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What is the
hospital’s policy on decanting?
Are staff aware how upsetting it is for the patient
to return from a weekend pass and find "their
space invaded"? Even a telephone call to make
them aware of the situation would be better than
returning and finding all their belongings moved.
Jack Stuart took the floor in answering
this question, explaining that decanting was not a
common event, and was not a decision taken lightly.
He explained that when a patient is decanted it is
usually at a stage when the move will not cause an
adverse effect, whilst the damage done to a patient
in an acute state being newly admitted to a different
ward from normal would be greater. He explained that
the mental health services are structured in such
a way that they are teams with a consultant having
a nursing team, CPNs, social workers and GPs linked
to them. It is important for the patient’s welfare
that a consultant, who actually spend little time
in the ward, has a nursing team that he knows and
understand well. On this basis, the only real alternative
to decanting is to put up more beds in a ward, which
would lead to over-crowding and distress for everyone.
Obviously, that decanting exists
at all is less than ideal, but there isn’t another
alternative. From the hospital’s point of view their
priority is always "Whose needs are greatest,
at the time, for continuity of care." Mr Stuart
did concede however that the courtesy of a phone-call
to the patient home for the weekend, explaining that
they are being decanted, would make all the difference
and will be instigated as common practice.
Dr Palin added that whilst decanting
was a decision made under duress, the hospital should
be better prepared and be honest with to-be-decanted
patient at an earlier stage. A member queried that
it might be better to move a patient wholesale to
a new ward, but both speakers emphasised the importance
of the relationships both between the consultant and
the nursing team and between that team and the patient.
Goto Top
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Why, when you change GP practice, do you have
to change your consultant?
Some patients have intense respect and trust for
their consultant. Often the change of GP practice
is because of a move. The move plus the change of
GP is upsetting enough, only to find that you are
also subject to a change of Consultant. Is it really
necessary to change Consultants?
Once more the importance of the mental
health team was emphasised here, and the fact that
changing a consultant could lead to changing every
member of the team. However, changing a consutant
because of a change of GP is not a blanket policy,
but is a decision jointly made between the consultant
and the patient, either has the right to, and may
request a change of consultant or GP independently
of changing the other. Dr Palin pointed out that the
patient always has the right to a second opinion,
and that a change of consultant can often present
the opportunity to have you care and treatment looked
at in a fresh light.
GP practices are not zoned in Aberdeen,
as such, in that moving house does not necessitate
a change of GP. However, if you try to change GP,
you may not be able to register with some practices
because of your geographical location. Whilst making
a change of GP does generally mean a change of Mental
Health Team, this is not obligatory.
One member asked if it was possible
to change just one member of the team, and Dr Palin
reiterated that a patient always has the right to
a second opinion. It could be argued that some of
the teams are too small, because the patient should
always have a choice within any one team, and the
reality is that this is not always the case. Mr Stuart
explained that, in the future, when staff are distributed
to teams, it will not be done in the same way that
it has in the past, i.e. equally, as there is more
demand on some teams than others, and some of the
city teams are understaffed for the number of patients
in their care.
Another member challenged that there
were enough staff working in the community, as carers
are being left with more and more responsibility,
whist social services are continually being reduced.
Both speakers agreed that facilities were lacking,
but that there was an improvement over time, and with
resources being moved from the hospital to the community
setting, services should continue to improve. Pilot
projects in other parts of Britain were discussed
where acute wards have been abolished altogether to
maximise services in the community, but there are
problems with this, including the massive strain on
staff.
A member asked if the number of beds
reducing was accounted for by an increase in community
care, and was there not a danger of beds running out?
The hospital has never run out of beds as they are
allocated on a basis of 85% maximum capacity, so even
if this was exceeded by 5 or 10%, there would still
be surplus. Whether or not funding is really being
re-allocated to the community is a more difficult
question to answer. The reality is that there has
always been a deficit in community care funding, and
whilst the cost of keeping someone in hospital is
massive, so is the cost of providing sufficient services
in the community for both users and carers.
Goto Top
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The DPM (Divisional Partnership Meeting
was a brilliant idea. Organisations could submit
questions to the managers of the hospital which
were either put on the agenda or briefly discussed.
Every 3 months we usually had a mquestion to submit
and the answers were given very quickly after the
meeting and you felt your issues were taken seriously
and dealt with at the highest level. The DPM has
now changed its’ name and remit. This new meting
certainly has potential and may achieve a lot, but
we have lost the direct access we had to managers
to raise issues. Is there something replacing the
DPM format?
