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A two-tier NHS...

Eddie Mair | 13:39 UK time, Tuesday, 29 July 2008

depending on whether or not you have learning disablities.

That, in essence, is the picture painted by a new report we will discuss tonight. The BBC News coverage is http://news.bbc.co.uk/1/hi/health/7530624.stm , and you can read the full report here. There is another version too, which we found via the Mencap website, described as easy read.

Naturally, if you have experience in this area, we'd be especially pleased to hear from you. Just click on Comments.


  • 1. At 2:58pm on 29 Jul 2008, jonnie wrote:

    Thanks for sticking up the easy read version.

    Much more my thing.

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  • 2. At 3:16pm on 29 Jul 2008, mygloriousleader wrote:

    Our local NHS hospital has a ground floor and a first floor. Does that make it two tier?

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  • 3. At 3:31pm on 29 Jul 2008, Hawkespeter wrote:

    Life is multi tiered. If you are in hospital and have money you can augment your stay with better food, better TV and other items you moight like. When you leave hospital you can pay for phsiotherapy, dietary or exercise advice or anything else that will aid your recovery. The boundary between what you pay for and what the state pays for should evolve to take account of changes in society.

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  • 4. At 4:17pm on 29 Jul 2008, Stewart_M wrote:

    Its two tier where you live also. Scotland for example.

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  • 5. At 6:05pm on 29 Jul 2008, skyzel wrote:

    What facile comments!
    This is a serious subject that says volumes about our attitudes to learning disabilities - and physical too.
    As parent of someone with profound multiple disablities i know only too well how difficult it is to get the correcrt treatment for her.

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  • 6. At 6:09pm on 29 Jul 2008, nomorepasswords wrote:

    PM Tuesday 29th July pm -
    can anyone confirm what carribbean island the unfortunate murder of the female Doctor took place - Eddie Mair seemed to think it was in Jamaicia although the reporter insitu signed off from Antigua, which he mentioned but Mr Mair still insisted it was Jamaica! - there are other islands you know where violence occurs - I'm surprised that there was no correction made whilst the programme was being aired, does that mean no one was listening!
    ps I didint want to do a blog, but I wasnt sure how to get through to complain.

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  • 7. At 6:57pm on 29 Jul 2008, RxKaren wrote:

    This is fine in principle but will need resourcing in practice.

    The number of nurse/physio/HCA/ward pharmacist hours are not particularly flexible within the NHS. I was allocated 90 seconds per patient when I worked on the surgical wards. If I had a confused patient or a patient with learning disability on my ward who needed a review I'd know that (a) they were likely to have co-morbidities and (b) effective communication with them would take more than their allocated 90 seconds! I didn't have any formal training in caring for learning disabled adults - just the experience I had with my own learning disabled uncle.

    I saw the nurses struggling with one learning disabled adult - her parents were on the ward much of the time helping with personal care. She had profound communication difficulties but it was possible to communicate with her in a meaningful way if you could take the time. She was moved to a side room to give her parents more privacy and to give the rest of the patients in her bay a break. She received less stimulation and became harder to manage. On reflection it probably wasn't the best care choice for her but it possibly was a better intervention for five other patients. None of us were particularly proud with the care we delivered but we know that we all did our best within very tight staffing constraints.

    This experience also helped me to understand one of my uncle's experiences in hospital. He had a speech impediment which made it difficult to understand him. As he got frustrated it got worse. He had an understanding of what was happening and was willing and able to participate in decisions on his care. He complained that doctors and nurses talked over him and not to him because it took so long to communicate. He understood them but they had to spend time to understand him and it was time they just didn't have.

    Private healthcare is better because we receive training on disability awareness and protection of vulnerable adults. We also have better stafffing ratios. Even so sometimes we're still knocked off track with a learning disabled patient if the hospital is busy.

    We also have a relationship with a local Special school - they bring students to visit us once a year as part of their course and we use the opportunity to brush up our skills with communication with this client group. It is valuable to both parties and everyone involved learns so much from the event. It isn't something I could ever envisage the NHS managing to resource though.

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  • 8. At 7:36pm on 29 Jul 2008, eddiemair wrote:

    6: The crime was in Antigua, the reporter was, as we said, in Jamaica. Maybe you weren't listening! Quite what correction you have in mind I have no idea.

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  • 9. At 9:11pm on 29 Jul 2008, RJMolesworth wrote:

    Is not so much a question of two tier NHS but more a question that you cannot treat people equally. As RxKaren (7) pointed out, some people need more time and resources than others. If private hospitals can manage it then it is time to bring the NHS up to their standards. There are not so many people with learning difficulties that it is going to be a hugely expensive problem to fix.

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  • 10. At 10:10pm on 29 Jul 2008, RxKaren wrote:

    RJM(9) Good point - but you also have the confused elderly that don't always get the time and attention that they need either. It is a sad fact of NHS life that if the organisation is not being paid for it or has it as a government target it just doesn't happen.

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  • 11. At 10:20am on 30 Jul 2008, Aperitif wrote:

    In my experience, as a relative and visitor of varying patients over the years, unless a patient has a concerned person present, who will chase nurses around the ward to get things done, remind staff of any of the patient's special needs and generally be his/her advocate/bulldog, that patient will experience inferior treatment.

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  • 12. At 10:33am on 30 Jul 2008, Big Sister wrote:

    RJM and Karen: But this is an area where, with a bit of funding to lift it off the ground, the voluntary sector could become involved, I think.

    Schemes where there have been *champions* (whether advocates, or 'friends') have been successful in aiding people like the elderly, and (though I know less about this) those with learning difficulties, to communicate with others and thus achieve better outcomes. I've been involved with one such scheme for the elderly, and can vouch for the difference it can make.

    Now I can hear people saying 'where do you get the volunteers'? It's a good point, and one that can't be ignored, but provided a scheme is well structured and considers the needs of the volunteer, it will usually succeed in finding people who are willing and able to help. Many people are happy to commit to, say, two hours a week to help others, and gain a tremendous sense of achievement when they see the difference their input makes. One group who are usually 'up' for such work are the recently retired.

    But, as I said at the outset, there is a need to provide some financial outlay so that a workable structure can be established and to ensure volunteers, if their own circumstances are tight, don't have to meet any costs out of their own pockets.

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  • 13. At 11:37am on 30 Jul 2008, heggieheggie wrote:

    as a speech and language therapist working with adults with learning disabilites in NHS scotland I am pleased that the issues of patient care has finally taken as step forward. I hope that this enquiry will help drive through new standards of care for our vulnerable clients. From a speech therapy point of view the need for communuication training for hospital staff is imperitive however we currently do not have the resources to support and train staff to any acceptable level.

    From the comments made in the blog, particualry the comment about 90 seconds per patient! I am shocked that a time limit is applied to any patient (although understand the neccesity of this in the NHS!) however, a client with a communication difficulty - expressive and understanding needs time to a) give their information in their chosen communication method and b) understand information also by their chosen method. This is often not verbally - the use of photographic and/or symbolic information should be untilised much more widely to aid a person's understanding. think how much time this would take! but it is a person's right.

    i'm sure the healthcare staff are doing their best for all their patients most of the time however they are under staffed and under resourced and with the appropriate regular training and skills update hospital staff would be more able to manage their most vulnerable of patients.

    don;t even get me started on eating and drinking issues for clients with disabilties!!

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