NHS=Negligent Health Service

[heeeed]

There is not a doctor I know that wouldn’t happily ditch sick notes. It is essentially impossible to do perfectly. Let people self certify for a period and then make an employer pay for a more fulsome occupational health assessment. Companies ‘win’ in the current situation in that it mostly works and they avoid the added cost to their business of lots of assessments. They ‘lose’ in that it is open to abuse and a higher level of uncertainty. If your company feels that they aren’t worth the paper they’re written on then pony up to one of the many occupational health companies and have that written into your staff handbook.

Other than when the issues is stress from their work then me providing a sick note really isn’t part of me providing healthcare, it’s entirely an occupational issue and I believe I can quite validly state it’s not my problem.

 

[Dis86]

There is not a doctor I know that wouldn’t happily ditch sick notes. It is essentially impossible to do perfectly. Let people self certify for a period and then make an employer pay for a more fulsome occupational health assessment. Companies ‘win’ in the current situation in that it mostly works and they avoid the added cost to their business of lots of assessments. They ‘lose’ in that it is open to abuse and a higher level of uncertainty. If your company feels that they aren’t worth the paper they’re written on then pony up to one of the many occupational health companies and have that written into your staff handbook.

Other than when the issues is stress from their work then me providing a sick note really isn’t part of me providing healthcare, it’s entirely an occupational issue and I believe I can quite validly state it’s not my problem.

You can state it's not your problem - that's true. But you can be creating problems for others as a result. Unfortunately many small businesses can't afford OcHealth contractors and even having just a few staff off can be enough to drive them under.

 

[heeeed]

Central serous retinopathy. First thing I mentioned was I'd fallen when bouldering and banged my noggin on the way down, that side making impact. Booked me an appointment at the eye hospital and offered to write me a sick-note for stress.

So he thought you needed time off, maybe he even thought you had CRS at that point when he referred you and stress as a cause (much more likely than trauma really). Personal I’d have simply labelled it as ‘visual symptoms’ or something like that, but I’d have offered you a note particularly if you were badly enough affected to have risks in eg driving

 

[Werewolf]

There is no investigation for most conditions that people are signed off for - stress/chronic pain/fatigue, so I don't know what you're expecting the GP to do other than listen to their patient and act accordingly.

Plus there is the conflicting interest of being the patients advocate vs deciding whether or not they're fit to work when they're telling you they are not.

Aye

I mean IIRC there is no clinical/chemical* test for CFS/ME despite it being around and recognised for something like 30 years, from memory it's a diagnosis over time and by ruling other things out, and none for long covid (although I did see something about a possible way to quickly screen for microscopic blood clots that IIRC are thought to be part of the damage covid does).
then there are things like IIRC they only recently found out one of the classic virus's did some major damage to the immune system (was it measles could cause it to forget some of the diseases it had previously encountered?)
I think some people forget how variable and imprecise the human body is, and how poorly we understand a lot of things/can't test because there isn't some simple blood test that can show pain (not to mention different people handle pain differently to begin with), so the GP often has to use their judgement based on what the patient says and their observations.

I had a period for several years where I was routinely coming across really faint (to the point of collapse), multiple trips to the GP but nothing ever showed up because by the time I'd got to the GP (usually a day or two later) whatever was going on had passed, so there wasn't any test the GP could do but he did believe me and referred me for some tests (which didn't show anything), in part because he'd known me for a decade, something that is really rare now (my current GP's practice seems to completely change GP's every couple of years**).

*IIRC the only two I'm aware of for ME/CFS for example are experimental involving proteins in the spinal fluid that one of the US military hospitals found when they went looking into GWS and noting how ME/CFS had similar symptoms included them as an additional test group when they looked for anything unusual (IIRC it was something like 20 proteins they only found in all the CFS/ME/GWS patients and not the control group, and another bunch hat were found only in either the GWS or the ME/CFS patients), the other thing I read was a test that looked at the chemical production in the muscle found something odd. Neither were/are practical for mass testing and needed a lot more research.

**It turns out everyone's "named" GP is "Dr Pooled List".

 

[heeeed]

You can state it's not your problem - that's true. But you can be creating problems for others as a result. Unfortunately many small businesses can't afford OcHealth contractors and even having just a few staff off can be enough to drive them under.

As I said, on the whole companies win from this free service, but it isn’t perfect. who should then pay for it to be nearer perfect? It would have a cost and quite significant to provide a good deal more

 

[Dis86]

So he thought you needed time off, maybe he even thought you had CRS at that point when he referred you and stress as a cause (much more likely than trauma really). Personal I’d have simply labelled it as ‘visual symptoms’ or something like that, but I’d have offered you a note particularly if you were badly enough affected to have risks in eg driving

I had a small blind spot and straight-line distortion to about 20% of my vision in one eye only. There was absolutely no discussion around stress or anything else. I literally got the appointment, described by symptoms, told him about my accident the day prior to the symptoms (which featured some lovely bruising by then) and that was it!

 

[heeeed]

Id probably agree then that as a cause was probably not great tbh and I’d have used different terms

 

[Dis86]

Id probably agree then that as a cause was probably not great tbh and I’d have used different terms

Absolutely. As it stood I had no intention of nor need to take time off work.

Nor did I get an eyepatch which was disappointing.

 

[ubersonic]

Sorry, only just had the notification for this.

iFit is our software for tracking hand held patient notes, they have a barcode on them but people don't track them.
Yes you can go down a tracking list but unlike our last system called FileFast, iFit only shows the odd tracking here and there.
I have asked the Health Records Manager if she has a higher access to see all tracking but she sees exactly what I see therefore I'm looking at iPortal which shows a patients journey and contacting everybody who may have had the records.
When you eventually locate them the reply is usually "I don't have time to track them"

Sounds like your trust may have cheaped out on implementing iFit

The way its supposed to work is that the barcode labels have RFID tags in them, and the hospital(s) get fitted with iFit sensors on corridors, thus the system can see the records being moved and auto track them, so even if somebody doesn't scan or loses one it shouldn't be any worse than "it's in room X and arrived at Y time".

 

[SexyGreyFox]

Sounds like your trust may have cheaped out on implementing iFit

The way its supposed to work is that the barcode labels have RFID tags in them, and the hospital(s) get fitted with iFit sensors on corridors, thus the system can see the records being moved and auto track them, so even if somebody doesn't scan or loses one it shouldn't be any worse than "it's in room X and arrived at Y time".

Wow, no ours are normal printed labels and we manually type them in unless you're the 1% who may have a scanner.

 

[Minstadave]

Wow, no ours are normal printed labels and we manually type them in unless you're the 1% who may have a scanner.

We've not got anything more fancy either.

 

[Scougar]

Dad was telling me that NHS has gone down hill massively. I'm not there so I get all news second hand now.

Doctors office they all work part time. Can barely get an appointment and have to wait weeks.

Derriford Hospital, family friend was put in a cupboard as they had no beds, and waited FIFTY hours to be seen. They had blood poisoning... /facepalm. Her daughter is a nurse, and basically came in and took care of her when the staff at the hospital couldn't. He claims that a lot of this is due to old people being long term in hospital due to no support network in place for the elderly anymore since covid, and getting rid of care homes etc, and that care people decided for a better quality of life by getting other jobs other than care work.

Question: Has it truly come this bad??

I was surprised to hear my parents say they are glad they have private health insurance.

My dad is no fan of the conservative government as having worked for the gov for most of his life, has seen things being intentionally destroyed in order to be privatised. (making departments etc so inefficient intentionally so they can claim that privatisation is the only cause of action, so MP's and their buddies can get rich in short. i.e. corruption).

 

[Minstadave]

Dad was telling me that NHS has gone down hill massively. I'm not there so I get all news second hand now.

Doctors office they all work part time. Can barely get an appointment and have to wait weeks.

Derriford Hospital, family friend was put in a cupboard as they had no beds, and waited FIFTY hours to be seen. They had blood poisoning... /facepalm. Her daughter is a nurse, and basically came in and took care of her when the staff at the hospital couldn't. He claims that a lot of this is due to old people being long term in hospital due to no support network in place for the elderly anymore since covid, and getting rid of care homes etc, and that care people decided for a better quality of life by getting other jobs other than care work.

Question: Has it truly come this bad??

I was surprised to hear my parents say they are glad they have private health insurance.

My dad is no fan of the conservative government as having worked for the gov for most of his life, has seen things being intentionally destroyed in order to be privatised. (making departments etc so inefficient intentionally so they can claim that privatisation is the only cause of action, so MP's and their buddies can get rich in short. i.e. corruption).

It's got very bad. Especially in adult inpatient care. The issue is partly difficulty in getting people home with appropriate care but also a massive lack of beds per capita.

NHS Hospital Bed Numbers: Past, Present, Future | The King's Fund

The number of hospital beds in England has more than halved over the past 30 years. This explainer looks at data on hospital beds, explores the drivers underpinning the changes it shows, and considers whether further reductions to bed numbers are realistic.

www.kingsfund.org.uk

We just don't invest in enough capacity and haven't for many years. When was the last time a new acute hospital was built? Not one to replace an old one, a bona fide new hospital?

 

[cheesefest]

My grandmother had a fall and when admitted to hospital, she was tested for various things. One of them was covid and was tested positive. She stayed in hospital for 5 weeks in total with getting water infections and other infections.

No care package was given and my aunt had to drive 40 mile round trip to collect the various things like perching stool, commode etc.

Had four care visits daily at home. Sometimes the gap between care visits could be 1.5 hours and sometimes as much as 9 hours. She should have never gone home as she was frightened and kept having falls. Plus the carers when they came round, they asked her what she wanted to eat. My grandmother has dementia and can't process open questions. She asked for something like toast and jam and that she got. Lost weight dramatically. If she was asked, would you like A, B or C, she would been able to process this with ease. The carers just ask what they want and not give them a choice.

For ten days after she went into a care home, my aunt and dad got phone calls from care staff asking why she isn't at home - they have a key accessed in a key safe near the front door. Both said she is now at a care home, so please update records so not to visit. Even contacting the carer 'hub' made no difference either. I feel sorry for the carers driving about 5 miles between patients wasting their own petrol etc. My aunt's grand daughter is a mobile nurse who specialises in taking blood tests etc at disabled people's homes and gets the odd visit where the patient isn't there for various reasons, usually at hospital as an inpatient.

Communication needs to be improved vastly.

 

[cheesefest]

It's got very bad. Especially in adult inpatient care. The issue is partly difficulty in getting people home with appropriate care but also a massive lack of beds per capita.

NHS Hospital Bed Numbers: Past, Present, Future | The King's Fund

The number of hospital beds in England has more than halved over the past 30 years. This explainer looks at data on hospital beds, explores the drivers underpinning the changes it shows, and considers whether further reductions to bed numbers are realistic.

www.kingsfund.org.uk

We just don't invest in enough capacity and haven't for many years. When was the last time a new acute hospital was built? Not one to replace an old one, a bona fide new hospital?

The UK is full of NIMBYs so if a hospital is planned, people will object for busy roads, people parking everywhere to avoid parking etc.

 

[Werewolf]

The UK is full of NIMBYs so if a hospital is planned, people will object for busy roads, people parking everywhere to avoid parking etc.

Hospitals are probably one of the few things most people wouldn't object to being built nearby.

I've noticed that it seems every time the developers put forward proposals for massive new housing projects near me they tend to always throw in a proposed "care hub", so far none of the developers have actually built one (they seem to run out of money for the project sometime between building the last house, and building any of the "community" parts of the development, which has happened about 4 times now).

 

[Blackjack Davy]

He claims that a lot of this is due to old people being long term in hospital due to no support network in place for the elderly anymore since covid, and getting rid of care homes etc, and that care people decided for a better quality of life by getting other jobs other than care work.

Question: Has it truly come this bad??

Bed blocking? Yeah, they're medically fit to discharge but nowhere for them to discharge too as there are no social care facilities available to put them into they can't just dump them on the pavement, it is a well known fact and the govt doesn't have a plan/have a clue what to do about it almost certainly because they don't want to spend any money on it. They keep burying their head in the sand deflecting all questions and hoping it goes away. And it won't. And yes, it really is this bad.

I was surprised to hear my parents say they are glad they have private health insurance.

For routine treatment it is probably the best option people are even opting to pay for hip replacement privately because they can't stand waiting years for it, 15k currently. Its not a panacea however because if something goes wrong and they frequently don't have the equipment to deal with it patients get dumped back on the NHS anyway

 

[SexyGreyFox]

Bed blocking?

We have over 250 patients Ready To Discharge but nowhere to go.
Most of the time it's their children who won't have them or 'can you wait until the weekend?'.

 

[cheesefest]

We have over 250 patients Ready To Discharge but nowhere to go.
Most of the time it's their children who won't have them or 'can you wait until the weekend?'.

Mum had knee and hip replacement surgeries. On the morning of her going home, she’s told that she’s going at 10am. It’s not until 5pm by the time she gets her discharge notes etc.

As how many times have people had surgery cancelled on the day due to no beds? It’s those like my mum who were in hospital for 7 hours longer than expected. Then this denies someone else having surgery that day.

 

[Chris Wilson]

We have over 250 patients Ready To Discharge but nowhere to go.
Most of the time it's their children who won't have them or 'can you wait until the weekend?'.

We, (the white English in general), have an appalling record of looking after our elderly relatives, even our own parents. It's not something you see such an issue with in the Asian communities, I think you might agree?