10 March 2009

The workhouse mentality

Dr Grumble has lost count of the number of hospitals he has worked in that used to be the local workhouse. People used to be terrified of the workhouse. Men were put one side, women the other. Husbands and wives were separated: children were separated from their parents. As a student Dr Grumble used to wonder why patients were terrified of going to particular hospitals. It wasn't MRSA. It wasn't that the hospitals were dirty. It was because the hospital had been the workhouse and the terror which the workhouse had held had carried over to the time when the workhouse had become a hospital.

In the Grumble hospital we have a new young consultant. She is very good and very enthusiastic. She is an integrated consultant or something like that. Dr Grumble is a hospital consultant but if you want money for a new consultant these days you need to go into integration mode. It's all to do with the government mantra that patients do not like hospitals and want and should be treated close to their homes. Perhaps this is right. Perhaps it is wrong. It really doesn't matter because that is what we are required to do. Dr Grumble has a patient who is chronically ill. Mr Coulthard is a nice man but he is struggling to manage at home. The nice young integrated consultant has been to see him. She has persuaded him to go into a home. Or she thinks she has. The idea is that he will go into a home. His wife will be elsewhere. It's like the workhouse. But Mr Coulthard is has changed his mind. The integrated consultant is said to be baffled. "I've been with my wife for 60 years," he told Dr G today. "I don't want to be apart from her". Nor should he be. We still have a workhouse mentality.

We treat people like this because they are old and don't matter. Or so you might think. But it's worse than that. The truth is that it is nothing to do with age. It is just that our systems do not begin to understand what matters to people.

What is the worst the Grumble hospital can through at you? Whether you like it or not Dr G is going to tell you. If you are a young lady and you have a baby that you are breast feeding and you have the misfortune to, say, have bad pneumonia you might think that the Grumble hospital would allow you to bring your baby into hospital with you. But no. That is not allowed in the Grumble hospital. The managers keep hectoring the staff about putting the patient first and patient dignity but you are not allowed to have your newborn baby in the Grumble hospital with you. It is workhouse mentality. It is an outrage. But it is not something Dr Grumble can do anything about. Which is one of the reasons why he has a blog.


BenefitScroungingScum said...

I can't speak for others, but the reason I'm too terrified to be admitted to hospital (to a point I'd probably risk my life to avoid it) is that once you become a hospital inpatient you lose all control over yourself and are at the mercy of what the system says you must do. For someone with a chronic condition they successfully self manage outside a hospital the prospect of being admitted is more than many can cope with

BenefitScroungingScum said...

PS: You may like this quote

"the principle underlying welfare reform is the principle of the workhouse... you make claiming benefit so degrading and so difficult that people don't want to do it.... that was the principle of the workhouse and that is the principle that the very lovely James Purnell* is introducing into welfare"
Diane Abbott 'This Week' 4/12/08

Anonymous said...

And once you are in the residental home you really are in a work house. Looked after by staff with no formal qualifications given poor quality food and in effect ignored. At best your GP might see you briefly once a month -usually when he sees another 10 patients all with complex multiple pathology rushing between surgeries, with no diagnostic back up and district nurses who refuse to take bloods

The Shrink said...

The Children Act 1989 spells out that a child is defined as being subject of significant harm where there is ill treatment or impairment of health or development:
'Health' includes physical and mental health
'Development' includes physical, intellectual, emotional, social and behavioural development
'Significant Harm' turns on the question of the harm suffered by a child in respect of its health and development compared with the health and development reasonably expected of another child. (Sec. 31(10) Child Act 1989)

A child of another breastfeeding mother could "reasonably expect" to be breastfed. Preventing that is therefore A Bad Thing. The principle of the welfare of the child "being paramount" means it's seen as legislation that trumps local policy and bureaucracy and arguably even other statutes.

Doesn't this also invoke ECHR article violation?

For a Trust to deny a mum and baby breastfeeding seems beyond draconian and to be flirting with unlawful, no?

Dr Grumble said...

Perhaps Dr G needs to tackle this problem again but the rules are very strict in the Grumble hospital.

We are not allowed any children. The reason is that we have not got resuscitation facilities for children and none of the staff is officially trained to look after kids.

A child did once manage to get as far as A&E. He had developed a life threatening problem which needed prompt surgery from a highly specialised surgeon who happened to work at the Grumble hospital. The surgeon operated despite the rules and the patient's life was saved. The surgeon very nearly lost his job as a result. He probably would have done if he hadn't actually been an income generator for the Trust.

Looking at it from the manager viewpoint you can see their problem.

The Shrink said...

I can see it's wholly valid not to treat children (save in an emergency) if you've not the resources to do so. Your managers are perfectly within their rights, there.

But does that mean no children are allowed on to the premises?

If a mum's admitted for appropriate clinical care and simply wishes to have her baby with her, causing no burden on the staff and requiring no healthcare input, there are no governance issues to fret over, surely?

the a&e charge nurse said...

Is this inhumane policy actually WRITTEN anywhere, Dr Grumble.

I imagine any such piece of paper would be dynamite ?

Worrying about healthy, breast feeding babies, whatever next ?

Dr Grumble said...

It is difficult to have a baby with a mother in a hospital without the hospital staff taking some responsibility for the medical care of the baby. In fact, they must. Things like drugs in breast milk or incidental problems need to be addressed. Looked at this way the policy seems more reasonable.

The solution should be to have a way of ensuring that patients with babies are admitted elsewhere. But there seems to be no such policy and even if there was shortage of beds would make it unlikely to happen.

Nurse Anne said...

We actually allowed a young woman who was breast feeding to bring her baby into the side ward with her.

We also have ward full of wanders with dementia, confused and aggressive patients and only 3 staff on a night shift. We take young women with pnuemonia as well. It is a medical ward.

We were so scared for that baby (as a result of the other patients behaviour and our inability to control them) that we parked one of the health care assistants outside the room all night while the 2 of us tried to managed all the other patients ourselves.

The health care assistant that stood guard outside the mum and baby room deterred at least 10 attempts by mobile demented wanders to get into that room.

The rest of the patients got ignored for most of the night because there was only 2 of us. I was trapped with all the drugs and a patient with a bowel obstruction who was really unwell and the other hca tried to do 30 bed changes and answer callbells her self. She also had 18 people who needed 2 hourly positional changes. By morning many of the pressure ulcers were worse!

I will think long and hard about allowing a baby onto that ward ever again. Unless of course management gives me a few more nurses.

Nurse Anne said...

that was supposed to read wanderers not wanders.

We did argue with management to put this woman and her baby onto another ward like a surgical ward where the patients are less confused and agitated. But they were adament that there were no siderooms anywhere else that could be vacated or swapped. They used the "she will be separated from her baby" line to get her into our room.

Scared the hell out of me. If it wasn't for all the confused patients threatening to "kill that screaming cat" I would have actually enjoyed having the baby on the ward.

Medical wards get a large number of emi patients and also are full of patients that are confused due to medical conditions. We are also the dumping ground for psyche when they have no where else to go. They won't increase the number of staff or recognize the situation officially.

Once we had a paranoid and aggressive psyche patient steal a bottle of hairspray from one patient and sprayed it into the face of a bedridden copd patient on 02. It took 3 days to get psyche into see her and the medics wouldn't presribe anything to calm her down. The medic was pregnant and left he ward asap when this patient went for her bump.

Never again will I take a mom/baby onto that ward unless the other problems are fixed.

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