Of all the animals of prey, man is the only sociable one.
Every one of us preys upon his neighbour, and yet we herd together.
The Beggar's Opera: John Gay

Monday 3 December 2012

Physician, heal thyself (and thy administrative staff)

In today's news of hospitals 'full to bursting', one figure in particular caught my eye.
Up to 3% of beds are occupied by those with dementia and hospital care would have little effect.
While I can't claim extensive experience in the area, it entirely bears out what I have seen of a system that is far from ideal.

In the first place, the pressures on the system and the fact that some of the agencies concerned function on a geological timescale mean that it can take years to arrange help for someone with dementia, assuming you have actually managed to get a diagnosis.

As a result, the majority of admissions to dementia wards, at least according to nurses I have spoken to, are via A&E, after a fall or being found wandering outside in cold weather. Once they have been restored to physical health, the fun begins.

For those patients who need secure residential care, a place must be found in a suitable nursing home. Thus it was that I had the dubious pleasure of meeting a woman whose job was to match patients with care home places.

It began in a less than auspicious fashion. With a two-hour drive home ahead of me, I was looking forward to getting things sorted quickly; I didn't know then that she and her sort run on what I have since come to think of as 'public sector time'.

More than half an hour after the appointment was due, she finally hove into view at reception, brushing chocolate crumbs from her face. I was ushered into her office, where she resumed her half-drunk cup of coffee and unhurriedly produced a stack of forms.

Over the next quarter of an hour or so, I appear to have got the better part of the deal; while she managed to fill in barely three pages - mostly tick boxes - of my relative's details, I acquired a positive cornucopia of information on the small doings of her four-year-old daughter thanks to her constant chatter on the subject.

At 3pm precisely, she finished her (third) biscuit, drained her cup and stacked the forms on the desk, announcing she had to collect her child from pre-school.

"But what about a care home place?" This was, after all, the whole reason I was there.

She handed me a brochure from the desk drawer: "There's a list of homes in here," she said, "Just phone me when you've made up your mind which one". And with that, she was gone.

Fortunately the story ended well, but she left her mark on the case; one of those boxes she ticked so blithely - I think she was answering her phone at the time - turned out to have been the opposite of what I had told her; had we not been able to find interim funding, the care home place I arranged would have been lost as a result.

It's hardly surprising, therefore, that the dementia ward, according to the nurse I spoke to, was full of patients who should have left hospital long before.

I  wish I could say my experience was unique; sadly that 3% suggests otherwise.


  1. "I wish I could say my experience was unique"

    Not even unusual I suspect. My experience was similar, particularly the woman with chocolate crumbs on her face. I met one like that too.

    Not even a glimmer of interest in doing a professional job, or in putting aside the demands of her private life.

  2. Up to 3% of beds are occupied by those with dementia and hospital care would have little effect.

    3% eh? Wonder if they can find room for me.

  3. Apparently, an increasing number of care homes now avoid dementia cases and it is becoming tricky in some areas to find a placement.

  4. AKH, you sum the type up very well indeed.

    The resemblance among the breed is so striking that I'd be wondering if there is a factory somewhere turning them out, had I not seen the formative process in action.

    A temp job in a public sector office introduced me to the culture of 'office queens' - large women who dictate the pace of work (glacial) and the number of tea breaks (frequent) and are waited on by an awed coterie of junior filing staff, who hang on their every word.

    The junior staff grow up to man the reception desks and record-keeping departments of the public sector armed with the values they learned from this monstrous regiment.

    James, not unless you contrive to break a hip or be found half-dead of exposure on the bypass at 3am - though I do know of one unfortunate woman whose admission was the result of frying her breakfast in washing-up liquid.

    Demetrius, you are, sadly, right; places are few and far between in some areas, which makes it all the more essential that relatives can call on a diligent and conscientious placement officer to act on their behalf and coordinate the search


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