Don't get old and ill in this country

[mr_mastiff]

We had a victory yesterday. The hospital has agreed to pay for the replacement hearing aids. I don't think they had much choice but it's welcome nonetheless.

 

Great news. Now for the complaint.

[Seminole]

Absolutely. They don't get off that easily. In fact, I'm a little annoyed that they didn't offer any assistance with the heading aids before this. They could have supplied a temporary solution but they never offered because, I guess, it would have been a partial admission of liability.

 

The crux of the matter is that they denied access to a specialist ward that could have dealt with my father's confusion better ( and reduced the chances of the hearing aids being lost) on the basis of his postcode.

 

As Sali mentions above, it's more than likely that I will end up screaming at the moon about this.

[mr_mastiff]

No use screaming. Have they given you a copy of the complaints procedure yet? If you hit a wall go to the next level of management.

[creepin60]

Success, or the start of some action at least. The complaints registered with PALS have actually been taken seriously and have been passed by PALS to the Trust head and the head of the heart centre. I just hope for my son's sake they get their act together and sort things out so that he doesn't get passed from pillar to post again, although I can see it's bound to happen. They've promised a full reply within their stipulated procedure time. We'll wait and see but there is no way they can dispute any of the points raised. Wonder what the reply will be?

[Lindamannion]

Risk assessment in relation to falls, yes they do that but they do not take any notice of it, my mother was assessed, and found to be a high risk, was moved out of hours to another ward with no notes, fell on the second night there, put back to bed and passed away 6 days later with brain damage, five doctors blatantly lied to cover this up and said she had a bleed to the brain and fell, this was subsequently dismissed after insisting an on autopsy, she died of a head injury, been through all the complaints procedures and same reply, thank you for bringing this to our attention, policies will be changed and so on, this was two years ago and nothing changed, same hospital under investigation this week. All so sad.

[creepin60]

Oh well, back to square one again. Son back in hospital again to have the procedure he should have had last time 3 months ago. Now it's more urgent but it's been 'planned' for Thursday. He's been transferred out of high dependency to that awful ward he was stuck on last time. Just as an instance of what goes on, how can they serve toast for breakfast without butter because they have run out? How can they 'run out' of cheese and biscuits. How can the nursing staff get an old guy out of bed with one of those awful gowns on and not close his curtains so as the poor old fella is manoeuvring all his worldly goods are in full view. No dignity whatsoever.

[Seminole]

I've now had letters from both the London Ambulance Service and Kings saying that they aren't able to respond to my complaints within their normal timescales as they are waiting for information. Never mind I'm patient.

 

Unfortunately my father is unwell again and has been in hospital for two weeks. His GP suggested that he should have some blood tests done after visiting him at home. He was taken to his local hospital in an ambulance. We waited for a couple of hours in A&E and he was then taken to a cubicle. His blood tests were fairly normal but they decided to give him iv antibiotics in case the kidney infection had come back. In the meantime my father because quite upset. He didn't know why he was there and wanted to go home. This got worse and worse the longer he waited. The doctor said he could go home once the antibiotics had been administered. By this time my father had become very confused and believed he was already at home. As he refused to use a wheelchair I then had the unpleasant experience of seeing the doctor and nurse (and eventually security) trying to literally walk my dad out of the hospital. Without going into more detail, they eventually decided that he was unsafe to go home and admitted him.

 

It turns out that he didn't have a kidney infection and the antibiotics they gave him have caused kidney failure. His creatinine levels have peaked at 266 and are now slowly coming down. The kidney failure seems to have caused even more confusion.

 

The whole experience has been numbing. I appreciate that mistakes can be made but the consequences have been extremely unpleasant.

[mr_mastiff]

I hope your father gets the care he needs and recovers soon. I worked in renal medicine for many years if there is any way I can help let me know. MM

[Seminole]

Thanks MM.

 

I've decided to ask for a meeting with my father's consultant. I have no complaints about individual members of staff at the hospital but it's impossible to consistently speak to the same doctor. It also doesn't help that the start of the evening visiting hours coincides with a nursing and care shift change.

 

Part of the reason for meeting the consultant is that I'm none too pleased with the discharge arrangements they seem to be making. I have asked several times whether my father has dementia and for a differential diagnosis if he does. The psychiatric team assessment simply resulted in a recommendation for an emergency placement and a financial screening. No mention of a diagnosis, a continuing care assessment, care plan or liaison with me as next of kin.

[mr_mastiff]

Seminole, while he is confused and there are possible physical causes the Psychiatric team will not give a diagnosis. When I worked on the wards we would start making plans for discharge almost as soon as the patient was admitted. These plans would change from day to day as more information was gained from occupational/physiotherapy etc, I hope this is the case with your father.

 

The psychiatric team are playing it safe with an emergency placement it gives more time for a full assessment to be made of his care needs etc.

 

When you speak to the consultant you need to pin him down on the cause of your fathers renal failure/confusion, IV antibiotics may be one of many reasons. From your description of your fathers condition he is fail and there could be other reasons for his kidney problems.

 

You need to ask his "named nurse" about discharge arrangements, I.E as he been referred to social services, ask for details about occupational/physio assessments etc, Ask them to write it in the nursing notes that you are to be involved in all aspects of your fathers discharge. As next of kin this is your right.

 

If you have concerns ask the nurse to put them in the nursing notes, ask if these concerns can voiced during the ward round, part of a nurses duties is to be the patients/relatives advocate.

 

By getting them to document your concerns it does not give them wriggle room if your expectation for his discharge are not met.

 

Hope this helps. MM

[Seminole]

Thanks again. I've actually taken a slightly different route. So far when I've asked for things to be noted I seem to have been ignored or at least they are really bad at proactively feeding back. I've therefore emailed PALS with a series of questions set out below and asking that they pass this on to the relevant person.

 

1) I have been told on at least three occasions that my father’s current acute kidney failure was caused by the antibiotics he was given when he went to A&E on 15 October. Please could you confirm this and whether he was suffering from a kidney infection when he was given the antibiotics?

 

2) Are you able to determine the extent to which my father’s current confusion/ delirium is due to the kidney problem rather than any cognition/ dementia issues?

 

3) Please confirm whether, if antibiotics were used inappropriately, this will have a long term impact on his cognition/ behaviour. If this cannot be determined at this stage, please confirm when you will be able to make this assessment.

 

4) My father was diagnosed with mild cognitive impairment by the Memory Clinic in May. Please could you confirm whether this has now evolved into dementia and, if so, please provide a differential diagnosis of the type of dementia.

 

5) If my father has dementia please confirm that you will develop a treatment plan including medication, if appropriate.

 

6) Please confirm whether my father currently has capacity to determine his future care arrangements. If, as I believe, he does not do so currently, please confirm that this will be tested again as part of the discharge process? My father has previously expressed very clear views about his care arrangements and where he wants to live. I appreciate that the situation has moved on but I would not want a temporary impairment of his faculties through a kidney problem to mean that his wishes are overridden.

 

7) The doctor I spoke to yesterday said that my father’s psychiatric assessment had resulted in a recommendation for an emergency placement and financial screening. I am extremely disappointed that I had to ask about this rather than be contacted. I am the next of kin and I would expect to be involved in the discharge decision making process. Before any decisions are made I would expect you to diagnose my father’s condition and determine the impact of his kidney problems on his care needs. I would also expect you to undertake a Continuing Care assessment especially if my father has an ongoing high level of confusion caused by his kidney failure.

 

8) If my father lacks capacity in the long term I want to be involved in determining how his care should be provided. In particular my wife and I would be happy for him to move in with us provided that we could arrange an appropriate level of care. Clearly this would not be possible if he has long term behavioural issues that could only be addressed in a care or nursing home environment. Please confirm that the hospital/ social services will produce a care plan based on his diagnosis before he is discharged.

[mr_mastiff]

Seminole, Direct and to the point, Good one.

[Seminole]

Well that was interesting. I had a voicemail from the consultant (I was on the phone when she rang). I called straight back but she had left the ward. Apparently I might be able to catch her on the ward between 10 and 11am tomorrow or more likely Thursday. The other doctors can't discuss my Dad's future with me. Not stressful at all. I'd like to see a private healthcare provider work like that but what should expect for £5k in tax a year.

 

I've found the consultant's email address on the hospital web site and I'm quite tempted to write to her...

[mr_mastiff]

Well that was interesting. I had a voicemail from the consultant (I was on the phone when she rang). I called straight back but she had left the ward. Apparently I might be able to catch her on the ward between 10 and 11am tomorrow or more likely Thursday. The other doctors can't discuss my Dad's future with me. Not stressful at all. I'd like to see a private healthcare provider work like that but what should expect for £5k in tax a year.

 

I've found the consultant's email address on the hospital web site and I'm quite tempted to write to her...

 

 

Better to get his medical secretary. See if they have a fax/email number you can contact them on. Have you asked if you can be on the ward round so that you can act as your fathers advocate? Your father made his wishes know to you! and in his confused state you should represent him.

[Seminole]

It's been a very busy week.

 

I had an hour with the consultant and it was actually helpful. She diagnosed vascular dementia with, sadly, a prognosis of 6-12 months. She recommended admission to an EMI home with nursing facilities. Since then I have moved my father into a specialist dementia nursing home and he is settling in well.

 

As he has savings we are paying £1,100 a week of which £110 will probably be paid by the NHS for the nursing element of his care. I had to ask three times for a continuing care assessment and one was done just before he left hospital. It's being posted to me. I was told several times that he almost certainly wouldn't qualify but I had more of a sense of budgets being defended than anything else. I'll decide what to do when I get the paperwork.

 

Right back at the beginning of all this I said that I wasn't particularly interested in seeking compensation but given the costs that my family is faced with I want to revisit this. The problem is that I don't know where routine lousy NHS treatment starts and actionable negligence begins. I am waiting for the results of complaints but I would be interested in any views. The specific issues are:

 

1) A delay of an hour and 41 minutes before the ambulance turned up when my Dad had his fall. He had a serious head wound but was conscious. It seems to me that the ambulance service was playing russian roulette with the health of a 92 year old man. The delay does not seem to have had serious health consequences but it could have done so. I suppose the other question is whether the fall might have been caused by the mini strokes my father seems to have been having and whether quicker treatment would have reduced their impact.

2) The failure of the Trust to place my father in an appropriate ward. They left him in a noisy and confusing acute ward and denied him access to a geriatric ward based on his post code.

3) The acute kidney failure during my father's recent hospital stay caused by the use of antibiotics to treat an infection that he didn't have.

 

I suspect that there's nothing here that's actionable. However, I would like to find a way to persuade the NHS to fund more of the nursing home fees assuming that they turn down continuing care.

[mr_mastiff]

Seminole,I am sorry to hear of your fathers poor prognosis, I just had an MUA and i am struggling to type. Give me a couple of days and I will get back to you.

[Seminole]

Thanks mm. I hope you feel better soon.

[Nystagmite]

Sorry to hear that x

[mr_mastiff]

It's been a very busy week.

 

I had an hour with the consultant and it was actually helpful. She diagnosed vascular dementia with, sadly, a prognosis of 6-12 months. She recommended admission to an EMI home with nursing facilities. Since then I have moved my father into a specialist dementia nursing home and he is settling in well.

 

As he has savings we are paying £1,100 a week of which £110 will probably be paid by the NHS for the nursing element of his care. I had to ask three times for a continuing care assessment and one was done just before he left hospital. It's being posted to me. I was told several times that he almost certainly wouldn't qualify but I had more of a sense of budgets being defended than anything else. I'll decide what to do when I get the paperwork.

 

Right back at the beginning of all this I said that I wasn't particularly interested in seeking compensation but given the costs that my family is faced with I want to revisit this. The problem is that I don't know where routine lousy NHS treatment starts and actionable negligence begins. I am waiting for the results of complaints but I would be interested in any views. The specific issues are:

 

1) A delay of an hour and 41 minutes before the ambulance turned up when my Dad had his fall. He had a serious head wound but was conscious. It seems to me that the ambulance service was playing russian roulette with the health of a 92 year old man. The delay does not seem to have had serious health consequences but it could have done so. I suppose the other question is whether the fall might have been caused by the mini strokes my father seems to have been having and whether quicker treatment would have reduced their impact.

2) The failure of the Trust to place my father in an appropriate ward. They left him in a noisy and confusing acute ward and denied him access to a geriatric ward based on his post code.

3) The acute kidney failure during my father's recent hospital stay caused by the use of antibiotics to treat an infection that he didn't have.

 

I suspect that there's nothing here that's actionable. However, I would like to find a way to persuade the NHS to fund more of the nursing home fees assuming that they turn down continuing care.

 

Seminole, Hi mate My first question would be "What was the cause of my fathers ARF if was not an infection"? Could he have chronic renal/acute on chronic renal failure due to his on going vascular disease?

 

How did the consultant arrive at her diagnosis of vascular dementia? Please read the following document.

 

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=161

 

After you have read it ask yourself was my father showing symptoms after he was discharged the first time from hospital? From what you have written I would be concerned that due to his strokes (TIA,S) that this diagnosis should have been considered during his first admission!

 

Obviously if his dementia was stroke related and not picked up then your point 1 would be very relevant because any delay would have caused greater damage.

 

When you read the document I think you will understand why you need to question events and diagnosis on his first admission.

 

Sorry its short but my arms and hands are not working too well at the present time.

[Seminole]

Thanks for this mm. I'll read thoroughly later.

 

Unfortunately things have moved on and my father is back in hospital with a very serious chest infection and further kidney problems. The prognosis is quite poor but his vital signs are stable.

 

At the risk of sounding like a broken record, his discharge from hospital seems to have been poorly handled. I and others drew the hospital's attention to throat problems that he seemed to be having. Initially I noticed that he sounded as if he was gargling when he spoke and others noticed a cough. These were mentioned to the hospital who said that there wasn't a problem.

 

The hospital also failed to mention the massive bruising on his back that the nursing home found and photographed when he was admitted. None of this was recorded in his discharge documents. His new hospital has made a safeguarding referral.

 

I really am beginning to wonder just how poorly the elderly are treated by the NHS. My father has a number of people looking out for him and he gets treated appallingly. What happens to those that don't have anyone?

[mr_mastiff]

Seminole, You are not sounding like a broken record, there is something very wrong here! I know you are very concerned about your father and understandably have lots on your mind so I will keep checking in in case you need a rant or have any questions. My thoughts are with you in this difficult time. MM

[Nystagmite]

I echo MM's comments. It's good that he has someone like you looking out for him.

[Seminole]

Another quick update. Sadly my dad passed away yesterday. He was 92 and had had a good innings. It was very peaceful in the end and the palliative care he received in his last days was excellent. This thread began with a rant about the NHS. From his treatment at St Peter's in Chertsey I can see the NHS can actually be good sometimes.

 

I'm going to let the dust settle for a couple of weeks but I do intend to pursue the previous issues with renewed vigour. The money aspect is now irrelevant but I do want to try to hold the system and individuals to account for their mistakes and failures. My Dad would clearly have passed away at some point but I think they may have shortened his life by at least a few months.

[honeybee13]

Hello Seminole. I'm really sorry to hear that your Dad passed on. I won't insult you by saying I know how you feel because this hasn't happened to me yet. I think you have done your best for him.

 

May he rest in peace.

 

Hugs, HB

[mr_mastiff]

I am sorry to hear of your loss. I wish I could say more but words seem so inadequate at a time like this. My thoughts are with you.