A couple of posts ago I gave a little rant about how I don't think that 'free market' systems result in a better health service. I have another example.
I was working in another area a little while ago, and while there got sent to a private nursing home. The patient was given to us as '80 year old female with difficulty in breathing'. We arrived and saw what looked to be two nurses having an animated discussion in the main foyer.
Grabbing our equipment we followed one of the nurses into the depths of the home, and were shown to the patient's room.
The patient was very much dead.
Also in the room were four nurses. They were standing around and they weren't doing CPR, they weren't breathing for the patient. They looked at me for guidance.
I immediately switched into commanding mode. “Why isn't anyone doing CPR?”, I asked.
“We were”, one of the nurses replied, “but I saw you coming in the mirror and stopped”.
The mirror was positioned so that if she had been doing CPR, she would have had to have eyes in the back of her head to see me coming.
When someone isn't breathing you have to breathe for them – this is the 'ambu-bag' that TV doctors put over someone's face and operate by squeezing the bag. It forces oxygen into your lungs. Unfortunately the patient had a normal oxygen mask on her, which would bathe her face with oxygen, but wouldn't get the oxygen into the lungs where it needed to be.
The patient was also lying on an air mattress, which would have meant that any CPR which may have been done would have been ineffectual because you need the patient on something hard so you have something to push against.
I felt the jaw of the patient – rigor mortis had already set in, so there was no point in attempting to continue any resuscitation attempt.
Someone had tried to take the patient's blood pressure, as there was still a BP cuff around her arm.
As is usual in these cases where we know or suspect that care has been…shall we say…lacking, we offer the services of the LAS to teach the nursing staff more effective resuscitation skills, they should have these skills anyway as qualified nurses. Talking to one of the people who teaches these courses, it seems that many of these nurses have forgotten how to do this. It's free to them although I don't think we get any extra money from the government to run it.
The nurse in charge (who was busy photocopying in the office while all this was happening) refused.
So, in a world of competition between privately owned care homes, it would seem that the care has not improved. Instead you get poorly skilled nurses, run by staff who don't want their staff to improve. This despite a number of suppliers who are all in competition with each other – it's a lucrative market providing elderly care.