I was being sent to one of our regular nursing homes - I'd been to 'Rose Cottage'* a few days earlier for a patient who 'wasn't eating' and had a low blood sugar. This time it was for a patient with chest pain.

It's not the worst nursing home that I go to - the place is clean and tidy, some of the nurses speak good English and the patients aren't beaten. But it's still not as good as it should be; the normal problems of the staff not knowing about their patients, and the usual cold cups of tea siting just outside of the patient's grasp render it an impersonal and borderline neglectful place.

We arrived to find that our patient was a 93 year old female, bedbound and only recently discharged from hospital. She also had dementia although more of the 'pleasantly confused' type. I have found that there are two main ways that dementia manifests itself in nursing homes, the 'constant screaming, scratching and crying' type, and the 'pleasantly stoned' type where the patient is dotty but fairly happy.

This tiny little bird was of the second type, she looked at me as I walked in the room and gave a big toothless smile.

Our patient had been discharged from a good hospital less than 24 hours ago. She had been in hospital because, even though she is bedbound, she managed to break her hip. While in there she caught a chest infection but had since recovered enough to go home where she would continue to be nursed.

Fat chance of that.

The nursing home staff had called the GP who had decided that the patient should go to the hospital. Like most out of hours GPs he saw us arrive, threw a letter at me and ran off.

For some reason they don't like talking to other medical people they can't bamboozle in person.

The doctor had decided that the patient needed to return to hospital - Fair enough, at the end of the day it's what I'm here for.

"She has chest pain", the nurse told me.

I asked the patient if this was true.

"Only when I cough", she was just finishing her course of antibiotics and this was to be expected.

It was obvious that the patient was dehydrated, the heating in the room was high and a full cup of water sat out of reach.

"She hasn't been eating or drinking", the nurse told me.

"Would you like a drink?", I asked the patient.

"Yes please", she replied.

So I did what nurses are supposed to do with patients like this - I helped her have a drink of water. At this point the nurse scuttled out of the room to 'photocopy the notes'.

I noticed that she had a recent cut and some bruises to her arm that were undressed - probably nothing as she does have frail skin, but I made note of it anyway. I lifted her to the trolley and, wrapping her up, took her back to the hospital.

"It's a Rose cottage special", I said to one of the doctors. She replied that she could tell that from a distance without needing to speak to me. The charge nurse who I handed over to spotted the cut to her arm before I had chance to mention it, which puts me in a good mind about the sort of care she'll get at the hospital.

So she returns to hospital where he will probably get another chest infection, and this one might kill her.

Even while the patient is in hospital the care home will be charging in the region of £500 a week for the empty bed. Is it any wonder they call for an ambulance at the drop of a hat? I would imagine that a care home with all it's patients in hospital would be very good for the shareholders.

At the moment I'm looking very seriously at the Commission for Social Care Inspection and their Expert by Experience as I'm getting fed up of tackling things on a case by case basis - I want to change things for the better permanently, something I just can't do in my current job.

*Not it's real name, although some people may well get the reference.

Over at Mental Kipple I have my review of Sunshine - I think it's the last time I'll be invited to a press screening...