Feelings of an ad hoc carer and frustrated professional

Just now I'm aware my mum is undergoing a endoscopy and I'm at home after spending a few days with her. In my earlier post about the NHS in November 2017 I laid out my views of what we were experiencing.  
Now it's time for an update and perhaps less positive reading.
After discharge from a 3 week stay in a rehabilitation bed the Friday before Christmas mum was experiencing trouble with reflux from what we eventually discovered (in a post Christmas telephone call with a GP) was a sliding hiatus hernia. This was known about in hospital yet no mention of it was ever made.
Mum has gradually regained her mobility and with support from the family and neighbours was managing just about at home. 
The big problem has been to get anyone to take her painful regurgitation and reflux seriously, along with her weight loss. For a serious cook like mum, who enjoyed a varied diet and particularly going out to eat the reduction in appetite and feelings of hunger have been a depressing downward spiral with no sign of improvement. 
The oral medicines prescribed to improve the situation were having no chance to work.
We've tried all sorts of things; bed head end elevated, mum using the internet to make sure she was using NHS advice for her diet and the variety of medication that was promised to make a difference.
Only this week have we got a GP to call round; the vomiting of almost every fluid and food mum has tried to take was largely ignored because its all 'infection'. Mum has lost half a stone in recent weeks and we believed we were approaching a crisis point that could surely have been anticipated with better community support. The community nurses who visited shortly after discharge told mum they'd keep an eye on her; though hearing impaired mum got the (correct) impression she'd not see them again. 
The senior GP who mum got through to thought she was calling her rehab place; we'd made it clear to the surgery that mum was home...
So between family members and her marvelous neighbours we've tried to find attractive foods and fluids; my catering experience helped here though only marginally.
This week, having been forced to take a frail and low energy mum to the local hospital for a blood test we reached crisis point. The 111 doctor called to say her bloods deranged and needs to go to hospital. So mum is now back in hospital and having her endoscopy. We'd considered getting a private consultation to see if we could get someone to take notice. 
For us, and my experience in the last week this seems unnecessary; felt like trying to keep mum out of hospital (understandable in some way given recent news) though at the expense of ambulance crews and long (overnight) waits in A & E. And we had more than one nurse advocate trying to get help for her. 
Where is the multi professional review and support for older people in the community?
Were mum without family and her support network I dread to think what would have happened. 
It's frustrating and we have some inside knowledge that you would expect to help get us further; it's frightening too.
Right now I have to trust my hospital colleagues and keep faith in the system overall; for Mum and as so many other carers have to do day after day.
As I finishing writing this mum's GP surgery have called me - they're trying to get hold of mum and wondered where she was - her blood results need rechecking... they are surprised (and relieved) she's already in hospital... where's the communication? 

The NHS as I see it just now

This feels a little tough to write; my lovely energetic mum has acquired a chest infection that's making her very ill so she's now in hospital with the NHS team doing its best to help her. We've visited  three clinical areas after A and E, and at the time of writing mum is in the ITU having supportive ventilation. 
An impressive array of clinical staff have been involved in delivering her direct care supported by a larger army of support workers and those whom we'll never see. 
My observations -

• #HelloMyNamesIs has not penetrated everywhere yet which feels disappointing though there have been many who have introduced themselves and wanted to know and use our family's names
• Car parking fees are crippling unless you're eligible for a special deal so ITU admission will save us money (mercenary on my part I know, and I wonder how those with lower incomes manage)
• There's a great focus on finding out about the person needing care and including us in conversations about options for care such a DNACPR
• All this work is being supported by people who are from around the world as well as those locals who are living down the road having been born in the same hospital 
• Limitations on immigration (and the current drop in nursing numbers linked to Brexit) will have dramatic impact in the near future 
• Outsourcing to private companies is increasing; depriving trainee GPs of pay for example; ward cleaning and catering have gone the same way and only personal teamwork based relationships ensure smooth working
• Busy staff can seem uninterested however we don't know how long they been at work that day nor what they have had to deal with so far 
• Cooperation with the caring team helps even in the times of uncertainty
• The gift of a cup of tea or coffee is a sign of caring for individuals and is much appreciated; however if providing tea and coffee making facilities please make it easy to find cups and water for the kettle; we're happy to do the rest
• The estate is often old and can look rough; even so I saw signs that reuse, refurbishment and rebuilding is going on. That said toilets out of use for some days because the drains are blocked is not good and symptomatic of the privatisation relationships 
• A and E queues for ambulance teams are so wasteful of all those resources; let's put money into getting people home and supporting them there
• Link the technology; observations made on one ward and recorded via the handheld device cannot be seen on another ward (?) after transfer. Hand written notes mean we have to repeat the stories
• Please be prepared to repeat instructions to dazed and anxious visitors like the cheerful security desk lady did
• Nursing - so much technological expertise required and this needs mixing with empathy and genuine communication; that combination will win the trust of the person in your care as well as their loved ones

Overall I've been deeply impressed with the dedication and commitment of those we've come across; the NHS is an institution that comes in for criticism too easily too often and what I've seen today shows a multi-faceted, multi-talented, multi-national workforce freely available to do their best for those in need. This is to be applauded and protected; it is something that our family is immensely grateful for.

Being a target

Those who follow my tweets and those who access my Facebook page might have seen my posting about my health incident this last weekend. Enjoying a 'self-care' stay at a hotel near mum's prior to the UK Mothers Day, I became unwell during dinner, experiencing severe abdominal pain and feeling feint. Within a few minutes the kind and helpful hotel staff along with Megan decided help was required. The London Ambulance Service crew showed up a few minutes later and took control of the situation. I remained conscious and with my first aid and nursing knowledge realised the possibility of either an aneurysm or heart attack were high on their list of concerns. Dodgy food was  considered though no evidence was seen.

I was soon in the ambulance and wired up to the ECG machine, whilst the crew calmly went about checking me over. Without further discussion we set off for the nearest A & E where after a few minutes wait I was loaded onto a trolley. At this point I'm sure the ambulance reached me inside 8 minutes, and I was dealt with efficiently so the crew were on their way after handover.
It was relatively early on in the Saturday evening so the staff were fresh and not under too much pressure; my vital signs were recorded by a RN who used hello my name is, nice! A cannula was put in my arm and bloods taken; Megan was asking if there'd been anyone in the lab to process them. I was sure there was; some things have changed a lot and I expect there was machinery close by for doing the analysis required; there has to be to aid meeting targets.

I was put into a single room and vitals checked again; different RN and no ' hello my name is ...'. A cheerfully helpful HCA recorded another ECG, and gave me a gown and blanket with an apology for the lack of a pillow. He was another 'hello my names is ...' hero along with the doctor who saw me. The HCA insisted I put the gown on (I kept my trousers and shoes on all through my stay) though I'd have preferred to stay in my T shirt; a curious requirement and no reason from my perspective. Does wearing the gown help differentiate me from visitors and make life easier for staff? Is this a money saving opportunity missed? On a similar point why not have universal ECG stickers so the ambulance ones aren't pulled off and new ones applied at hospital?

My main question I suppose is around the need to transfer me without question to A & E? Would a wait a little longer at the hotel have reassured all concerned it was a one off and that resting in the room would have been ok? Maybe with my insight I would have been ready to take the risk that it was a one off episode and did not need hospital intervention. I suspect though that algorithms and risk averse targets played a part in driving my care rather then patient choice and perhaps an application of experience and common sense.

Treated with warm politeness at the hospital, privacy and dignity were only nearly there. Wearing a gown as one carried a sterile pot to the toilet clearly shouted - "he's a patient off to do his urine sample" - amplified by the evidence visible in my hands on the return journey did dent both privacy and dignity. As a nurse its ok to walk about carrying other people's bodily fluids; as a individual carrying ones own, its a whole different situation. Within about 3.5 hours I was allowed out after some IV fluids and pain killers, clutching my blood results sheet - though not sure why I was given it. We dutifully completed the Friends and family test card. So, I was treated and moved on from A & E inside the 4 hours and the ambulance team did their job too in that regard; I was a target met.

Was I safe, cared for effectively, in a responsive manner by a well-led team? Yes, so CQC-wise I have no faults to mention. I am still left questioning whether the expense of resources for me was a good use of what was available that evening. I asked the senior nurse who helped administer my IV medicines about the coming shift; it was clear that my case was a straight forward one; single episode of nasty tummy pain that passed off quickly and simply. Yet to come for the ambulance and A &E teams was an after midnight rush of drunken fighters and fallers, that required an increasing police presence. That makes those public servants targets of a different kind, and a group of people for whom I have the greatest admiration.