The A & E Revolving Door Protocol - UHW

The A & E Revolving Door Protocol

No guilt, no change in direction, no remorse, NO INPATIENTS

No need to guess who we are still trying to make see sense.  There is nothing logical about the NHS/Wales government’s changes, nor is there any financial justification for the murderous policies being adopted by either legal entity.  I have little enthusiasm left in me. for continuing the horror story, even after hearing the misleading promise of a 45 bed neurological ward for Llandough hospital.  Re-arranging the deck-chairs on the deck of the Titanic was of no use, neither are any such stupid outpourings from our Minister for Health and Social Services, Mark Drakeford,  Professor of gardening implements and their application.

Not even the article of 11^th October about an increase to 13,147 patients waiting 36 week or more from their referral to hospital for treatment. What chance anyone elderly or with a chronic illness got of surviving until his first appointment .  My answer is “damn all”, with not a care in the world  However, I would like to relate my own personal experience of being taken to what used to be called Accident and Emergency Department at many of our local hospitals.  Now, it is said – by the great horticulturist and the First Minister of Jokers – that “we don’t need more than 4 or 5 A and E departments any more, even though we have, apparently, been making excessive demands on these facilities.

Once upon a time, the A and E department of the hospital was its’ front door. Now, for reasons of falsification of figures and costs, this entry point door has become  a revolving door, intent on sending you out faster than you were brought in – even following  a 999 call or an urgent referral from your GP. My first such emergency trip to hospital received short, sharp shrift.   I had a suspected heart attack and endured a day and a half on a trolley before being given a hospital bed.  The following morning I did not see or hear from a cardiologist, only a 16yr old ( looking  ) F1 who had been told to” discharge me” before lunchtime. My protestations were ignored, the only response being “make an appointment to your GP for a referral to a cardiologist” !  But the 999 call had been made by my GP, so what the blazes were they playing at ?

The most recent visit was as a result of an increasing pain in the surface of my left side, and the 999 call being made by a ‘concerned party’, despite my protestations. Ah well  “Better to be safe than sorry – eh  ?“ [Why is it that most people speak in platitudes, sound-bites, or Americanisms ? ]

To continue my tale, neither of the ‘first responders’ was a paramedic so, no mandatory E.C.G. Taking a mere 45 minutes to drive from Penarth to the Heath ( 7.1/2 miles max }, I waited a relatively short 20mins before being wheeled into a small corner of the new Assessment Unit – still under construction, and exposed to the open air – the ambulance man was instructed to wheel me to ‘Ambulatory Assessment” , where I waited little more than 45 mins before being taken to a ‘trolley’.

Nope ! – not the old type of uncomfortable trolley with the side-gates and no room to move – but a new trolley,  Black 2 piece, covered in shiny PVC , impossible to adjust yourself and as uncomfortable as the rack designed by Edgar Allen Poe.  A short wait and a highly efficient doctor – dressed all in black, making me feel as though in the presence of a pall-bearer – who bunged a canular into my arm, took some blood, and said “A medical doctor will see you shortly”. During that period of wondering what the difference between a doctor and a ‘medical’ doctor, I attempted a find a comfortable sitting or lying position on the rack-sorry trolley both were impossible, so I bent my knees to enable me to lie onthe flat bit whist a charming nurse (over 12y.oa ) took an ECG. Needless to say, I was still in great pain, and relieved to see a fresh-faced medical doctor ‘in civies’ who examined me and asked me every detail of my medical history ( in spite of having all the data to hand on his computer. ) This true professional then escorted me to x-ray for my chest to be examined.  After being returned to my rack-trolley, I endured a further  E.C.G, conducted by a green woman - who allowed no speech – then told me that I could take off all the stickers.

The hours past, without my being offered a cup of tea and/or a sandwich, until the time came to take my usual medication. No one answered my - “Is it alright to take my tablets now…….?”. Another hour passed with me longing for some fluid and nourishment from my tablets, at least. The bench grew more uncomfortable and I was becoming a little frustrated.  Eventually a new shift brought a charming sister who provided a welcome cup of tea AND a sandwich, promising to organise my meds and to arrange a trip home. Sated, I realised that no one had given me any results, so I began asking “Is my doctor still here….?” Again, no answers but a short 45 minutes later, a most charming, distinctly Irish consultant bussled up to me, apologising and saying that “The tests showed nothing so I have to agree with your original feeling that you are suffering from Shingles”.  During his most charming manner, he touched my skin in several places, causing me to yell out in pain, before saying “Shingles – yes” before bustling away again.

My happiness was short-lived as another import from the Emerald Isle approached, saying “Is this your bag “, rather abruptly, to which I said “Yes, what’s wrong with it ?”

“I Need this trolley” he, continued, rudely.  Fortunately, Sister Fiona intervened, telling me to send anyone else like him to her and she would sort them out. Regardless, of her kindness I collected my bag in silence and went back to the grubby chair area, to await the ambulance.

At last, 10.00pm slipped by and the St John’s ambulance men slipped, offering the friendliest smiles I had seen all day. A mere 40 minutes later I was being escorted into my flat by these wonderful men.

Not bad after eight / nine, hours of purgatory . Unsurprisingly, they didn’t have my medication, so I gingerly followed my way out as the nurse was washing the blood off the trolley !    Since then, then pain has not lessened during the following seven days, and all my GP can tell me is that I “must have perpatetic neuralgia” without giving any indication of how long this might last.   R.   W.

N.B.   One sad sight on my way into the A and E Dept. was seeing a young man in handcuffs being kept outside by a policemen. I asked the nurse if he was mentally ill and she replied " I'm afraid so". So, if we treat our so-called 'norma'l patients badly, just imagine how awful it is to be mentally ill and unable to access proper care.

Robbing Paul to Repay Peter - a.k.a. The Budget

"Sing a Song of Sixpence, a pocketful of Rye.........."

In the government game of Monopoly, money changes location with annoying regularity.  The only problem being, is that there is no NEW money being added to the game.  Rather, we get bogus announcements of budget allocations from La Hutt, Finance Minister, that bandy huge sums of money about like the £500 note rents payable when you're unfortunate enough to land on Park Lane or Mayfair. Unfortunately, as I say, this is the same old money that has been floating around government departments for years.  Why, even dear old Mark Drakeford was torn away from his allotment to announce ( once again ), that £88m was to be allocated for the building of the new adult mental health unit at Llandough. ( Explantion : 3 Years ago, Paul Hollard and Katie Norton confirmed that £80m had been 'ring-fenced' for this important project, so what extra £88m is for, nobody knows.  The project remains three years late, with not a sod of earth having being lifted in preparation ).

Yes, Jane Hutt AM announced that £570m was being budgeted for health over the next three years. This would have meant £190m extra each year, except for the fact that  the Minister explained that this sum included £150m until April 2014.  As you avid mathematicians would have worked out that means that only £420m is to be available for health over the next three fiscal years, making us all wonder why the Minister said £570 over three years in the first place !  So, NOW we have the actual figure of £140m as the annual share of this booty.

Sadly - when we listen further - the dear old thing mentions that this extra money will come from cuts to made in Local Authority budgets, where cuts to further education (£43m), libraries etc will have to be made.  Hence the title of this post Robbing Paul to repay Peter, as "£800 has already been cut from the health budget over the last five years" - verbatim Shadow Finance Minister, Paul Davies.

Clear as mud, isn't it ?  except - in reality - we know that every amount budgeted to enable this government to function, is cloaked by an impenetrable fog, contradicting the "Openness and Transparency" that we were promised by the second First Minister, Rhodri Morgan .

So - there we have it ! £570m 'over three years', which will actually only be £440 m = ca £140m p.a.. And, let us not forget Professor Drakeford's promise of £88m for the new mental health unit - assuming, of course - that it will ever be built. Or, if it is built, whether this imaginary cost will also be taken from the £570m !

I know I have said this to the point of boredom but, as a writer, I wish I could create fiction as well as our Welsh Government.     R.  W.

Media headlines are REAL madness

(the Sun news-rag's monstrous exaggeration of tragic circumstances - again. Wasn't their Hillsborough coverage cock-up bad enough ?)  This is their headline of Monday 7th October 2013 :-

1200 killed by Mental Patients

These figures are supposed to cover a decade -  ten long years, which is an average of 120, per annum - IF their figures are to be believed. However, that fuller statement wouldn't be as dramatic and collar-grabbing as the one above, would it ?  Also, it wouldn't be as damaging to anyone who suffers from a wide range of health problems - from emotional crisis to life-long incurable  problems such as paranoid schizophrenia, bi-polar manic depression, or a more difficult diagnosis of a personality disorder. That's not forgetting psychopaths who are capable of attacking anyone at any time, with no reason and no remorse after the event.

The problem here is that anyone can kill a person and then have an appropriate psychotic label attached to them afterwards. So, getting back to the atrocious Sun article was probably written by some unknown journalist, who wouldn't normally be allowed to publish anything more sinister than a pizza menu !  You may be aware that such dramatic figures are published in this unsubstantiated manner, in order to vilify and even demonise any poor soul who is perceived as having a 'mental' problem.

The internal 'investigation', lists only eleven murders committed by people with a diagnosable mental health problem. We are not told where the balance of victims hail from but the general - and ( I think ) intended effect of the article is to stigmatise anyone who suffers from the simplest, curable ailment, such as the emotional stress from a divorce or a fatality in the family.

In fairness to the NHS, the article hints that these 'broken people' have been failed by the mental health system and consequently have 'slipped through the net'. If we are to believe the Sun, that's a hell of a lot of broken people and a net in need of urgent repair. The point is that you cannot condemn NHS mental health services for every death occurring from a sudden, unpredictable destructive incident.

On the other side, of course, there are incidences of manias brought on by a failure to take the prescribed medication.  For example more patients than ever are being prematurely discharged from hospital, resulting in the shameful statistic that most suicides occur within the first two weeks after discharge. The idea behind this notion is that patients will improve quicker if placed back into the community. 

In theory, Community Mental Health teams will pick up the discharged patient and then prepare a Care Plan for his or her on-going treatment which provides details of all medication and the regularity of each dosage.  It's a great theory but, in practice there are never enough CMHT nurses, or council-run social workers to ensure that no one 'slips through the net' and misses out on a vital call. Experience has taught us that schizophrenics have predictable periods of 'normal' behaviour and feel confident to go out not having taken their medication.  It is during these periods that the patient is at most risk of harming himself, or at a much smaller risk of him/her harming others out of fear that they themselves are being threatened.

Similarly, bi-polar patients will have periods where they feel that they can manage their conditions without taking their medication.  Some of these may have a mania where they strip naked or stand in the middle of a road stopping traffic. However, the small number of times these incidents occur, no harm results to anybody.

So - in conclusion - the Sun newspaper is misrepresenting the facts in order to create a far greater alarming effect, than simply printing the facts gained from putting such incidents into their proper perspective. Therefore, frightening headlines like these sell newspapers, whilst causing unnecessary alarm amongst the public. Unfortunately, the inevitable effect of such irresponsible journalism is greater stigmatisation of the mentally ill, which is unforgivable.         R.    W.

Christmas is coming, the Patients are getting fat, but NHS Wales, is too small to cope ! ......

Get your excuses in early, before the winter rush !

Filling the moats and raising the drawbridge is the order of the day from David Sissling, part time NHS Wales Chief Executive. He's written another report, you know, this one is an early copy of all previous years' stock excuse for not being able to cope. vis-

"The pressures experienced by the NHS in Wales during the winter period saw an unprecedented demand on our urgent and emergency care services"   ( Yawn )  He goes on to say, "We have been able to learn from these experiences and we are now planning the rest of 2013" ( Yeah right, double Yawn ).

Of course, the report is endorsed by the BMA who - as Secretary Dr Richard Lewis instructs - "Get ready for winter ( etc etc ad nauseum )". Let's examine reality, shall we ?

Every year, the need for health services grows with the population ( home-bred, immigrants, health tourists ), yet the services don't increase proportionately in order to meet this increased need.  In fact, they do the exact opposite - they radically reduce resources throughout Wales, whilst telling us that if we change our health styles we won't need the treatment for the illnesses that we caused in the first place. So, we now have less A and E units, less emergency services which ( naturally ) causes log-jams in emergency departments and with the ambulance service. Let's not forget that - unlike other countries - we don't have dedicated A&E teams, which means that doctors have to be called from their ward duties to go to A and E and vice versa !

The logic behind the NHS's thinking ( if anyone there thinks at all ) is non-existent because nothing they have done, or do, makes any sense at all. Imagine a private business adopting the same attitude.  They get more and more customers, so they make their shops and their stocks smaller every year, and then say "We had to get smaller because of the unprecedented demand" an insane scenario, you'll agree ?

And, what of the poor staff that are overworked, yet reduced in numbers, who are expected to deal with normal increased demand - let alone 'unprecedented' demand ?  They are expected to do more with less colleagues, in half the time. Crazy ? you bet it is, and we are heading for a winter crisis that has never been dreamed of in our worst nightmares.  That isn't scaremongering, that's common sense being used to examine inexplicable policy changes.

So, Sissling and the BMA can sing in unison, "We told you so !" when the nightmare that the NHS has created becomes reality as more people die due to being unable to access the reduced, inadequate services. So, ten years of cost cutting, by reducing beds, rationalisation and centralisation of essential local services, will finally solve the bed-blocking problem by killing off the chronically ill, the elderly, and the mentally ill, and the NHS won't give a damn !   R.  W.

Does repeating a lie make it believable ? - I think not, Minister

Mental Health Unit Given £88m

I guess you can't tell a good story too many times, especially when you have no intention of making it true. Yes, here we are again on Fantasy Island, high on heady imaginings of the new Adult Mental Health Unit, to be built on the highly congested site at Llandough hospital.

Perhaps Robert J Owen isn't aux fait with the painful journey to reach the promised land?  Maybe he's too young to know about the seven attempts to build a new hospital on the Whitchurch hospital site where - to my certain knowledge, no less than 5 sets of plans have received Planning Permission over the past 12 years.  To be fair, the last extortionate cost of £80m was followed by some of the most expensive site preparation known to the construction industry - every red cent wasted, totalling £6m of public money - thanks due to the total ineptness of UHW's incompetent Planning Department ( a man, a mangy dog and a hopeful young lad with a box of crayons and a fishing pole.)

From the failed new unit at Whitchurch, ( planning wise ), a new idea was born out of the madness that is NHS Wales and our Labour government, with not a competent bureaucrat to make the coffee.  Then - like the Phoenix ( of hope ) out of the ashes of the disastrous Whitchurch hospital fiasco, emerged the Great Plan 'Making a Difference', that included the Adult Mental Health Unit to be built on the existing Llandough Hopsital Site - Hallelujah ! we all cried.

Sadly, this wondrous idea was a tad flawed in that it lacked any detail as to How ? When ? Where? What ? or Who would make this plan reality, given the noticeable lack of  any details, specific costs, design, location - or anything that would normally constitute a 'Plan'.  In spite of this, months of public consultation where no further information about countless unanswered questions, the Great Plan was given the royal approval of the old Foggies and Donkeys organisation, the Community Health Council, much to everyone's consternation.

Now. three years after the hospital was to have begun construction, not a brick has been laid in anger, nor anything resembling the site for an adult Mental Health Unit of unknown size and detail.  As usual, I hope you will forgive my cynicism, but this great unit was to have been completed next year ( 4 years promised  by Paul Hollard and Katie Norton for a 'ring-fenced £80m' that failed to appear ).

September 2013 - the Penarth Times reports that the new Minister for Health and Social Care has been pledged £88m for the new hospital  - a 135 bed unit that is to replace Whitchurch Hospital services and complement the Llanfair unit already at Llandough. Suddenly, I'm beginning to wake up and smell the rat-shit in the coffee.

Llanfair is a 57 bed unit built for £7.155m ( £125kper bed ) but - at a staggering £88m ( more than ten times the cost of Llanfair ! ) the cost per bed leaps to £652k, So - we the dumb public - are expected to swallow this deliberate confidence trick, once again. When I published my first report, in 2010 on this huge rise in costs no one could believe the cheek of our government. Obviously the wool was being pulled over our eyes.

Since 2010, the Finance minister, Jane Hutt AM let us know that ca. £16m was to be spent on the new Mental Health Hospital, which seemed a more realistic figure.  Still, not a single brick was laid. Now we're expected to believe that £88m is to spent.  Even if we include the cost of the 150 place new car park ( not in original plans ), the cost of relocating Rookwood hospital to Llandough, plus the new concourse / super mall attached to the M.H. unit, plus the new entry road and infrastructure, we STILL would be miles away from spending £88m - in my opinion.

Of course I expect Professor Drakeford will have a ludicrously ridiculous and unbelievable explanation for this cause of all my angst, but somehow I doubt it, I really do !       R.  W.