Postcodes

As is my wont, I often find myself moaning about social care, or rather the lack thereof.

We were sent to an elderly man who had fallen over, the police had already arrived and had gained entry to the address and by the time we go there they had already picked him up and sat him on the end of the bed.

We did our usual checks, and a few things were a little 'off'. For example his ECG showed a chronic heart condition that may have been the cause for him to collapse.

The patient didn't want to go to hospital, he'd only recently returned home after an extended stay there. As I've mentioned in the past, I'm not actually allowed to kidnap people against their will.

So, I made sure he understood the risks of remaining at home – “You could die”, I told him. “That's fine by me”, he replied.

But we couldn't just leave him there, for a start his mobility was so poor it seemed inevitable that he would fall again.

So, what to do?

What he really needed was a referral to a frequent falls team, some occupational therapy, some physical therapy and for the GP to check on the patient's medications.

Unfortunately, while we can recognise this, us rank and file 'stretcher monkeys' don't have to tools to make these referrals.

However, our ECPs do have the 'pathways' for referring people to various teams designed to keep them out of hospital. Of course, this only works if there is an ECP on duty.

We were lucky, one of the ECPs on our station was working that day, so we rang through to Control and asked if they could send him.

I'll spare you the hoops that we had to jump through in order to get the ECP to visit us – apparently Control won't let you 'book up' an ECP for a patient.

Our ECP arrived and listened to all that we had to say. Then he found out the postcode that the patient lives in.

The problem is this – our ECPs can only refer patients who live in certain postcodes – if they live outside of the designated areas then the funding isn't there and the 'keep 'em out of hospital team' aren't interested.

(Having ended up in North London, far from my patch, on my final job the other night I wish I could refuse calls outside of certain postcodes).

There was nothing that we could do – it was a weekend so all the regular services had shut up shop, any GP that we would ring would be a locum, and the patient was still refusing to go to hospital.

The list of the patient's problems continued – he was supposed to have carers, but he often locked the door so that they couldn't come in, sometimes the carers 'forgot' to turn up. He was also refusing to take his medication – in my inexpert opinion he is suffering from depression. He had wounds from previous falls that weren't being dressed properly.

The list goes on.

His son, who'd arrived during our assessment, had been trying to 'get things sorted' for the last month but he'd been getting nowhere.

At the end of the day, all we could do was write a letter to the patient's regular GP explaining all that we found and hoping that the GP would take the required action. Now, you must understand that we aren't trained to write referral letters to GPs, we aren't expected to do this, and it would probably surprise a lot of people in both our management and government to realise that we do these sorts of things off our own backs.

I'm a poorly paid multi-drop delivery driver with bandages, a defibrillator, and extended social skills. Yet I could see where this man was being failed, and was ultimately powerless to help, and all because of him living in the wrong postcode.

Jobs like that are frustrating and depressing – because with the right input he could continue to live at home. At the moment his future will probably consist of frequent falls until he breaks his hip and dies.

Unless the GP acts on the letter we wrote. The letter that we aren't supposed to write.

Fingers crossed.

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If this reads a little fragmented and wobbly, it is purely because I'm fragmented and wobbly – I've just finished my third night shift and am yet to sleep.

5 thoughts on “Postcodes”

  1. its just wrong. you should be able to stop people falling through the cracks like this.I don't envy you your job, it must be very frustrating.

  2. Hmm. Up norf in yorkshire we (techs, paras, ECPs, and anyone else who wants it) can make referrals for both frequent falls and frequent hypos.Not so long ago I had a patient who was refusing to attend hospital after a fall. Fallen twice in as many nights, no injuries. He's an insulin dependent diabetic with a BM of 1.9 (normal BM for him is 10-20). No obvious signs – apart from the BM – that he's hypo. The only food he had in the house was a tub of ice cream. What would you do? Oh, is 4am, no neighbours or NOK.

  3. The only thing that I could do is take him to hospital. And if he refuses there is nothing else I *could* do because the out of hours services are just not there.I doubt my bosses would like me popping down to a 24 hour shop to get him some grub…

  4. TR – Ref the comment about Control not allowing a “booking” for an ECP is not as simple as that.Firstly – half the time we don't have ANY ECPs on duty throughout an entire sector.

    Secondly, the ECPs we do do have are being used – wrongly, to my mind – as FRUs merely to stop the clock. This means they are often on job after job after job, none of which are actually appropriate for ECPs. Unless we can actually get to change an ECPs status so that they don't get auto sent calls by FRED we are f**ked.

    Thirdly, the bit about postcodes is spot on. I've lost count of the number of times I've been asked to send an ECP to a call by a crew/CTA etc in order to do a referral, only for me to pint out that – sadly – an ECP working in one PCT cannot do a referral for a patient in another PCT.

    To my mind a good ECP is worth their weight in gold, WHEN we are allowed to use them properly. Unfortunately a patient like the one TR refers to gets in the way of LAS targets, figures, statistics, response times etc etc and doesn't serve to “stop the clock”.

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