The doctors in my practice have well over 100 years of combined experience as GPs, so you’d think we’d seen pretty much everything. But last week we were confronted with a scenario we had never before encountered.
The patient concerned – a 42-year-old called Terry – has been battling a particularly nasty form of lymphoma for several years. He’s an unconventional person, and his life hasn’t featured much in the way of stable relationships, but he has an elderly aunt and uncle who have stuck by him as he’s sought alternative remedies for the disease that orthodox medicine has been unable to cure.
He’s now arrived at the end of the line. The lymphoma is overwhelming him, leaving him incapable of getting out of bed, let alone managing his daily needs for food, drink and hygiene. While he kept mainstream services at arm’s length during his exploration of complementary therapies, he’s now relying on us in what will be his final days.
What is required more than anything is help meeting his basic human needs. One of my partners spent quite some time on the phone, organising equipment at short notice, rapid hospice outreach support and an urgent social care assessment. The social worker came to an uncontentious conclusion: Terry needed care visits four times a day. But she was sorry, this wasn’t going to be possible. It wasn’t the funding – despite ongoing budget cuts, they still have money for cases like this. No, it was staff. There are not enough care workers. They simply have no one available to look after Terry.
This is unprecedented, and I actually couldn’t compute it when my colleague broke the news. A swift look at the figures, though, tells you everything you need to know. According to the training charity Skills for Care, there are now 110,000 vacancies in adult social care – that’s around 8 per cent of all positions unfilled. And this is an exponentially increasing trend – 22,000 of those posts have been added to the total over the past year. Job turnover in the sector is around 30 per cent.
The reasons for this crisis are multiple, and most can be laid squarely at the door of the current government. Years of austerity-driven spending cuts have piled stress and pressure on staff, many of whom have voted with their feet. Others have gone for different reasons: around one in six of our care workforce have traditionally come from EU countries; Brexit Britain has become a very unattractive proposition. Caps on non-EU, “low-skilled” immigrant numbers have choked off alternative sources. And as ever fewer staff struggle to cope with constantly increasing demand, stress and demoralisation mount further.
My partner spent another hour on the phone trying to find some way of getting Terry help. The service specifically set up to avoid “inappropriate” acute hospital admissions had no available cottage hospital or nursing home beds – the only solution they could offer was to throw in the towel and admit Terry to our local district general. As winter takes hold, and yet again you hear about patients who don’t need to be in hospital “blocking” beds, remember Terry’s story.
Terry did not want to die in a busy, noisy hospital ward. He is currently being supported by a rag-tag assembly consisting of his remaining elderly relatives, a hospice night-sitter, and some capacity that my partner eventually managed to beg from the community rehabilitation team.
The government’s response to the care crisis is to be a “national recruitment campaign”, due to be launched any time now. I predict it will be as successful as that aimed at attracting an extra 5,000 GPs by 2020 (numbers continue to fall). At some point, surely, someone has to wake up and accept that sparkly adverts won’t recruit and retain staff when services are so chronically underfunded and overstretched. By then, though, it will be too late for Terry, and for many others like him nationwide.
A collection of Phil’s columns, “Chicken Unga Fever”, is published by Salt
This article appears in the 31 Oct 2018 issue of the New Statesman, The Great War’s long shadow