The other day Dr Grumble exchanged emails with an American colleague. Healthcare in the US is claimed to be fantastic but they have their problems too. Dr Grumble was bemoaning the fact that the hospital managers now want Grumble to focus on money-making activity. You can understand why. The hospital needs money. And these days, now that we are in a market, there is no point in doing work that doesn't generate much of an income. Since this new system Grumble has become something of a blue-eyed boy. A new department was built. Agency staff were hired at great expense. It all paid for itself. More tests meant more money. But Grumble is also responsible for elderly patients whose main need is to be looked after well and with dignity. That doesn't pay for itself. The more you do of it the more it costs the hospital. It is not work our managers seem to want and because it is so very expensive to supply this sort of care great efforts go into paring down the staffing levels to an absolute minimum.
It's the same in the US. My American friend told me how much the interventional radiologists are now earning. It's a staggering sum. But if you look after the elderly it is quite another matter. That's the market for you. Worse, Grumble's friend told him not to bother with the elderly. Just focus on the things that make you money was his advice. That's what we do here, he wrote.
The elderly care ward certainly doesn't pay for itself. Agency staff are shunned. If you are a bit short staffed the tendency is to get by somehow. Nor are the wards as they might be. We are told that patients like to be treated with dignity. Now isn't that a surprise? So what do we do? We have red pegs on the curtains. Meanwhile elderly patients are required to crap into an equally elderly commode. The ward stinks. The commode is trundled to the sluice with faeces spilling on the way. It is no way to treat people. In the US even condemned prisoners have a loo next to their bed. And is it any wonder we have outbreaks of C diff?
Whatever system you run the elderly are always going to put a drain on resources and their care is always going to be expensive but with this new market stark differences between their care and the care of the young have been highlighted. The worried well now get their endoscopies in double-quick time because with the test comes money. If there are not enough staff the managers will offer more and more money to get those staff. If better facilities are needed they will be built. But it is not like that on the general medical ward.
15 February 2011