"My 90 year old aunt"

About: East Riding of Yorkshire PCT / Emergency GP out of hours service York Hospital / Accident and emergency Yorkshire Ambulance Service NHS Trust

(as a relative),

My aunt had recently been discharged back to her care home (an establishment with no trained nursing staff) with a broken hip, being 'conservatively managed'.

Due to severe pain when being moved she was unable to resume her routine of being helped to a chair during the day. Instead she had to be left in bed in her room, which as it happened was the remotest possible one from the main part of the home. I visited her on Saturday at 5pm and found her very unwell, not recognising me, feeling clammy to the touch and unable or unwilling to communicate. She said she felt 'terrible' 'awful' etc in answer to the various times I asked how she was. She had uneaten food on a tray on her bed (in fact she can only eat finger food, as she has severe arthritis in her hands - and this food included a bowl of pudding with spoon).

I spoke to one of the care assistants about my concerns and she came along with me and agreed perhaps we should call the out of hours doctor. This is when the nightmare began. The care assistant spoke to the doctor who attempted to make a diagnosis over the phone, but given my aunt's age and condition, his questions were completely inappropriate. She was requested to lift her hands over her head, to smile, and to repeat some words from a nursery rhyme, or some such. None of which she would do under normal circumstances, let alone when she was feeling as bad as she obviously did, and none of which she was able/willing to do on this occasion. I realise this was an attempt to see whether a stroke had occurred, but it was repeatedly stressed that she was very old and very infirm.

After 20 minutes or so of this, it was apparently decided that the First Responder should be called. They turned up, with an ambulance and a car, defibrillators and all the gear. Four people in all, in yellow visibility gilets. After examining my aunt, they found her vital signs to be reasonable. They were a little brusque and not easy to communicate with. When I asked what one paramedic would do if it were her own grandma, she said 'I'd insist on her seeing a doctor'.

Once I was reassured that my aunt was less unwell than she appeared, I asked if she could be left at the care home. They told me this was up to the out of hours doctor, but within a few minutes and conferring with someone out of my sight, they came back and said they were taking her to hospital. Moving my aunt is very painful, and I heard her cry out several times as she was transferred to the gurney.

My sister and I followed her to the hospital where she/we waited in A&E until 11pm when it was finally decided to keep her overnight. Today is Wednesday and she is still in hospital, but she appears better and they are waiting to discharge her, having had little or no treatment.

This whole episode seems to illustrate how the failures of the out of hours service are creating scenarios which cost the NHS far more than would a short visit from a doctor to check on the underlying condition of the person concerned. Four paramedics, an ambulance, a car, and all that is entailed by admission to hospital and a four day+ stay in hospital set against a half hour visit from an out of hours GP. And that is leaving aside all the unnecessary stress and upset caused to my aunt. This has to be wrong.

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