The Nation's Health + Paramedic

Get your house in order

"79 year old female, constipated "

Ok, not the most glamorous of jobs, but lets be honest, four days without a crap is not gonna be comfortable! We'd spent the previous six hours rolling our eyes at various 20 year olds with headaches, back pain and man flu so an old dear was just what the doctor ordered. We pulled up outside a large block of flats knowing full well there would be stairs to climb and not a lift in sight. We traipsed up the stairs to the third floor and entered the rather lavish apartment. The live-in carer met us at the door and took us to Edna. Edna was bed bound from a stroke a number of years ago. She was paralysed on the left side and had very little cognitive function which required 24/7 care.

In all fairness, her carer was excellent, she'd done everything she could to prevent an ambulance being called but she had been let down by the service she relies on. A GP had been out the previous morning for the constipation and had prescribed an enema. Not being a nurse she asked the GP what to do. The GP told her to arrange a community nurse so she did. After hours of trying to get through one was arranged for the evening. Unfortunately they didn't turn up and by the time the carer called to see what was happening the office was closed. In the morning, another visit was arranged for lunchtime. Again, they didn't turn up but this time they wouldn't answer the phone. This is common practise, if the phone isn't answered they don't have to commit to jobs, similar to crisis teams and various other NHS services. It had now been four days since Edna had opened her bowels and appearing in real discomfort her carer, quite rightly, called us. We will always turn up regardless of day, time or call rate. If only other services would do the same.

We started assessing her and within just a few seconds it was clear this was now beyond constipation. Her skin was clammy, her face was pale and the pulse was racing. Her breathing was very fast, her blood pressure was low, as were her oxygen and carbon dioxide levels. She had a huge temperature and was hyperglycaemic and was without any doubt, septic. Her abdomen was also distended and extremely rigid. We blued her into hospital and left her in the care of the doctors. She probably won't have died but it is more than possible. How can something as simple as constipation get so out of control? The elderly totally rely on the services that the NHS provide and there really is no excuse for these failings. It happens time and time again where the ambulance service and the A & E departments are left to pick up the slack for poor practise. I put in a futile complaint but in all honesty it was to make myself feel better, rather than the possibility it will actually do anything.

Giving a patient full time care in their own home requires services to work together and deliver the care they are there to provide. Prescriptions need delivering, GPs need to visit, carers are required throughout the day, nurses are needed for catheters etc, meals need delivering, ambulances are needed for hospital admissions and appointments and social services are needed for facility provisions. These patients often need all of the above simply to exist. All it takes is one not to pull their weight and you end up in a situation where a simple home visit being missed, costs a life. There are also financial implications too. The conveying to hospital and an extended stay costs £1000s upon £1000s. Money the NHS can ill afford whilst trying to stave off privatisation, especially when it could have been avoided. I am totally opposed to the NHS reforms, I think it will be bad for patient care, bad for the country and people will get left behind. Sadly though, there are areas of the NHS which are not doing their job and are providing the policy makers with all the excuses they need to out-source services. If people are serious about keeping the NHS as a non-private, non-profit, free for all organisation, then all areas within the NHS need to get their house in order and prove they are fit for purpose.

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Relevant to: Get your house in order + Paramedic