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A pain in the back(side)

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I’ve just returned from a Sunday night shift for the local out-of-hours team.  A few triage calls, then I volunteered to take the home visit forty minutes across the county. 

It was an odd evening from thereon.  First, the home Cliff (the driver) and I were visiting was in the darkest backwater in the east of England.  Then, I couldn’t get in: I rang the main bell three times and the side bell too.  I even phoned, but the only noise coming from the former stately home was their phone ringing.  No one picked up.

Finally, just when I wondered whether some axe murderer was wielding his weapon on the top floor, there was a flicker of movement and the carer let me in.  The patient was quite the wellest centurion I’ve ever met and after a normal examination, I gave my assurances and left. 

More weirdness next as the Urgent Care Vehicle refused to start.  Cliff rang the RAC and I imagined hours of the morning spent stranded in an ancient home for the aged, in Nowheresville.  I returned to the enormous front door and rang again.  We explained to the carers what had happened and they invited us in for tea whilst we waited for recovery.

Our discussions in the kitchen turned to paramedics.  ‘They can be proper moody when we ask them to pick a patient up,’ a carer commented.  ‘Really, why’s that then?’ I asked, with Hunt’s plans for pre-hospital care and named GPs fresh in mind.  ‘Well, it’s the waste of money: £250 for a call-out to help us lift the resident back into bed.’  I asked why the paramedics were called in at all.  They told me that if a resident falls, they need hoisting back into bed or chair.  Fair enough.  Carers are not permitted, under any circumstances, to lift: any resulting back injury is deemed entirely their own fault.  In other words, if they knacker their back and can’t work, they don’t get paid.

And where do the ambulance service come in?  The protocol runs like this: resident falls. Try to use hoist. If unhoistable (tricky resident location or hoist on wrong floor of building), phone for ambulance. Paramedic then has to attend to help resident off floor, attracting large and frankly ludicrous call-out cost to NHS.

Private care homes across the country are, due to their conditions of employment, costing the NHS a fortune.  Care staff are petrified to help their residents because one dodgy maneuver and they’re on statutory for six weeks.  To prevent the risk, when Doris goes down, they dial 999.  Is it just me or is that insane?  Surely the ambulance call-out tariff should be charged to the private care home who’s skinflint policy prompted the call-out, rather than the NHS? 

By all means give everyone over 75 a named GP.  Do equip paramedics to see and treat on-site.  Get community teams out in their droves to assess for falls risk and prevent admissions.  None of these interventions, however, will prevent the absurdity I heard about that night.  The most sensible comment came from the 102 year old, who said that my visit really was a fuss about nothing.  Agreed.  Yet, all in, it still cost the taxpayer a hefty sum. 

Tom Gillham is a GP in Hertfordshire and Specialty Doctor in A&E. You can follow him @tjgillham.

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