In September last year I commented on my experience as a recent visitor observing the care received by a close relative as a hospital inpatient. This is an update based on another episode as a visitor observing yet another episode of hospital inpatient care experienced by the same close relative.
Many years ago I formed the view that rehabilitation was the cinderella of the NHS. The numbers of staff – physiotherapists, speech therapists, occupational therapists – were small, predominantly female and with little political clout compared with the much more numerous nursing profession and doctors. And, importantly, in the main doctors were ignorant about its method and potential and disinterested.
I had thought that over the years this truth had been recognised – not because I had pointed it out but because it was self evident – and that the rehabilitation arm of the NHS had been strengthened and given more prominence. In fact I think there has been a sea change in the recognition given to rehabilitation but in practice this has had little impact on what happens on the ground.
However, another recent experience of a hospital inpatient stay of an elderly close relative was profoundly depressing. Being bed bound is bad news for any patient but it is particularly so for the elderly. So, as soon as the medical condition which had occasioned the hospital admission was under control I expected the physios to come into their own in getting the patient out of bed and mobile. But this didn’t happen. For two reasons in my view. Firstly, there just weren’t enough of them to be able to spend time with the patient; and secondly, there seemed to be little encouragement from the nursing staff as having patients sitting out in chairs and being mobilised disturbed their routines and made giving drugs and attending to toilet needs more time consuming and difficult. So, many days were spent lying in bed with muscles and joints becoming weaker and stiffer; and pressure points put at risk.
The shortage of physiotherapists was also very evident when my relative was admitted some months ago to a community rehabilitation unit. I was led to expect that the rehabilitation regime would be really intensive and that this would be needed to recover the mobility lost through many weeks of being bed bound. In fact the rehabilitation regime was extremely low key because of a lack of physiotherapy input. I was told by the unit manager that the patient would do better at home where they would be able to access the community physiotherapy service and supplement this if necessary with private physiotherapist sessions. A remarkable admission I thought.
My conclusion from these exeperiences is that rehabilitation is still a cinderella service but that the main reason for this is not so much lack of priority and recognition of its importance as lack of funding.
On the basis of my recent experiences as a patient at one remove there is no doubt in my mind that the NHS is significantly underfunded and that this impacts very adversely on the quality of patient care. The aim must be to bring the level of funding up to the average level of other European countries – why should we think that we can deliver an acceptable service on fewer resources than our neighbours? To achieve this the country faces a difficult choice. Either we accept higher taxes to pay for this or we accept that “free at the point of use” is no longer sustainable and that patient contributions must be levied as they are for dental and opthalmic services. Or, that we change the whole basis of funding to an insurance based model.
It seems to me that this truth is now increasingly recognised. Unfortunately, it is only a Labour government that could get away with doing something so revolutionary to the NHS. The likelihood of a Labour government having the opportunity to do this in the near future seems rather low so meanwhile the quality of healthcare will continue to decline through increasingly severe underfunding. It will not just be a case of dreading needing to use the NHS at weekends – it is a source of amazement to me that the lack of a seven day service in the NHS has been allowed to exist for so long without evident complaint – but rather of dreading needing to use it at any time. A grim prospect indeed.
Dr Edmund Wycliffe, June 2016