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Archive for December, 2008

money_pounds

Last week I was flitting around the web and somewhere I read that an antenatal appointment with an NHS midwife costs £60. My reaction was predictable really, I ranted along the lines of ‘ How on earth have they come to that? The appointment only lasts 15 minutes. I only earn that in 4 hours’. etc, mingled with indignation and disbelief.

In my blog I have often grumbled about all the paperwork that I have to complete, much of this form-filling is generated courtesy of the PCT requiring community midwives to itemise antenatal encounters with women. It’s all to do with PbR, or in the case of community midwifery non-PbR activity i.e midwifery-led clinics, midwifery care in women’s home, parentcraft. I have been intrigued to discover that there is differentiation of cost between an antenatal appointment for a woman under midwife-led care and one who is registered as being under consultant-care, even when both encounters take place solely with a midwife in a G.P’s surgery, for the first the cost is £55, for the second it is £66. Why the difference? I can only assume it is because there is a consultant obstetricians name on the notes (not that s/he would carry any responsibility if the midwife made a mistake).

Anyway, I found this interesting, informative explanation of PbR and Maternity Services by Dr Suzanne Tyler for the Healthcare Commission, it can also be found here with slightly different information. It details the tariffs for different aspects of maternity care, from this I should have some idea of what a midwife is worth, £220 per hour apparently. Gosh, I should be rich.

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Christmas present

Acknowledging the credit crunch, weddings, births and critical illness we decreed that this year we would be having a slightly pared down christmas present frenzy. However, looking at the mountain of parcels under and around the tree on Christmas morning I did wonder if anyone had listened. Hubby and I had agreed no presents to each other in view of our up and coming holiday so…….I gave him an all-weather microfleece for golf and the latest John O’Farrell and he gave me a digital photo frame! (Thank heavens I had ignored our ‘agreement’).

All the family were together and, as the grandchildren are all so young there is a huge amount of equipment required just to enable us all to have lunch together; two dining tables, one booster seat (Izzy), two highchairs (the boys), one electric swing (Evie)* and an assortment of different bibs, plates, bowls and feeding utensils, all Nanny’s resources are called into action. It is also total, absolute mayhem. There’s Jack using the kitchen floor as a race track, whilst you are trying to prepare the meal. The boys are taking advantage of the locks being off cupboard doors so they can distribute the cupboard contents all round the kitchen. Izzy is being potty-trained, so there are a selection of potty’s dotted around and everyone is keeping an eye out for signs that she may need reminding to sit on one. Amy has disappeared behind the sofa with the nibbles and is gorging herself on a selection of tummy fillers and Evie is under constant siege from her cousins, kisses from Jack and Amy, mouth-poking from Iz and thumps from the boys. Ahhh, families.

My greatest joy? Having son there, looking so healthy, enjoying his baby. Poor lad was subjected to frequent hugs from me, we are so lucky that he is celebrating, and enjoying, Christmas. Yesterday I downloaded some photos for my frame, amongst them was a photo of son cuddling Evie minutes after her birth. He had had his op about 2 weeks previously so was starting to look better but he was still painfully thin and had that yellowish pallor which I associate with nasty illness. Hubby said he didn’t think I should have that image in the slideshow, I disagree as it is a reminder to me how close we came to losing son and how well he is now. That, however horrified I was by the care he received in hospital, the end result was positive and, that as we approach the New Year, we not only have a new daughter and grand daughter but also a son who is pain free and able to enjoy life again.

* Electric swing – wonderful piece of equipment for enabling parents to ‘steal’  time when baby is grouchy.

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The twins, Jamie and Louis have been the proud possessors of amber teething necklaces for about 5 months now and have both worn them continuously. Daughter has been non-committal about their effectiveness but, when I have suggested that one of the boys stops wearing his surfer-dude accessory, she has proclaimed ‘This is my life you are talking about – no!’  Shame really,as I thought it would be a good way of having a ‘micro-controlled trial’ after all they are identical twins.

Anyway, two weeks ago Jamie developed a rash over much of his body, including his neck and because she was concerned that the necklace may be exacerbating it daughter took the necklace off Jamie but left Louis in place. It stayed off for a week and a half, meanwhile both boys started teething, within 2 days Jamie’s bottom was so sore that the skin was breaking, Louis’ posterior was fine. Jamie’s necklace was put back on, within 24 hours his bottom was clearing-up and now it is fine and peachy again. Daughter’s verdict? The amber necklaces work, she is going to recommend them to everyone and even bought one for Evie’s stocking.

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Wasting money

Just a couple of issues winding me up at the moment

  • The Olympics – 2012

Why are we celebrating the fact that we are expending billions of pounds, which we can ill-afford, on this totally OTT event? I’m all for having a frugal games. Lets go back to basics, to a time when the competitors were all amateurs, when the public purse was not used for supporting a few privileged people to spend time doing something they enjoy and, whilst I’m being an old killjoy, the National Lottery. I’m sorry but I thought this was to be used to fund good causes. Now, to me a good cause would be improving care for the elderly, the terminally ill, and a multitude of other areas and not for pouring money into the bottomless pit of the 2012 Olympics.

  • Prescription charges and PCT’s instructing G.P’s not to give out prescriptions for more than a 2 months supply.

Why are the English paying more than the Scots and the Welsh for their prescriptions? NHS – NATIONAL HEALTH SERVICE. If  Hubby took his prescription into a pharmacy in Wales to have it filled would he be charged?

I have a condition which entitles me to exemption from prescription charges, I will be on medication for the rest of my life, if I don’t take my tablets I will, eventually, die. My G.P used to provide me with a prescription for a 3 months supply, now he is only able to provide one for 2 months. Apparently the PCT have advised the surgeries that millions of pounds are being wasted by people not using the medication dispensed. I can empathise with the PCT’s concern over this waste of money, I can appreciate why they may instruct G.P’s to minimise their prescribing, however, I will only stop taking my tablets when I die and if the dosage is adjusted it will only ever increase, I will not be wasting any pills, unless I die unexpectedly and/or prematurely.

For me this reduction in repeat prescription length is inconvenient, for those having to pay the prescription charge it is a 50% increase in their expenditure.  In the same way as I applaud the PCT’s attempts to minimise waste I also have to congratulate them on increasing, so stealthily, the amount Joe Public is paying for a benefit which is free in another part of our nation. 

snowwoman

Happy Christmas to all

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Goodbye to an old friend

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Woolworth

With 27,000 workers about to lose their jobs my sadness about good old Woolies closing is unimportant. I am not approaching Christmas in the certain knowledge that, as I watch the goods disappear from the shelves, so does my employment. I am not having to deal with insensitive customers, annoyed that they haven’t read the signs advertising ‘up to 50% off’ correctly, berating me for paying more than they expected. No, I’m just one of the ‘scavengers, picking over the bones’ (Hubby’s description), who will miss having this gem of a store. Living in a small town we have very few shops so, to have a Woolworth, was a wonderful amenity. Yes, I could buy pairs of children’s socks in an expensive, bijou establishment, but I would rather not; suddenly remember that it’s little Johnny’s birthday, no problem, quick walk into the shops, into F.W, and the problem is solved.

I have memories too. I remember Woolies when it had worn, wooden floors. When all the goods were on counters, and the assistants served you. As a small child I was fascinated by a glowing machine which dispensed warm, oily peanuts into a greaseproof cone. Woolworth has always been there, I jumped down it’s wooden floors as a child, took my own children shopping there, lamenting the day when the floor became vinyl, and now take my grandchildren in there, but not for much longer, the handy ‘in town’ store is succombing to the not handy ‘out of town’ store.

Usually at this time of year I wish assistants in shops ‘A Happy Christmas’. Yesterday, at the till, I so wanted to do that, despondency was all around, I didn’t say it as it seemed somehow inappropriate. I’ll say it here though-

HAPPY CHRISTMAS

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The Change – Part 5

Yet another joy of this transition into this ‘new phase of a woman’s life’  is cystitis, can it get any better? The last time I had this painful complaint was as a student nurse when I was 19, then I was told that it’s also called ‘honeymoon cystitis’ due the suggestion that it is caused by energetic lovemaking, okay, so what catchy little name should I give it now, ‘over-the-hill cystitis’ perhaps?

I had ignored the initial symptoms for a couple of days, peeing all the time, nothing new there, it is a known manifestation of the menopause “You may also experience an urgent need to pass urine, and need to pass it more often than normal”, unfortunately I hadn’t read it all, “During the menopause, you may find that you become prone to recurrent lower urinary tract infections, such as cystitis” so, the stinging I put down to  a new shower gel but when the stinging became a burning I thought I would do a dipstick urine test, leucocytes +++, blood +++, protein +++. Right then, stop the coffee, increase the water. By yesterday evening it was obvious that my efforts were failing, I now no longer wanted to drink anything as that would make me pee, and that was far too painful, plus I was now passing urine which contained frank blood, so frank in fact that it looked like blood. I was also feeling unwell and, unheard of for me, I had a temperature. Time to speak to a doctor.

In this area we have an ‘out of hours’ service which has little consultation surgeries dotted around and this innocent thought she could just phone up and arrange to see a doctor at one, no. When I phoned they were busy and a clinician needs to speak to you to assess if they need to see you, I would have to wait for a doctor to phone me back. I told the operator that I didn’t need a super-urgent appointment, so should I phone back tomorrow? Her advise was to just wait for a phone call as they may be just as busy in the morning. A night of phone calls followed, ‘comfort calls’! Yes, the on-call folks keep calling to check how you are, if you are getting worse, apologizing for the wait and promising that a clinician will contact you soon. The fourth call was the doctor, who gave me an appointment for 8.30am, hurrah! I am now on trimethoprim, drinking glasses of water and looking at a carton of cranberry juice. Cranberry juice may help to clear-up cystitis, if you read one article, according to another it may help prevent cystitis, whatever, it seems to be the way to go but I just really don’t like it.

Prone to now that upsets me and makes me think that I had better start loving cranberries!

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The needs of the living

My friends Mother has been very ill for the past three weeks. A year ago she was diagnosed with throat cancer but due to her age, 87, the doctors advised against aggressive treatment and ‘solved’ the problems she was experiencing with swallowing by the use of an oesophagial stent. It didn’t really solve her problems as she had diabetes, was elderly and somewhat confused so would eat foods unsuitable for a person with a stent, it would block and then once it had been sorted out she would then be too frightened to eat for a few days and so would then become hypoglycaemic and collapse. So, over the past year she had multiple hospital admissions, gradually lost half her body-weight and started to ‘give-up’. Three weeks ago there was a crisis when she developed severe diarrhoea and, after a protracted argument with on-call G.Ps and palliative care nurses, she was admitted to hospital. Obviously the hospital were concerned about the cause of her GI upset, they were thinking C Difficile, so she was barrier nursed until there were 3 samples which showed no infection, eventually she was pronounced clear but the cause remained unknown. During this time more tests and scans were carried out which showed that her cancer had spread to her liver, also her mental state was deteriorating, the morphine now being used probably didn’t help, but at least she was more comfortable.

On Friday she was transferred from the acute hospital to a more local, low-risk unit, the family were pleased as it was a relaxed atmosphere and closer to home. They all knew that she wasn’t going to ‘get better’, that it was unlikely she would be going home but they were totally unprepared for her death in the early hours of Sunday morning. 3 am the phone rang and the nurse broke the news that when they had gone in to check on Edith she was dead. My friend asked what she should do, the nurse said that she could go and see her Mum then, or wait until the morning, the decision she made was to go in the morning with her sisters, there are 4 of them.

In the morning they phoned the ward to find out when would be the earliest they could go in, they were told that they couldn’t, they would have to wait until Edith was taken back to the main hospital and that wouldn’t be until today, Monday.

This morning a bereavement nurse contacted my friend, they don’t work weekends as people don’t die then, apologised for the fact that the family had not been allowed to see Edith yesterday, and then gave her a lot of flannel (my interpretation). Unfortunately they couldn’t go today either because a doctor hadn’t seen Edith yet and there was a lot of paperwork that needed to be done before she was taken to the main hospital. Friend is now devastated and condemning herself for not going when the hospital rang to tell her about her Mother’s death.

Guess who I’m condemning? I shall say no more, just quote here an excerpt from Confirming and Certifying death in Community Hospitals from West Devon PCT.

“Dealing with the loss of a patient in a community hospital is undertaken in a caring,  compassionate and professional manner……. Arrangements following death are carried out sensitively and respectfully, in order to comfort the bereaved and ease their suffering at their time of loss.”

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