“He’s swimming in shit…and they told me to speak to my GP if I have any problems!”
The exasperated words of one of our patients whose father had just been discharged from our local hospital, having had a stroke and pneumonia and was previously continent. Our local hospital has an enlightened care pathway for patients needing additional support in the community following discharge from the hospital called a LIFE package, which continues for six weeks. After this, patients and their families can decide what aspects of care they would like to continue.
Somewhere along the line, this well-intentioned programme had failed, and in my mind, I was struggling to respond to his plea for help, knowing that my medical training had not equipped me with the tools to deal with this, but my experience as a GP had! So, I allowed him to express his frustration and outlined the situation so we could ensure the right people could provide the help he needed for his Dad. I explained that incontinence pads and mats do not come on prescriptions, so he would need to buy these from a local supermarket or the care supply warehouse nearby and to call the care agency who were supposed to be providing carers to deal with his Dad’s needs to clean him up. After giving him the chance to vent, I explained the incontinence pads are arranged via the nursing service, which should have been informed of this requirement before he came out of the hospital so he did not have to swim in his own faeces/urine. Sadly, this scenario is all too familiar to us as GPs because we have been the safety net for as long as I can remember for many public services, which are not adequately resourced and have worsened after a decade-plus of austerity.
One initiative in the NHS is an important driver to prevent these types of scenarios and is called GIRFT (Getting It Right First Time). In this situation, all of these issues could have been identified and addressed before discharge, but often, the shock of admission and seeing a parent become incapacitated can cause a “rabbit in the headlights” moment for many families where they become unable to rationalise what is happening to their loved one.
In the rush to get patients out of the hospital, which can also be driven by patient and family demands, we should remember the adage “More haste, less speed”, and it is vital to ensure the voices of patients and their families are properly heard, and that care needs are met, and that the families are clear on what the next steps are and not to use the “Call your GP” as a “Get out of jail free” card. We should also be closer to ensuring these situations do not occur as General Practices are now part of integrated care boards (ICBs), which encompass hospitals and other agencies providing health and social care, which theoretically means we should be working collaboratively.
Whether it is GIRFT, ICB or LIFE packages, one must never forget the path to Hell is paved with good intentions and unless we actualise these initiatives and treat patients and their families as we would want to be treated, then we could all be swimming in shit.
