Always interesting, often different

Posts tagged ‘NHS’

Thank Goodness for the NHS

A couple of weeks ago I booked to see my GP. I had a very swollen right foot. This had started about 2 weeks beforehand. It was not improving even when I was sitting in bed with my feet elevated.

My leg was slightly swollen, but nowhere near as much as my foot. I also had some discolouration. Thankfully I had no extra pain. 

Having examined me carefully my GP was concerned that I might have a Deep Vein Thrombosis.  My only previous history of DVT was 40yrs ago, when I was on the pill. My GP was also concerned that I may be at risk of Pulmonary Embolism, a clot of blood on my lungs. I had been getting increasingly breathless – though I did not feel it was any worse than when she saw me in April.

But, being as thorough as ever, my GP advised me to go to my local Accident and Emergency Department ASAP. She printed off all my medical notes to take with me. 

So, less than an hour later I was at a large London hospital. I was checked in at the desk immediately and only had to wait 10 more minutes to give all my details to the clerk.  At this point I will admit to feeling slightly scared, I really don’t want or need another medical issue or diagnosis.

90 minutes later I was seen by a highly experienced professional Triage Nurse called Natalie. My BP was raised at 186/92, my pulse was 124 and my oxygen saturation levels were 92. Both of the latter results are fairly usual for me. My severely reduced lung function had at least, not deteriorated.

Natalie quickly did an ECG – electrocardiograph. This did not show any abnormal rhythms. Despite everything being ok, Natalie made the decision to take me round to the major treatment area to be seen by a doctor.

Within 5 minutes I was seen by Dr Elle. She quickly put a cannula in my hand and took bloods from me. The main test I was going to have was a d-dimer which can show if there are high levels of fibrin in blood. This can give a good indication of the likelihood of having a blood clot in my lungs or leg. 

The results would take an hour to come through, so I settled down to read my kindle again.  Dr Elle had explained to me that the hospital protocol varied, depending on my results. If my d-dimer was raised, I would have an immediate CT scan and possibly be admitted. If the results were ok, I would be sent home with a short course of blood thinning medication. I would then return for an ultrasound scan of my leg after the weekend.

Thankfully my results were negative – whew!! I was so relieved!!

I went home, rested and took my medication over the weekend. I returned to the hospital on Monday for my scan. That too was clear.

Within another week the swelling on my foot was greatly reduced. What caused the swelling remains a mystery.

I couldn’t help but be grateful for all the wonderful care I received. Whilst Dr Elle was fairly sure I had nothing seriously wrong, I was treated as though I did. The reassurance of knowing I would have those tests was priceless. Yet it is so often something that we in the UK take for granted. 

We still have a great NHS despite the efforts of this ghastly government and its predecessors attempts to destroy it.

When I hear of those in the US who cannot get good health care or the level of health insurance they need, it makes me even more determined to campaign to keep our NHS free at the point of use.

 

Should Nurses go on Strike?

An ethical dilemma.

Last month I watched my Royal College of Nursing colleagues give Jeremy Corbyn a standing ovation at the end of his speech to RCN Congress. I felt proud of the support they gave him.

But 24 hours earlier the RCN made a worrying announcement. They have been balloting nurses about the current pay crisis. 91% of nurses said they’d take industrial action short of a strike. 78% of members who completed the poll said they were prepared to go on strike. This is the first time in 101 years of the RCN that nurses have decided to strike.

I have been a qualified nurse for 40 years. Never in my career have I known nurses wanting to strike. We’ve previously protested about pay. As a student nurse in the 1970s, I and many of my off-duty colleagues marched through the streets of Exeter. I will never forget the reaction of some of the by-standers. Whilst the majority were supportive, some spat at us and accused us of killing patients by being on the march. Nurses were only allowed to march if off duty or given formal permission by a Matron. No patient care was affected by our actions. It took some time for my student nurse pay of £11 a week to improve!

RCN members have now voted at Congress to begin a summer of planned protests. And so they should. There is currently a 1% cap on public sector pay rises. Unless there is a change of government, this will continue until at least 2019-20. The effect being that the average nurse has suffered a real-terms pay cut of 14% since 2010. This is not acceptable. Nurses are now being forced to use food banks.

Our professional registration and indemnity insurance fees have risen. We have to pay these before we can work. Pay and conditions are worsening. Most nurses are now working long 12 hour shifts. When I started to train these had just been phased out, apart from Night Duty. We were told that such long shifts meant nurses were too tired and could make mistakes. Why is the same advice not valid now? 

What can nurses do to highlight their plight? There are few actions they can take without jeopardising care. Working to rule, what would that involve? Not staying on after a shift has ended if there is an emergency? I guess some nurses if they have pressing family issues, such as collecting children from nursery, may feel they can’t stay on. But most nurses I know would willingly stay on to help. Not helping a patient in some extra way? I doubt it.

What would I do if I were still working in the NHS? I really don’t know. I would certainly ‘cover’ so more junior nurses can protest in some way. I suspect when it comes down to taking strike action, most nurses will be very reluctant. I went into nursing because I cared about people and wanted to learn how to help people get better. That still holds true for nurses today. The word vocation may be rarely heard, but nurses still care, deeply.

This current government knows this. It’s why they have treated nurses and other healthcare workers so disgracefully when it comes to pay and conditions. Theresa May did not even bother to acknowledge her invitation to the RCN Congress. Whilst the two other party leaders did attend, Theresa was nowhere to be seen. There are 675,000 nurses in the UK how many votes did she loose? 

I have seen at first hand over the last 6 years how hard nurses work. During that time I’ve had 4 different operations as well as other treatment. Most of my nursing care was good. I saw nurses having to care for confused and elderly post-operative patients in a High Dependency Unit. The unit was understaffed, the nurses not adequately trained. There were not enough doctors  on duty either. 

Visiting a friend in a psychiatric hospital last year, the picture was the same. The ward was chaotic and noisy, with not enough staff. There were no extra staff to provide activities either. The reason? More bed closures including the specialist high care unit.

Yes, nurses can protest outside hospitals or Downing Street. But I cannot imagine any nurse leaving the ward to actually withdraw their labour. In itself that would be a breach of the NMC Code of Conduct. Nurses could refuse to do overtime. But the effect of that will be to reduce their pay even further. 

All I know, is that when nurses are protesting – I will join them. Both as a patient and a nurse. 

 

 

Why this election is personal

The disability vote and why it matters

The UK is now in the midst of a General Election campaign. I have been a political activist in the UK and US since I was 14, and this time is no different. I’m involved in organisation and campaign strategy. I also manage several social media accounts to support our local candidates. 

I’m doing all of this because I want a change of government.

But for me, this is not just about voting Labour, a party I passionately believe in. A party that has the best policies to give us greater equality. In Jeremy Corbyn we have a leader who seeks a great distribution of wealth, and goverment for the many, not the few. The election is also about what this cruel and heartless government and the two preceding ones have done to disabled people.

Almost 19% of UK citizens have a disability. For most of us, we were either born with the disability, or we have become disabled having worked for many years. Those of us who have congenital conditions often suffered as children. Sometimes through neglect and sometimes through ignorance. Those of us who have acquired disabilities frequently find that even though want to work again, even part-time, that option is not possible. 

I have one friend, A GP who used to work with drug addicts. He has had a stoke, and as a result needs a wheelchair to get around. But his home is not wheelchair accessible, so he is denied a wheelchair. If he had a wheelchair, kept in his car or in a garage, he would be able to work again. But this is now denied him. All his years of training and expertise have gone to waste. He cannot afford to move, as he can’t get a mortgage because he’s not working. 

I have another friend, she has a congenital condition, and experienced a abusive childhood. She has trained as an actor and voice coach. Most of her work opportunities are in London. But she can’t afford to live here. So she struggles to survive on part-time hourly paid jobs with no security. She is also in constant pain and cannot afford ‘time out’ for the surgery she needs.

These storied are replicated all over the UK. I know other people who could work part-time, but cannot get the care support they need to enable to be employable.

So this election is personal for me and for my disabled friends. We are asking to become valued members of society again. It is wrong to view us as scroungers or cheats. We have skills aplenty – but need accessible transport and work environments. We need employers to treat us, and all workers, fairly. Did you know most people who use food banks are actually in work?

We need an NHS, free at the point of delivery that is run for the benefit of patients, not for managers or private companies bidding to run services. We need more nurses, especially in mental health, who are paid properly for the work they do. We want properly funded schools for our children and grandchildren. The money this would take can easily be found if companies and Tory backers no longer have ‘sweetheart tax deals’.

The only way that can happen is if people vote out Theresa May and her cronies.

Disabled people are becoming more involved in this election than ever before. My next post will give the story of what’s happening. 

 

Ending PJparalysis doesn’t work for us

Carol Midgley’s Comment article in The Times today strikes an arrogant and unrealistic tone. Her assumption that the new NHS campaign #endpjparalysis is good for everyone is not correct or helpful. 

I fully understand the need for post-operative patients to begin to mobilise as quickly as possible to prevent DVT. But the presumption that every NHS patient should be up and dressed during their time in hospital is not realistic. Who is going to help those for are too frail or ill to do this for themselves? 

I’ve had 5 hospital admissions in the last 4 years. Each time I have needed help from nurses to get dressed. Many elderly and frail patients do not even get help to eat their meals in hospital. Who is going to help those people to get dressed?  

19% of the UK population is disabled in some way. We are also likely to make up the majority of patients on any ward. Another article in the same paper talked about the rising number of bed-blocking patients. The reason: there was no social care available for vulnerable people. That care is needed precisely because people cannot do basic tasks for themselves. Forcing all patients to get dressed gives a false impression to Social Workers of how fit people actually are. 

I’ve had Social Workers seeing me at home, dressed, but lying on my bed. They then presume that I’m capable of cooking a meal without help, or doing a myriad of other household tasks. I have most likely used up all my energy for the day, getting that far. Because they see me looking ‘respectable’ a whole set of unrealistic expectations appear in their thinking. These become intrenched and are difficult if not impossible to dispel.

Carol’s final point about needing to wear a bra to feel “fully functional” struck me as particularly ludicrous. Lots of disabled women find it difficult, if not impossible to wear a bra. This is especially true for those of us with arm or spinal problems. Those of us who are fortunate enough to be able to work in some way, may not have the choice to dress as she does. So, Carol, next time please check your ability privilege, before making your judgements.

 

 

Getting the best from your GP – Part 1

Having great interactions

Finding a good GP is essential if you are to get good support and the right medication. It also matters when you need a hospital referral. Because of my nursing background, I also expect visits to my GP be an equal two-way conversation about medication or treatment.

Most GP’s surgeries allow you to order regular medication and book appointments on line. It’s well worth learning how to do this – it really isn’t difficult. Booking non-urgent appointments and ordering medication from home saves time and energy too.

I use the Health app in my iPhone to store all my medical informations. There are similar ones for other phones and they can be accessed even if your phone is locked. If you don’t trust technology make sure you have information available in case of emergency. Some people use Message in a Bottle.

If you have life-threatening conditions or allergies you may want to consider MedicAlert. They do charge a yearly fee, but provide a great service.

1 Do your research

Ask friends and neighbours, especially those with health problems.  If you need a GP who speaks your language, make sure that there are at least two GPs in the practice you choose that you can talk to. The same rule applies if you prefer to always see a woman GP. 

Check the Surgery out on line: the CQC is an indepedent inspection body who rate all GP practices on a variety of standards 

There is a totally independent site. It’s a great place to check. Their reviews are straightforward and give clear percentages for each question.

This NHS run site allows patients to give their own ratings on different services. I don’t find it as helpful as it tends to cite only the best or worse experiences.

2 Don’t think the nearest GP is best

Never chose a Surgery because it’s the nearest one to get to. I have to pass two GP practices to get to see my GP and it’s well worth the extra time. 

My friend Sue who lives the other end of London to me, chose her GP because he was nearby. Sue has type 2 diabetes and in the last 3 months has had 3 leg infections with blisters on her skin. Her GP wouldn’t send her to specialist Diabetic Nurse. He refused to give her a glucose monitoring kit. She was told she couldn’t see a specialist Tissue Viability Nurse about her dressings. She was also told to pay for the wound dressings.

The way she was treated not only broke NHS guidelines, but could have severely endangered her health. Because the NHS is short of money, Sue presumed that what she was being told was ok. She felt she didn’t ‘deserve’ any more care because it was too expensive. I was furious when I heard about this.

I spoke to Sue and explained the care she should be getting. She is now with a better GP. Although the surgery is a 10 minute bus ride away, Sue is getting referred to the right specialists and she will get the right care.

3 Speak to a GP before signing up

If at all possible, ask to speak with one of the GPs at the practice you are considering. This is especially important if you have a rare condition or multiple interacting conditions. You can often get an idea of they way you will be treated in future by the response you get to your request.

Also GPs who are training practices are often more up to date on new treatments and complex conditions. 

4 Find more than one good GP

Most GPs work in group practice settings. So whilst you maybe registered with a specific GP you can be seen by any GP who works there. You will probably easily find one GP who you have a great rapport with. But, GPs have holidays, are sick themselves or they go on training courses. So find at least one more GP in your practice who will know you and can look after you if you need something urgent when your GP is away. 

5 The power of paper

When seeing a new GP or hospital doctor for the first time I always take with me a concise medical history of the 12 operations I’ve had as an adult, my current medication and the allergies I have. This paper also lists the 8 conditions I’ve been diagnosed with and a summary of my current issues. This makes consultations much more focussed and doesn’t waste valuable time going over irrelevant stuff. It also means the Doctor has everything in front of them if they need to write referral letters or evidence letters for Social Services and the DWP.

Part 2 coming soon.

 

Update on my spinal surgery

6 weeks further on I’ve made really great progress. I’m able to sit for longer periods in my chair and soon went back to driving – though I’m finding it uncomfortable on my back still. But I’m due to collect a new car in the next two weeks which has specialised seating. I’m still quite nervous of walking as whilst the numbness and neuropathy in my right foot has reduced, my left foot has not improved. On my follow up visit I was told this is quite usual, and that I may always have to cope with some level of neuropathy. 

I’m able to get around my flat much more easily, and am able to walk a few steps, which is how I was back in August last year. I have to limit what I do & pace myself carefully as I still get spinal pain and of course my breathlessness is another factor in how much my body will let me do. 

My after surgery appointment was good, my wound had healed really well, the scan showed that the surgery was good, but I may need some more surgery in the future as there is some wear and tear damage to another disc. I will be reviewed in 9 months and then yearly after that, with the option of my GP being able to send me to see my consultant straight away if I have any major problems.

The NHS gets many brickbats and complaints, often quite justifiably, but I could not have had better care. This was the NHS at its best and many other hospitals could learn lessons from the way the RNOH treats patients.

There is also good news about the RNOH rebuild. Funding has been agreed to build a completely new hospital on the same site and work has already started. I’ve seen the architects drawings and have to say they look really great, with amazing up to date equipment and design, and specialist areas for children as well as long stay rehab and new surgical suites and wards.

The first class surgeons, nurses, physiotherapists will soon have a state of the art building to work in and patients will be able to benefit from all the new facilities have to offer. 

I’m sure some will miss the old buildings and the tales they can tell, but the RNOH is a flagship hospital which needs and deserves the best the NHS can do. An NHS that many of us are fighting for, to ensure it remains a public service, free at the point of treatment.

Asking the obvious

I was recently referred back to Charing Cross Hospital to the Rheumatology department for a steroid injection in my left wrist, I’ve been there before and had excellent care from a lovely Consultant who has sadly left.

I was seen by a Registrar who I’d not met before, and for some reason my full notes were not available. So, I gave him a potted medical history; severe spinal arthritis, scoliosis of the spine, displaced vertebrae in my neck, only 50% use of my left arm and 40% Lung function – not smoking related. I showed him a list of my medication, which includes morphine patches for pain relief.

He then asked why I was using a wheelchair………………!!

Which left me rather speechless. I‘m not usually lost for words, but said something like; “Severe arthritis, on morphine, get very breathless, is that enough?”

I got a sort of grunt in reply.

Afterwards I felt really shocked.  Was it too much to except that a senior Doctor would realise why I was using a wheelchair, without needing to ask?

Are my expectations too high?

Or is the NHS not recruiting Doctors of a high enough caliber?

So near and yet so far………..

Garden

This is the view of the garden for my flat, I just wish I could go and sit outside and enjoy the sunshine, but there are a number of very steep steps from my balcony down to the garden which are impossible for me to negotiate safely.

Yet another reason for needing to move.

Using the balcony is an option, but gives me no privacy as my very nosey downstairs neighbour insists in either pushing his way through the gate at the end and coming up and smoking right next to me, or interrupting any conversation I may be trying to have with visitors.

I find his smoking not only objectionable but also totally inconsiderate as I have greatly reduced lung function and being near people who are smoking makes my breathing so much worse. I have told him this, as has the housing officer who looks after both our flats, but to no avail.

So, during these lovely sunny days I remain in doors, instead of being outside soaking up some Vitamin D. I guess that’s why a couple of years ago I was diagnosed with severe Vitamin D deficiency and now have to take daily supplements.

It would probably be cheaper for the NHS to help get me moved to a new flat!

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