Pissing the money away

Given that our glorious chancellor is pouring squillions into the NHS, many have asked, where is it all going? It seems tiresomely pedantic to keep going on about it but, at a time when for some reason we cannot afford to treat breast cancer properly, it has to be asked.

Wat Tyler, Guido Fawkes, EU Serf and many other splendid bloggers rant on and on. What is happening to all this money?

Is it just being pissed away?

Which gets Dr Crippen on to two of his favourite topics? Incontinence, and “nurse specialists”.

Alice is a very old lady. She also happens to be a very intelligent old lady. She is a widow. Her son and daughter live a long way away.

Alice is incontinent. She had two difficult births long before the days of controlled episiotomies and sustained a lot of damage to her perineum. She never had HRT and as her hormones deserted her so did the elasticity of her bladder control.

Being a rather old-fashioned, proud lady she does not find it easy to talk about her incontinence.

Let’s look how she coped before 1997 when there was no specific funding for this problem, and after 1997 when there was.

In 1995, the family doc, who knew Alice well, had noticed that despite all her best efforts, she frequently smelt of urine. Very gently he coaxed a history out of her. Underwear being changed several times a day, rubber sheets on the mattress and so on.

She needed some help.

He visited her with Betty, the district nurse, and managed to examine her. Nothing catastrophic down below. Urine test negative. No infection. Not diabetic. A plumbing problem, really. And it was obviously only a small urine loss, mainly when she coughed and walked. But enough to smell.

Ideally, she needed surgery to tighten things up. She would not hear of it. Never had an operation in her life. Terrified of surgeons. Out of the question.

So the family doc prescribed various pads and things, and Betty popped in from time to time, and generally Alice managed. Not an ideal situation, but she managed.

A bit like life, really.

Ten years later, Alice was older and frailer and not managing so well. She was not able to change her underwear without help.

Thankfully, with all the money that Gordon had provided, there was now an array of “specialist resources” to deal with this problem.

We don’t have to rely on Betty and the family doctor any more.

Betty has in any case retired and has been replaced by two “nurse specialists”. They however do not “do” incontinence, and they do not visit old ladies at home as they are busy teaching doctors how to manage asthma and blood pressure.

They cannot give Alice any incontinence pads because they don’t have any and, even if they had, such pads are now only available from the Incontinence Nurse Specialist. And whatever the doctor says, she will not provide them until she has herself “assessed” Alice.

The family doctor feels he has already done an assessment, but is helpless. The “Incontinence Nurse Specialist” is a busy and important person, and there is a six week wait to see Alice, during which time she gets smellier and smellier.

Finally the assessment is done. Still no pads. Alice is asked to keep a fluid balance chart, recording how many cups of tea she drinks per day. Alice concludes from this that the incontinence is her fault and cuts her fluid intake so much that her kidney function goes off. The doctor sorts this out for her, but is now cross.

He tells Alice to keep drinking, and steals some incontinence pads from the nurse’s locked cupboard and gives them to Alice. The nurse manager finds out and complains about the doctor. He responds by writing a rude letter to the Incontinence Nurse Specialist. She responds by telling him that Alice should see a “specialist” to be “assessed”.

The family doctor has already assessed her. He knows she would benefit from surgery but also knows that she will not have it. But the nurse specialist refuses to agree to the pads until Alice has seen the gynaecologist.

So Alice goes to the hospital clinic, is offered surgery, politely declines it and goes home. She has completed the obstacle course. She gets her pads.

In the modern world, the old fashioned management of, “Have you got some pads, Betty?” is not acceptable.

This is a much more successful outcome. Tony Blair is happy. The regional nurse specialist for box ticking is happy.

Specialist Nurse Assessment – Tick, Done.
Gynaecology Assessment – Tick, Done.
Incontinence Pads shown to be necessary - Tick, Done.

That’s where your money is going, guys. Just don't get breast cancer.

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