessment was arranged. I went to work… an hour away. I was then phoned to say the assessment would take place in 45 minutes on the ward. As luck would have it my daughter has a week off uni, lives in the same town and was free to go to be with her. My daughter then witnessed a row between the staff nurse and the social worker about how long it would take to organise a placement for my Mum, which only stopped when my daughter interrupted and asked them not to talk about her grandma like a piece of smelly baggage no one really wanted. The outcome: a short term nursing home placement and a long term change or residence hopefully to an extra care flat, if being in the nursing home didn’t lead to too much loss of independence and confidence whilst we waited. Her discharge was delayed ,even then, because the Doctor in change of her care decided at the last minute an echo might help… after 3 more days, an increasingly confusion and no echo and with the help of a very enlightened Sister, I all but kidnapped my Mum and took her to the nursing home…

We talk about the problems in urgent care. Lots of people have tried to look for who to blame. The problems like most in the health service as complex, wicked…. If they were simple we would have got it right be now. The evidence tells us older, increasingly frail people attend A&E with complex problems. In our own area we didn’t see much of an increase in numbers of admissions in November, December and January, and yet the hospital was really busy. The people in hospital were older and more frail and took longer to be sent home. So urgent care is linked inextricably to care for older people. Stopping them going into hospital in the first place and getting them home as soon as possible….Get that right and the A&E issues will diminish…ignore it and focus only on more A&E services and nothing will change… treating the increase in minor problems and the worried well is relatively simple…

And how long will it take us to realise the ONLY way to make NHS111 work for patients and the system is to have highly qualified people at the front end.. doing triage straight away. More expensive in terms of labour costs- YES but system wide it will save by reducing unnecessary blue light trips to overcrowded A&Es and most importantly will make the service better for patients.

And can all of us remember every day and every time that patients are just people in nighties and pyjamas, but they still need to be treated with respect and kindness.