Monday, 5 March 2012

Get your house in order

"79 year old female, constipated "

Ok, not the most glamorous of jobs, but lets be honest, four days without a crap is not gonna be comfortable! We'd spent the previous six hours rolling our eyes at various 20 year olds with headaches, back pain and man flu so an old dear was just what the doctor ordered. We pulled up outside a large block of flats knowing full well there would be stairs to climb and not a lift in sight. We traipsed up the stairs to the third floor and entered the rather lavish apartment. The live-in carer met us at the door and took us to Edna. Edna was bed bound from a stroke a number of years ago. She was paralysed on the left side and had very little cognitive function which required 24/7 care.

In all fairness, her carer was excellent, she'd done everything she could to prevent an ambulance being called but she had been let down by the service she relies on. A GP had been out the previous morning for the constipation and had prescribed an enema. Not being a nurse she asked the GP what to do. The GP told her to arrange a community nurse so she did. After hours of trying to get through one was arranged for the evening. Unfortunately they didn't turn up and by the time the carer called to see what was happening the office was closed. In the morning, another visit was arranged for lunchtime. Again, they didn't turn up but this time they wouldn't answer the phone. This is common practise, if the phone isn't answered they don't have to commit to jobs, similar to crisis teams and various other NHS services. It had now been four days since Edna had opened her bowels and appearing in real discomfort her carer, quite rightly, called us. We will always turn up regardless of day, time or call rate. If only other services would do the same. 

We started assessing her and within just a few seconds it was clear this was now beyond constipation. Her skin was clammy, her face was pale and the pulse was racing. Her breathing was very fast, her blood pressure was low, as were her oxygen and carbon dioxide levels. She had a huge temperature and was hyperglycaemic and was without any doubt, septic. Her abdomen was also distended and extremely rigid. We blued her into hospital and left her in the care of the doctors. She probably won't have died but it is more than possible. How can something as simple as constipation get so out of control? The elderly totally rely on the services that the NHS provide and there really is no excuse for these failings. It happens time and time again where the ambulance service and the A & E departments are left to pick up the slack for poor practise. I put in a futile complaint but in all honesty it was to make myself feel better, rather than the possibility it will actually do anything. 

Giving a patient full time care in their own home requires services to work together and deliver the care they are there to provide. Prescriptions need delivering, GPs need to visit, carers are required throughout the day, nurses are needed for catheters etc, meals need delivering, ambulances are needed for hospital admissions and appointments and social services are needed for facility provisions. These patients often need all of the above simply to exist. All it takes is one not to pull their weight and you end up in a situation where a simple home visit being missed, costs a life. There are also financial implications too. The conveying to hospital and an extended stay costs £1000s upon £1000s. Money the NHS can ill afford whilst trying to stave off privatisation, especially when it could have been avoided. I am totally opposed to the NHS reforms, I think it will be bad for patient care, bad for the country and people will get left behind. Sadly though, there are areas of the NHS which are not doing their job and are providing the policy makers with all the excuses they need to out-source services. If people are serious about keeping the NHS as a non-private, non-profit, free for all organisation, then all areas within the NHS need to get their house in order and prove they are fit for purpose. 


  1. Whenever I hear the words crisis team on shift, I shudder. They usually don't answer the phone or deal with any of their own workload, even when it is someone they have recently spoken to. Maybe they just don't like me, but they always fail to deal with people and jobs which fall within their remit.

    On another note, thanks for the blog, always a good read. Please don't stop! x

  2. ...I know people get annoyed with crisis teams on a regular basis but to say we deliberately don't answer the phone to avoid work is libellous and untrue. I work in a crisis team and if we don't answer the phone it's because every single phone in the office is ringing at once (yes often with ridiculous calls as you yourself report...we have people who can't find radio 4, people who are worried they might have an argument at a party two weeks from now and people who want to know what chemists are open past midnight in a certain area of the city, often shouting at us BUT THIS IS A CRISIS!!)

    I can't speak for the working practices of every crisis team but we have an answering machine and a "shift coordinator" mobile which we divert the phones to if everyone's out of the office (visiting people, attending a&e depts, police cells etc) so that we don't miss calls. Do you honestly think crisis teams up and down the land are paid to sit giggling, drinking tea and ignoring phone calls? Do you think we did our training and years of experience (and please remember that a considerable number have personal experience of MH problems and the MH system) to ignore patients...? I do understand that professionals get frustrated with each other but being so offensive and libellous is not at all appropriate (or professional for that matter) and risks the knock-on effect of persuading/suggesting to patients that there is no help, no support, that we are actively ignoring them, which may add to a person's already depressed or paranoid thinking, and result in them not seeking help when they most need it. Yes of course we must whistle-blow when abuse and neglect occur within the caring professions but to say as a blanket statement that crisis teams and community nurses routinely ignore phone calls as a method or tactic to avoid work is incorrect, massively offensive and extremely irresponsible.

    For what it's worth I could reel off horror stories of paramedics acting unhelpfully and sometimes illegally, but as everyone knows how under-resources and under-pressure the NHS is at the minute, I really don't think professionals (who are after all doing the same job from lots of different angles) should turn on each other to ridicule, demean and destroy one another.

    1. Thank you anonymous for your comment however you have focused on one sentence rather than the entire blog. I can only talk from personal experience and from that experience making contact with a crisis team is near impossible and on only one occasion have I had a visit to a patient on my request. The same stands for many community nursing teams. Bear in mind, we generally only have an hour at most with a patient at any time. In that time we need to assess, treat and arrange difinitive care be it a referral or conveying to hospital. Spending half of that time listening to a phone ring and in the end leaving a message in the hope someone might ring back is not good enough for us to be able to leave someone at home. You've taken my post about 1 job on constapation and services needing to up their game as an attack on crisis teams. I merely mentioned them as one of many services we as an ambulance service have problems accessing. That is all. If you think me being unhappy about not being able to provide the best outcome for my patients is unprofessional then that's your opinion. I stand by what I said and how I acted. I clearly hit a nerve though about phone answering. There is no smoke without fire.

    2. Points to raise:

      Yes I focused on one particular aspect of the post rather than the blog as a whole because I'm critiquing the point rather than the whole blog. I don't think that narrowing down a text to analyse one particular point is particularly controversial nor should it devalue the analysis or response (hint: this is how points are debated)

      Secondly yes you hit a nerve because your statement is so untrue and offensive and irresponsible. If I were to publish a piece hinting that ambulance crews went on joyrides to avoid attending to patients and you became offended, would that indicate that there was "no smoke without fire" as you so intelligently said...?

      It is an often-made point that all services are massively under-resourced so as I've said I understand your frustration at not being able to secure services for patients quickly enough (this is something I believe we've all experienced), but I repeat that turning on your colleagues (and we are all colleagues) to suggest that they routinely ignore cries for help as a way of avoiding work is shocking on all counts.

      If you can't accept someone highlighting that your sweeping statements may be just that then you shouldn't write such bloody stupid and offensive things about your colleagues.

    3. All I said was that it is common place for phones not to be answered. This is a FACT. If They are not answered then no one will come out to us. This too is a FACT. Regardless of reason be it understaffing or high demand for your service, the result is the same. We don't get a crisis team when we need one.

      If you call 999 for an ambulance you will generally get one quickly. If we call for a crisis team that is NOT the case. Don't get petty and rude or try and be patronising on MY blog. I know how debate works and if your initial comment hadn't been so confrontational I would have happily had an open debate and even post a balanced blog on thr subject. Instead you chose to take what I said out the context it was meant.

      Regarding ambulances, our control know everything. They know when the key is in the ignition, the speed we are going, when the lights and sirens are on and can listen into our cab. If you have criticism of ambulance staff them air your problems. I have no doubt people have had bad experiences. I have had bad experiences with crisis teams as have many colleagues, the police and patients so that is all I can base my opinions on.

      Also I don't think my statements were that sweeping, offensive or stupid as you so elequantly put. Especially as the blog wasn't even about crisis teams. There will be one. I look forward to reading your no doubt abusive closed minded comments.

  3. 'I do understand that professionals get frustrated with each other but being so offensive and libellous is not at all appropriate (or professional for that matter) and risks the knock-on effect of persuading/suggesting to patients that there is no help, no support, that we are actively ignoring them, which may add to a person's already depressed or paranoid thinking, and result in them not seeking help when they most need it.'

    I have yet to find someone who has had a positive experience with their crisis team, apparently it exists, somewhere. The thing is for most people who have accessed mental health services they already feel 'there is no help, no support' and they feel ignored. Perhaps you would like to read Mind's year long independant enquiry to find out how well Crisis services met peoples needs.
    Perhaps you want to read my blog on our 'cause a crisis team' as I am a carer for someone with a mental illness.
    Ella isn't saying something that no one has never heard before or no one will ever hear again. In fact Mind are taking 50 people to Parliament on 13th March to tell MPs and service providers what works, what doesnt and what they want from services because clearly at the moment more people think services are failing than not.
    I suggest that instead of taking it to heart you take on board what she said and strive to never be like the example she came across. Its clear Ella wants the best for her patients and it gets to her when for whatever reason that cant happen.
    I am not for one moment saying crisis teams are all rubbish, what do I know, but I dont for one moment believe they are all amazing either and that everyone is making stories up just to be difficult.

    1. I don't think I've said that they are amazing and I contributed to the crisis team study you have quoted. I am well aware of the troubles and failings and difficulties in running such a service and am working with trust managers to improve upon services.

      My only stated point which I will make again for the third time is that stating professionals deliberately ignore work and requests for help is untrue, misleading and dangerous. Yes ambulances have quicker response times than crisis teams. They are funded, resourced, organised differently and deal with life or death medical situations and my continued respect to all paramedics. I stress that they are necessarily different from crisis teams so comparing response time is again rather misleading.

      The speed at which this has degenerated into name-calling is disturbing to say the least and I continue my statement that as colleagues we should all continue to respect each other through these horribly difficult times, and perhaps not state that when it is difficult to get through to a particular service the staff are not ignoring phone calls as a matter of course.

      I am aware that very few people have positive experiences of crisis teams. The area in which we work is a controversial and often poorly-understood one, surrounded by media misrepresentation as so many aspects of care are. We are bound by the constraints of the mental health act (itself a controversial piece of legislation) and are chronically under- resourced. I wish things were better and am putting a great deal of energy into improving the service. However we necessarily work within the constraints of the legal and the possible. I am saddened by the remarks on this page which appear to adhere to the view that such problems stem from staff laziness and/lack of care, and that speaking out to defend the considerable efforts of my colleagues (who yes also often work long unpaid overtime in deeply frightening situations) meets with such viciousness and anger.

      It is not a perfect world and health&social care professionals understand this well. I repeat my hope that we can work together for the benefit of patients and families without being abusive to one another.

    2. To Sarah:

      Thank you Sarah for you reply. You are in a similar situation as a lot of people and I can only imagine how frustrating it is and how isolated you must feel. You are dead right on the points I was trying too make. Thank you for reading as always

      Ella x

      To Anonymous:

      This is what I said...

      "Again, they didn't turn up but this time they wouldn't answer the phone. This is common practise, if the phone isn't answered they don't have to commit to jobs, similar to crisis teams and various other NHS services."

      At NO point did I say it was ‘deliberate’ or that they were ‘ignoring’. At NO point did I say they were being ‘lazy’ nor were they ‘drinking tea’. I fail to see how this could be construed as me being ‘libellous’ nor can it be ‘untrue’. IT HAPPENS.

      I also didn’t make a ‘blanket statement that crisis teams and community nurses ignore phone calls as a method or tactic to avoid work’. I simply said that the phone wasn’t answered. If it isn’t answered then no agreement / appointment or commitment can be made. That too is a FACT. Regardless of legitimate reason for the calls not being answered.

      At no point did I ridicule, demean or destroy anyone. I simply said an appointment wasn’t kept and the phone wasn’t answered. Both facts relating to the job I was on.

      Regarding ‘the speed at which this has degenerated into name-calling’ being ‘disturbing’ it is something that you indulged in. Only after I had been accused of ‘ridiculing, demeaning and destroying’, being told I ‘shouldn’t write such bloody stupid and offensive things about colleagues’ and being told I used ‘viscousness and anger’ to describe your colleagues did I say you were abusive and close minded.

      None of what you have accused me of is true and certainly cannot be gained from the one sentence in which ‘crisis teams’ were mentioned. This is not what the blog was about. It was about an elderly lady being put in a position where she may die because the community nurse did not arrive or answer a phone. That is what should be discussed, not your defence of crisis teams. Sorry if you don’t like my blog. I write it, like I say in my bio:

      “I have always been the type of person that questions right and wrong and in this job you experience a lot of both. Be it politics at local level to government policy, be it patient behaviour to staff attitudes, be it life or death and everything in the middle I find myself asking questions. Invariably that involves an indignant rant and grumble but that's me.”

      That is all.


  4. You miss my point entirely.. while you might think that SOME professionals dont and i quote 'deliberately ignore work and requests for help is untrue, misleading and dangerous.'
    It does happen and you cant argue otherwise, its not misleading its true. Read my blog.. partner referred, rings up on a Sunday night asking for help because he is suicidal to be told he isnt their problem and FAIL to tell anyone involved in his care they had even taken this decision. So while your team might be great, or a lot better than the one I am on about it isnt the same for everyone.

    1. Exactly. It's not a universal truth and some of us work extremely hard to deliver and improve services. My team are recovering from an extremely traumatic incident lately, and I have been struck by the importance of the work we do and the strength and dedication of my colleagues.

      while of course I can't speak for all teams or all workers, certainly my colleagues and I give our all.


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