Dr Philip Lee Profile picture
Jan 3, 2018 13 tweets 3 min read Twitter logo Read on Twitter
Ok, I'm not a health expert, or a politician, just a low level, acute care grunt who look after sick people and the elderly.

But here's my idea of why the #NHScrisis is happening, and how to (maybe) solve it.
The government and Hunt are quite right, spending on health is at record levels. Even accounting for inflation, growing needs etc, why are things this bad? With record trolley waits, ambulance queues, mental health crisis, surely something must be wrong?
Where is gone badly wrong is this:

Social care

Social care, which includes everything from care homes, meals on wheels, carers, day centers, are largely funded by the local councils.
Since 2010, local authorities' budgets have fallen by 26%, with a 40% decrease in central government funding.

As a result, older people ready to leave hospitals cannot, either because it takes longer to get care, or the local authorities have no choice but to stall for time wth lengthy assessment processes for care home funding.

Not only does this cause flow problems in ED, it can kill.
Hospitals are designed to handle capacity, my colleagues in emergency medicine are excellent at stabilising sick patients, and making decisions about who needs to be admitted.
Similarly the Acute Assessment Units are good at ensuring a rapid and safe turnaround of patients.

But we cannot operate safely when patients cannot be safely discharged from specialty wards.
Stopping elective operations is fine, it will free up some beds in general wards and critical care, but who will look after those beds? Consultant physicians are already at full stretch looking after medical patients, surgical wards are not the right place.
What would I do? Commission extra intermediate care beds in the short term, purchasing capacity from the private sector if needs be, so we can get patients moving again.

In the longer run, social and health services need to be integrated, so we can work from a single budget.
Stop the cuts to local authorities, or at least ring fence social care funding.

If we're closing acute beds, fine. But for every bed closed there needs to be an alternative that's safe and caring. Be it "Home First" initiatives, community hospitals, or care homes.
Because people's needs don't just disappear when hospitals close.

And right now Jeremy, you owe us 15,000 beds.
I'm not an expert in primary care, so I'll leave its commentary to those who know, like @HelenRCGP. Suffice it to say the loss of the workforce and the mounting workload, coupled with poor investment and mountains of paperwork, is disastrous for the NHS's backbone.

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More from @drphiliplee1

Jun 13, 2018
Trigger warning: (#Grenfell)

"Wake up, your phone keeps buzzing."

14th of June, 2017. 3:39 AM

I sat up, I was not on call, I looked at my phone. Two missed calls and a text from NHS-NoReply

I dialed the given number and punched in the code, rubbing my eyes.
"What is it?"

"Major incident, fire in West London apparently." I replied. Heading out of bed to the shower as my wife headed to the kitchen, turning on the TV on the way.

The tepid water woke me up, it was a hot, humid night.

"How bad is it?" I shouted.
"Bad. Really bad. Go."

I grabbed the coffee she handed me and jumped in the car. I caught a glimpse of BBC news on the way out.

Growing up in Hong Kong I've seen high rise fires. This was nothing like what I've seen before.
Read 15 tweets
Apr 17, 2018
Britain, December 2021:

A bleak winter, as Britain's transition period nears an end to exit the EU.

A city sized spaceship lands atop Boston, Lincolnshire, crushing the entire city. Aliens attack inhabitants.

Prime minister Rees-Mogg mobilises the armed forces to attack.
Stop the War coalition blockades the M11 to "Stop unjust imperialist war" against aliens. Blames Israel and Tony Blair.

BBC courts controversy by photoshopping Corbyn's head with an alien helmet.

Corbyn releases statement: "both sides to blame for conflict"
Government releases scores of bad news about NHS, economy, on day of main armed forces attack.

British forces crushed after Trump tweets: "British force assembled at grid ref 225170 336189 are BEST EVER. Closest allies, Mueller is SAD"
Read 6 tweets
Mar 27, 2018
You're sitting at the nurses' station on the ward, trying to finish the admission documentation and prescriptions of your last patient.

Suddenly, a shiver runs down your spine as you hear someone shout:

"Can I have some help in here please?"
You drop your pen and stand up, commotion in one of the bays, a senior nurse runs out, "Get the cart and put the call out!"

You pick up the phone, dialling 2222.

"Adult Cardiac arrest, Ward 12 East" you speak, your voice slightly shaky

"Adult Cardiac arrest, 12 East. Thank you" the voice replies, calm.

Hanging up you hurry into the bay.
Read 16 tweets
Dec 26, 2017
As a British Citizen born in Hong Kong, with family in China, I find the whole branding remainers who are "talking down #Brexit" as "traitors" and "saboteurs" disturbing and odd. Especially coming from those who insist this is to defend democracy.
In China, the cultural revolution occurred between 1966-1976. Starting out as a campaign to restore the Communist Revolution to greatness, and to purge the country of "traitors" and "counter-revolutionaries"
Those who were against Mao's policies, and intellectuals, those branded "elite" in general were publicly denounce, humiliated, imprisoned, forced into hard labour, and often killed by organised mobs.
Read 7 tweets

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