the domino effect

Even if I was sitting the other side of the office – and not just the other side of the desk – I could tell it was a difficult call.

It isn’t anything to do with Michaela’s body language. She often sits like that, a little hunched over, focusing on the task at hand until it’s done, then switching fully to the next. And it certainly isn’t how loudly or quickly she’s speaking, because generally with Michaela, the more pressurised she is on the phone, or anywhere else, the quieter and more precisely she speaks. It ‘s more to do with the fact that she’s repeating the same thing over and over again.
I can’t hear what the caller is saying, of course, but from Michaela’s insistent ‘Yes, I understand doctor, but I’m sorry to say we have no capacity’ it’s a fair guess it’s something like: ‘My patient is struggling and needs some care.’

It’s a conversation we seem to be having more often. And if the glib answer would be to point out the current state of the NHS and ‘the domino effect’ of public spending cuts, I suppose the one reassuring aspect would be that at least it isn’t a particularly long line of dominos. Four at best, with one really big, Treasury-patterned domino at the beginning.

In some respects, our service is a victim of its own success. Or at least, the clarity of our mission statement. The Rapid Response Team was set up as a three-day service to provide the clinical support, care and equipment someone might need to stay at home and avoid hospital admission. Our referrals come from four main places: the ambulance service, A&E, GP surgeries and the District Nurse clusters, with some additional patients from other community healthcare agencies. In the context of this bewildering mesh of services, the simplicity of our aim makes us a clear target. As things have got tighter we’re increasingly seen as the fixers, a kind of NHS marine corps, the thin red line between The Service and The Courts.

Which brings me back to the doctor on the phone, and the dominos.

When Michaela says we have no capacity, what she means is that our carers are working at full stretch, with lots of patients still on the books after a month, many of them complex palliative cases that require double-up carers three or four times a day. And the reason for that is that there aren’t enough carers in the community to refer on to. And the reason for that is that councils across the country are buckling under the strain of maintaining adult social care services in the face of continuing budgetary cuts. And the reason for that is, well, the government.

‘Yes, I’m sorry doctor. But I’m sorry to say we just don’t have the capacity.’

And even though Michaela says goodbye very politely, and puts the phone down with admirable restraint, maybe it’ll be enough to add a little something to all the other shock waves currently playing out across the system, to join together into one big wave, that might finally start pushing the dominos back the other way, and setting things right again.domino

2 thoughts on “the domino effect

  1. In the US all of these people would be on their own, no one to come in and do any of the work that you do. No carers either. Looking at the senior population, we’ll assume they are over 67 and are on the government health care called Medicare. You don’t get any coverage for personal care like help going to the toilet. No help cleaning or making food or dressing. You can get a nurse in if you have complex care. Nothing like blood draws or observation things like blood pressure or temperature or urinalysis. If you need equipment like a walker (zimmer frame) or a bedside toilet, you get to pay 80% of what Medicare pays for it.

    As bad as it is in the UK, seniors still get more care from your stressed services than they do in the US at the best of times.


  2. That’s a very salutary comment, B!

    It’s worth being reminded that as bad as things get here, they could certainly be worse. It’s hard to imagine how you cope in the US. I mean, I would think that in many cases the family manage somehow or other, but still there must be plenty of examples of suffering & neglect (God knows there are enough of those here, even with all the safeguards). With the demographic changing, it’s probably true the model needs to be rethought and creative solutions found. But I think the basis of the NHS is worth fighting for. Difficult as it might be, the alternatives are unthinkable.

    Thanks very much for the comment, blargh. Hope all’s good with you.


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