Apathy

On a consultant ward round a few days ago, I presented a patient who's been under the team's care for some time. A very sweet 90 year old who we'll call Mrs M, she came in to hospital with a flare up of diverticular disease. That's not massively important - we got her over it in less than a week, and she was declared fit to go home. Unfortunately, it transpired she'd not been coping so well at home, and her family and social workers at the hospital agreed that she needed extra support to remain in her own home. Straightforward, you might think. You'd be wrong.

The junction between healthcare and social care is shockingly bad. Not so much smooth transition between two agencies working closely together, as two tightfisted Scrooges playing hot potato with patients they don't want to pay for.

Instead of my patient being able to go home as soon as she was well, with a suitable package of care in place, the following happened:

No planning or action took place until Mrs M was declared 'medically fit for discharge' by her team of doctors.

Because nothing was organised, Mrs M had to wait around in hospital as it would be unsafe to send her home.

Two days into the waiting, Mrs M started coughing and having a bit of trouble breathing. A chest X-ray showed she had a chest infection, so we treated her with antibiotics.

Three days after that, her chest was much better.

On the fourth day, Mrs M developed vomiting and diarrhoea, probably as a result of her antibiotic treatment. As if that wasn't miserable enough, the team was worried about her becoming dehydrated, so two doctors spent half an hour making her cry in order to finally succeed in getting a cannula into her (elderly, spindly, fragile) vein so that she could have some intravenous fluid. To make absolutely sure it wasn't her diverticulitis again, they also prescribed her a course of IV antibiotics.

Consultant ward round day comes around again, and the consultant yells at anyone who will listen because this lady is still sitting in hospital. The nursing staff tell us that the social workers are 'in the process of organising her package of care'.

Mrs M gets over all her troubles, is once again medically fit, and sits in bed smiling sweetly and cheering up everyone who goes by for a week.

Thursday afternoon, on the third week of Mrs M's admission, I was on the ward writing a referral. A nurse spots me and lets me know that Mrs M seems quite confused, and so she's going to test a urine sample. I promise to go and see Mrs M before I leave. When I do, the usually bright, lucid lady tells me that she's very worried because she usually looks after her baby granddaughter while her daughter is at work, and she thinks she's lost her somewhere. This is a problem, since I know for a fact her daughter has been retired for some years, and that the baby granddaughter has children of her own. I gently remind Mrs M where she is, reassure her that she and her granddaughter are perfectly safe, and agree that it might set her mind at rest if she calls her daughter. The nurse appears to show me the test results, and lo and behold, Mrs M has a urine infection. Just in time for me to tell the consultant that once again, Mrs M is still here, and once again, we've made her ill.


It's an infuriating story even if I leave it there. What worried me the most is that I left the ward seething, and was met with a wall of apathy.

Registrar: "That's just how it is."

F1: "It's bad, but it's no use getting angry about it. You can't do your job if you waste energy doing that."

F1#2: "Maybe when you're a consultant you could do something, but even they don't seem to get anywhere."

Physio: "It's all about money"
Me: "But it's a lot more expensive to keep her in hospital than to look after her at home"
Physio: "It is, but different people pay and they all try not to"

I couldn't get through to them that the reason nothing changes, and people sit around in hospital when they don't need to be there, costing money and getting infection after infection, is that everyone accepts that 'that's just the way it is'. They've clearly never studied politics. (In fairness, neither have I, but I know a girl who has, and I'm a raving idealist.)

I may have to become one of those hated NHS managers, just to damn well do something about it.