Wednesday, 17 April 2013

Is this the new NHS or has it been this way for a while?

My father is about to have a hip replacement. It's the last of his natural major joints below the waist, so we joke that he is the bionic man. To be fair though he is 82, has type 2 diabetes and has become increasingly frail. The hip replacement will hopefully have a genuinely radical effect on his life, at the minute he is almost housebound as his pain is intense.

At his pre-operative assessment he went through the usual procedures, blood tests etc, but one aspect of his pre-operative assessment really stood out. While seeing the occupational therapist he was told, in what seemed very much like a pre-prepared statement:

"When you are on the ward you will be expected to care for yourself. You are not sick, you are well, and you have elected to have this surgery, so the nursing staff are not going to run around after you. If a situation arises where you feel you cannot do something for yourself you must press the call button and a nurse will come and assess the situation."

Now I used to work in the NHS, and I still do in an honorary role at two hospitals, and I haven't heard this before. Is it common practice? Is it just the opinion of one rogue member of staff?  I understand that there are pressures on ward staff, and I understand that some, maybe most, elective cases can self-care but my father is clearly frail. He is unstable on his feet, has lost weight in the past year, has several chronic health conditions and is not able to fully self-care (he hasn't been able to touch his feet for several years, since his knee replacement surgery). Surely a statement of this type should be made on a case by case basis, with those who are able being told that self-care is the rule. But for those who are clearly frail, surely a separate approach should be taken, one that highlights admissions as requiring more care. We used to call this care planning, and I assume something of this form still happens on admission. 

At a time when the NHS is facing accusations of a lack of compassion is this really the message hospital staff should be putting across?