Friday, 23 October 2015

Caring for my mother in the face of Tory austerity in the NHS

22 Oct 2015

We hear all the time about the gradual nibbling away of the NHS - public-private partnerships, out-sourcing of services to private companies, and now – since the election that saw this bunch of total bastards get back into power – a faster, harder squeeze on the service that will surely result in the total privatization of our beloved health service.  This isn’t really a political rant, but to point out how the political and private can never be separated when our lives are being so drastically affected by government. 
When my mother needs to use the NHS it seems the same as it’s always been. Unpleasant, yes, overcrowded and uncomfortable at times, but she’s never been let down by them.  In fact, she decided to let her private health insurance go as the only thing she ever used it for was her checkups with the eye-specialist, which costs less that the excess on her policy, so she just pays him when she sees him and it costs her less than having an expensive private health-care scheme.
But for everything else she just gets dealt with by the NHS quickly and efficiently. When she blacked out four times in half an hour, about 5 years ago, I just used the emergency button she'd had installed by Social Services and an ambulance turned up really fast. She had to wait several hours in A & E to get a hospital bed, but no private health-care plan would provide that kind of service anyway.
But this past year I’ve had to use ambulances to get her to out-patient appointments, as she has been unable to climb stairs to get out of the house, and so needed to be carried up. I’ve noticed that the crews that turn up to take her are private companies.  I’ve no idea how long that has been going on, probably for years, but how would I know that if I’m not using them? 
Now I have a wheelchair ramp dug out and graveled up the side of the house, by my brother while he and his wife were looking after Mum. I’m always trying to plan two steps ahead of what is needed and found the whole process of trying to book an ambulance to transport Mum so difficult that I realized this would be a useful thing to have. And it has proved itself already. 

But we needed to call an ambulance a couple of weeks ago when Mother was so weak from lack of breath that she collapsed, while she was with the carer and I was away from the house.  Fortunately I was not far away, so I got back and took charge within 15 minutes.
The carer and I both knew Mum only needed help to get up off the floor. She was not injured.  The reason for her collapse was already being dealt with, as she had an appointment to have her lung looked at by bronchoscopy later that same week. All we needed was some strong, trained people to help us get her up off the floor. She was so weak she couldn’t get onto all-fours in order for us to get her up from that onto a nearby piece of furniture, which is the usual method of getting someone up from a fall.  So I called the emergency services so they could get her onto a stretcher and carry her to her bed.  Ambulance crew are the only part of the professional health or care services that are legally permitted to lift a patient these days. A private individual like me, can lift, and injure their back, but not anyone who is doing it as a paid job.  Fair enough.
I don’t know if what happened next was to do with the fact that they were a private ambulance company, but I got the impression that’s what they were. Maybe it was because it was a weekend – a Sunday evening.  It wasn’t even that the level of training they had was clearly not very high – I didn’t need highly trained paramedics, I only wanted muscle, not brains.  But the litigation-conscious ambulance crew were just not prepared to take responsibility for leaving a patient at home, with a possible, (entirely imaginary) “head-injury” – a very small carpet burn just behind one ear, which had bled a bit.
The result was that at one time we had 5 ambulance crew (two ambulances plus an advance assessment bloke who arrived in his own car) and we were subjected to four hours of what I can only describe as bullying to get me to agree for her to go into hospital, rather just to her own bed. 
It was just horrible. They left Mother lying on the floor for another hour before they got her up. Of course, I had put a folded duvet under her and covered her with a blanket, but she was still cold and painful from the hardness of the floor after lying there for a total of over two hours. 
I mean, I get that they have to make an assessment and do tests etc.  I get that they have their paperwork to fill in. I get that they can’t just lift a patient without really being sure it’s the best thing to do.  But five crew, all stepping over her as she lay there, saying it was more than their job’s worth not to take her to A & E (on a Sunday evening!!!???? Exactly how would that have been better for her than staying in her own bed????)  When I said she was not to go to hospital, that the cut behind her ear was clearly not a head injury, did not require stitches or gluing or whatever they said, they just wouldn’t accept my, or my mother’s clearly stated wishes.  What is it if someone takes you against your wishes?  Assault? Kidnapping? False imprisonment?
I didn’t let it get to that point - I just called my brother-the-doctor.  As in – “My brother is a doctor – a consultant – you can talk to him.”   Again - I use the fact that two of my brothers are doctors all the time to get a bit more consideration and respect from health professionals, but it still galls me that they felt neither Mother nor I were able to make a correct decision in this situation. What would I have done if brother had not been in?   I mean - I can’t go round being rude to these people, I might need them again, probably will, at some point in the near future.
Anyway – brother-the doctor/consultant was there and gave the ambulance crew-member who reckoned he was qualified to say Mum had a potentially serious head-injury, a very brusque talking to and that ended all their attempts to take her to hospital. Plus - they heard me complain to brother that I had five of them all crowded into Mum’s living room, so they sent one of them away. That left four of them to get her up.
Did they bring in a stretcher and keep her horizontal?  No! They decided they weren’t allowed to do that – so they got her up to standing, which obviously took all four of them.  Even though she’s tiny and only weighs 6 stone 4, they still can’t just haul her up. They did that well, she didn’t get any more bruises in the process, and then they sat her in her own wheelchair to get her into the bedroom. Even then, I had to explain that they had to take her down the ramp backwards as the supposedly qualified ambulance crew tried to take her down forwards, risking tipping her out of the chair.  And I had to get her from the chair to the bed, as I was the one with all the experience at moving Mother.  Poor Mum, she’d fallen just as she was about to have a cup of tea. It was now about 8 pm and she’d missed supper too.  So she was thirsty and cold, but was so fed up she just wanted to be left to go to sleep.
Even then I couldn’t get rid of them! Two left, but the remaining two stayed on, insisting they had to get someone out to dress my mother’s head wound. Apparently none of them are allowed to do this. WTF?????!!!! They kept phoning up different parts of the emergency services, while I sat there, starving, as I, too, had had no supper.  I texted my brother who told me I was allowed to order them to leave. He would say that, wouldn’t he? He’s a doctor - used to giving orders to hospital staff.  Basically I was being bullied and neither Mother nor I could do anything about it.  Finally at around 10 pm, I got them to leave after promising faithfully that I would take Mum to a walk-in minor injuries department the next day.  But they still couldn’t leave until the one crew who had said and done nothing the whole time, went in and put a great big bandage on the side of her head, making her look like Pudsey the Bear, or Mr Bump.  She pulled that off half an hour later as it was stuck to her hair.  The next day she couldn’t even work out which side of her head she’d sustained this massive injury, it was so totally un-painful.  When I washed her hair later that week, and cleared the dried blood from it, there was a tiny mark less than a centimeter long where the skin had broken. Needless to say, neither of us considered it necessary to take her to a minor injuries department to have her “wound” stitched.

All of this made me so furious.  On one of the busiest nights of the week for A & E, two whole ambulance crews were tied up, plus the advance guy. Mostly doing nothing.  For hours.  But it was far more important that they cover their arses than to actually do what was needed.  I’d like to tie this in with all the cuts and privatization of the NHS, but maybe it’s more to do with litigation than privatization. All I know is that even a few years ago this would not have happened. My closest friend had ambulance crew out on several occasions to help get her father up from the floor when he was developing a form of dementia that causes sudden falls, and no-one demurred at needing to lift him, a far heavier person than my mother.  

In my usual careful, forward-planning way I have decided that I will do anything rather than call an ambulance crew again, unless I actually DO need Mum to go to hospital, or there is absolutely no-one else around to help me.  To make this possible I have purchased a light-weight, folding stretcher from eBay (courtesy of US Army surplus). My plan is to call the next-door neighbor (who unfortunately wasn’t there this time). He and I can use the folded duvet under Mother as a kind of hammock to lift her onto the stretcher and from there get her to bed. This would be far less distressing for Mother as it would keep her horizontal, and only needs two people to do it, rather than the four it takes to get her up to standing.   Even if I do have to call the ambulance crew – if there’s no neighbour to help us – I will get the stretcher out and tell them this is the way we do it. I find they are usually persuadable if I say we’ve done it that way before.
Over this past year I’ve seen Mother deteriorate so fast. She’s no longer able to walk the short distance between living-room chair and bedroom, or to use the bathroom and shower.  She knows she’s not got long, and has accepted this with dignity and grace – even to the point of discussing with us about end-of-life decisions (do not resuscitate) – but as if that weren’t bad enough, I now have my fears about the even more rapid deterioration of the NHS (I should call that destruction) to deal with too.  The UK Health Service is in the top 3 on every count of world-wide league tables and the US Health Service is near the bottom on those same league tables, but somehow we are supposed to believe that we would be better off following the US model. (Whilst simultaneously believing the NHS is safe in this government’s hands)   I’m not looking forward to the time when Mother is in intensive care, dying, but I wasn’t dreading it nearly so much when I started living with her and caring for her, before all this Tory austerity shite began to happen.

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