NHS rant alert

[Kellfire]

Give over kellfire, that old cheggar. ��

Well, I am. I'm nowhere near senior enough to hold anyone accountable except some limited amount over the people in the team I lead, but from my relatively low position I see people being held much more accountable than previously. Not saying it's ideal yet but it's improving.

 

[Tashyboy]

Well, I am. I'm nowhere near senior enough to hold anyone accountable except some limited amount over the people in the team I lead, but from my relatively low position I see people being held much more accountable than previously. Not saying it's ideal yet but it's improving.

Kellfire, am joking honest, but to pick up on what you say re accountability. Missis T and colleagues have the view that when it comes to accountability. Drs , nurses, care assistants etc know and accept they have IT. But there is a level within the NHS that does not know what it means and are not held accountable for there
" mistakes".

 

[Ethan]

But this talking about financial accountability, demanding that they code every procedure and interaction, cost everything, and lots of paperwork. It is a nonsense and a complete waste of time and money. Doctors want clinical accountability and responsibility, but management don't want that. The idea that these changes are to improve patient care is risible, and demonstrably false.

Back in the day, if I saw a patient at a medical outpatients, and found they had a specialist problem, say a neurological issue, I could call round to the neuro clinic running at the same time, get someone to see the patient and they would walk round there and then. Now, doctors have to write a letter to the GP, ask the GP to make a new referral, punter goes home, goes to see GP, gets a new appointment 6 weeks later and goes back to the hospital. All in the name of financial accountability.

Likewise, if a GP send a latter to a named Consultant for a referral, the letter is intercepted by a referral team, who check the details against their clipboard, and if they find something missing, they bounce the referral. The Consultant never even sees it. But it helps manage the waiting list because it does not count as a valid referral.

Every Trust has a formulary committee (or similar). Every time a new medicine is approved, each Trust then reviews the clinical data and makes a decision on how it will be used in that Trust. Now, whether it is a good medicine or a bad medicine, it works pretty much the same in patients in Northampton as Newcastle, yet a range of different decisions emerge. This is a colossal waste of time and money.

The A&E 4 hour wait limit causes convulsions in hospital management. It is based on the interval between arrival in the dept and disposal (admission, discharge etc). So if the wait time starts to approach 4 hours and there is a risk of "breach", squads of managers descend and start to harass staff to move patients through. They also instruct ambulances with non urgent cases not to arrive, so they wait in the car park. They generally don't bring extra staff or muck in themselves.

Most of these targets get gamed and distort proper clinical priorities, although they make keep the books tidy.

 

[SocketRocket]

Have you an opinion? Care to share?

Tell me what I said that you think is incorrect and why.

I never suggested you were wrong, I only suggested it was your opinion. Others may have different opinions and they will also believe them to be right.

I dont hold any particular opinion as I believe the issues are very complex and subjective. I can see that there has been rather a lot of Government input into the way the NHS operates and that has been the case as long as it has been in existence, but as they are the purse holders of Public funds so I guess they will want and expect some input on our behalf. I guess we have a choice during elections on who we prefer to hold that purse.

I would like to think that all Governments have the best interest of the NHS at heart and are being advised by a great army of civil servants, I doubt if many Ministers have the where-with-all to understand the complexity of the organisation. Maybe we have the wrong people in the Civil Service?

I doubt very much if the NHS will ever exist without financial problems, whatever is poured into the hole it will still be a black one with an insatiable appetite for the green dollar. We would like to believe that this very large investment will be used to the best effect and value is wrung out of every buck. Somehow I cant see that ever happening.

I like to look at issues from different angles and have a detached view that is not blinkered by sentiment. Some Health Services in other countries seem to be working well and don't seem to produce the emotion and strife we experience. Germany and Australia for example seem to produce the product and to a high standard but they seem to use a mixture of State and Private insurance to fund and service it. I am not an expert on the subject by any means but I think we should be more open in looking into such schemes rather that considering them the work of the Devil.

I would also agree with current suggestions that an ageing population is putting an amount of stress on the NHS and would also say that the increased user base is also doing the same. We don't seem to have increased services to take account of these factors, even though we have known they are happening.

Will there ever be enough money available to make it work? I don't think so!

As I suggested I am not an expert but thats the way I see it at the moment.

 

[Tashyboy]

Missis T has just got in from work and is having a nice little rant. been sat in an office most of the afternoon with consultants etc listening to managers talk about "the vision for the future".
Anyway they have been told that they can no longer have "open " appointments. reason being that when patients are referred again for the same problem, there GP has to pay again. Missis T and others said if you think we will discharge patients who have ongoing cancer and other long term conditions you can get stuffed. After much discussion managers agreed there " may" be special circumstances where open appointments may be used.
Heres the best one. Said manager then said that "Anyone who is serving or has served in HM forces that needs an appointment, they are in the same category as cancer patients, and will be seen within 2 weeks". Now Missis T and said consultants were livid and asked how long this has been the case and why were they not told from day one.
So ladies and gents, if you know of any serving or served members of our forces please let them know. If anyone has anything to add to this, please add.
Have a good weekend Tash.

 

[Deleted member 16999]

Missis T has just got in from work and is having a nice little rant. been sat in an office most of the afternoon with consultants etc listening to managers talk about "the vision for the future".
Anyway they have been told that they can no longer have "open " appointments. reason being that when patients are referred again for the same problem, there GP has to pay again. Missis T and others said if you think we will discharge patients who have ongoing cancer and other long term conditions you can get stuffed. After much discussion managers agreed there " may" be special circumstances where open appointments may be used.
Heres the best one. Said manager then said that "Anyone who is serving or has served in HM forces that needs an appointment, they are in the same category as cancer patients, and will be seen within 2 weeks". Now Missis T and said consultants were livid and asked how long this has been the case and why were they not told from day one.
So ladies and gents, if you know of any serving or served members of our forces please let them know. If anyone has anything to add to this, please add.
Have a good weekend Tash.

Been in a while mate, it's part of the Governments "Armed Forces Covenant" some hospitals/areas are aware, some less so.
We are meant to make our GP's mention it when being referred and then the hospitals are meant to react.
It somehow seems wrong to me and my missus, why are we anymore medically important than someone else who needs treatment.

 

[Tashyboy]

Been in a while mate, it's part of the Governments "Armed Forces Covenant" some hospitals/areas are aware, some less so.
We are meant to make our GP's mention it when being referred and then the hospitals are meant to react.
It somehow seems wrong to me and my missus, why are we anymore medically important than someone else who needs treatment.

I think your first sentance is what Missis T and Co were unhappy about not being informed about when it first came out.
having said that, I know where you are coming from to an extent. However talking to one of my lads pals who comes out of the army soon (medically discharged).
He has seen some bad things (as has probably most) and I would like to think he would or should be in front of me in the queue.
Got a pal in the TA REME's, sergeant now. Served in the first Gulf war, anyway he has had some serious medical problems and I don't know if A, serving TA soldiers qualify, B if he is aware.

 

[Deleted member 16999]

I think your first sentance is what Missis T and Co were unhappy about not being informed about when it first came out.
having said that, I know where you are coming from to an extent. However talking to one of my lads pals who comes out of the army soon (medically discharged).
He has seen some bad things (as has probably most) and I would like to think he would or should be in front of me in the queue.
Got a pal in the TA REME's, sergeant now. Served in the first Gulf war, anyway he has had some serious medical problems and I don't know if A, serving TA soldiers qualify, B if he is aware.

If he suffered the problems whilst on Duty he'd already be in "the system" already and those looking after him should be aware, Any TA soldier injured on Duty would be covered.
I get the point about service personnel seeing some bad things, but possibly no worse to what some civilians have seen and I don't think they should be less of a priority.
My missus is ex-military, registered disabled and receives a war pension, but she won't use her previous service to queue jump, even though the MOD were found liable for some of her health problems.
The Government announced the Covenant in 2013!

 

[Tashyboy]

Just told Missis T re the 2013 date. Don't suprise her at all.

 

[Kellfire]

Armed forces/ex-armed forces getting preferential treatment is disgusting, in my opinion. All because they picked a certain job?

If there was still conscription then maybe there's an argument for it, but in an era of people actively choosing to serve, no way.

 

[Deleted member 16999]

Armed forces/ex-armed forces getting preferential treatment is disgusting, in my opinion. All because they picked a certain job?

If there was still conscription then maybe there's an argument for it, but in an era of people actively choosing to serve, no way.

I agree with your point we chose our certain job, but we also didn't ask for the preferential treatment, that was the government, The only service personnel who should get preferential treatment imo are those who were injured in conflict.

 

[Tashyboy]

Seen the best and worst of the NHS over the last couple of days and I am not a happy bunny at all.
As previously mentioned on another NHS thread Missis T has been having a bad back of late, But for last 8 days has been in agony.
Last night we ended up in A and E at 22.20, she sat, walked and stumbled in agony til midnight when she was seen by a nurse. BP through the roof. She showed them the analgesia she had been prescribed which was not helping. She was taken to
a and e inner sanctum and handed over to another nurse who would prescribe analgesia.
At 01.00 she was offered the same medication which she had in her bag. Missis T was close to tears, said nurse said " well what has the dr said". Through gritted teeth I told her we have not seen one yet. At 01.30, some three hrs later she was given stronger pain killers.
15 mins later she saw a surgical dr and from that point everything has been excellent. But she is still in pain, and at times a lot of it.
But and this is a massive but, Triage in A and E, why treat it in chronological order. Asses yes, but treat no. There are people with cut fingers and sprained ankles being seen before baby's, children and people in agony. Having had several scans today they are still not sure what the problem is. They still think it is still a back problem and rang the hospital trust ( who is taking over kings mill) who has a back specialists. They said "sort out her pain problem before we even contemplate seeing her".
Quite frankly I am bogged off with some of the standard of treatment she has recieved.

 

[SocketRocket]

A relative collapsed this week after some heavy internal bleeding. He was taken to Hospital and given a blood transfusion and some coagulant medication. He was then sent home as there was no bed available and has to go back for a colonoscopy in two weeks. You can imagine how he must be feeling!

 

[Big Whacker]

A and E is for life threatening injuries or serious accidents.

Local GP's are for everything else.

It's no wonder there's a strain.

 

[Tashyboy]

What did not help is that the receptioniat asks everyone if they want to see a dr next door.
Should that not be the job of a triage nurse?
Patients in here abusing staff in no way helps either.

 

[Ethan]

Triage arose in war, as a way of sifting the walking wounded (who could wait) and the hopelessly wounded (who were too far gone) from those who needed immediate care not to fall into the latter category. It is a widely held view amongst medical circles that triage should be performed by the best trained person available, as it is a very challenging task.

Triage in EDs serves a slightly different purpose. ED managers are most worried about breaching the 4 hour target, so triage also serves to move people through the sausage machine. It means that complete wasters who have sod all wrong with them still need to get seen, so people that actually have something not too serious but worthy of an ED visit wait longer than they should. It also means that Trusts game the system. When waiting times rise, they do not allow ambulances to check in unless with serious cases, so others drive around the car park, or park offside for a while. Ridiculous. The punters are just as sick, but the managers top the clock starting until they are ready.

The issue of demand is interesting. The population is not any more sick than it was 10 years ago. In fact, people are generally a bit healthier. So where is the demand coming from? A lot is coming from the toxic combination of raised expectations and low quality referrals. 111 is a curse, and send far too many people to EDs and too many ambulances out. The 111 algorithms are very very risk averse. A GP reported a recent case where a patient found a feather in her infant sons nappy, and called 111. They advised her to go urgently to the local ED. Not sure if they thought the kid was at risk of metamorphosing into a bird and flying off, but time wasted round. Doctor forums are full of similar stupid referrals. If you ever say you are having difficulty breathing, there will be a blue light ambulance at your door, even if you have had difficulty since 1976. The Govt have also raised expectations by promising this and that, putting targets and giving health advice to see a doctor if ... lets of things.

All is made worse by the staffing pressures in GP land and hospitals. There is a major 5 alarm bell head to the lifeboats crisis coming in the NHS and it is the fault of successive Governments, mostly Tory but also New Labour who have driven morale, pay and conditions and career prospects down so far that Aus and NZ are much much better options. Canada is pretty popular with young doctors too. When I was a lad, it was next to impossible to get onto the GP training scheme in Northern Ireland, such was the demand. Now they can't fill the posts. The situation is EVEN worse in most other parts of the UK.

My wife and I are both doctors and we will be doing what we can to persuade our scientifically minded sons to choose something else.

 

[SocketRocket]

Triage arose in war, as a way of sifting the walking wounded (who could wait) and the hopelessly wounded (who were too far gone) from those who needed immediate care not to fall into the latter category. It is a widely held view amongst medical circles that triage should be performed by the best trained person available, as it is a very challenging task.

Triage in EDs serves a slightly different purpose. ED managers are most worried about breaching the 4 hour target, so triage also serves to move people through the sausage machine. It means that complete wasters who have sod all wrong with them still need to get seen, so people that actually have something not too serious but worthy of an ED visit wait longer than they should. It also means that Trusts game the system. When waiting times rise, they do not allow ambulances to check in unless with serious cases, so others drive around the car park, or park offside for a while. Ridiculous. The punters are just as sick, but the managers top the clock starting until they are ready.

The issue of demand is interesting. The population is not any more sick than it was 10 years ago. In fact, people are generally a bit healthier. So where is the demand coming from? A lot is coming from the toxic combination of raised expectations and low quality referrals. 111 is a curse, and send far too many people to EDs and too many ambulances out. The 111 algorithms are very very risk averse. A GP reported a recent case where a patient found a feather in her infant sons nappy, and called 111. They advised her to go urgently to the local ED. Not sure if they thought the kid was at risk of metamorphosing into a bird and flying off, but time wasted round. Doctor forums are full of similar stupid referrals. If you ever say you are having difficulty breathing, there will be a blue light ambulance at your door, even if you have had difficulty since 1976. The Govt have also raised expectations by promising this and that, putting targets and giving health advice to see a doctor if ... lets of things.

All is made worse by the staffing pressures in GP land and hospitals. There is a major 5 alarm bell head to the lifeboats crisis coming in the NHS and it is the fault of successive Governments, mostly Tory but also New Labour who have driven morale, pay and conditions and career prospects down so far that Aus and NZ are much much better options. Canada is pretty popular with young doctors too. When I was a lad, it was next to impossible to get onto the GP training scheme in Northern Ireland, such was the demand. Now they can't fill the posts. The situation is EVEN worse in most other parts of the UK.

My wife and I are both doctors and we will be doing what we can to persuade our scientifically minded sons to choose something else.

I guess that there are a lot more people in the country and using the system is not worth of mention.

 

[Ethan]

I guess that there are a lot more people in the country and using the system is not worth of mention.

No, not really.

http://www.independent.co.uk/news/u...ting-times-there-research-finds-a6686501.html

 

[SocketRocket]

No, not really.

http://www.independent.co.uk/news/u...ting-times-there-research-finds-a6686501.html

From 1987/8 to 2002/3 – attendances at A&E were fairly static at around 14 million per year. But in 2003/4 when the EU was enlarged they jumped by nearly 18 per cent – to 16.5 million, and rose to 21.7 million by 2012/13. This is an overall rise of around 7.5 million (a 50 per cent increase) over the past decade.

 

[Ethan]

From 1987/8 to 2002/3 – attendances at A&E were fairly static at around 14 million per year. But in 2003/4 when the EU was enlarged they jumped by nearly 18 per cent – to 16.5 million, and rose to 21.7 million by 2012/13. This is an overall rise of around 7.5 million (a 50 per cent increase) over the past decade.

And in addition, NHS Direct, known as NHS Redirect amongst doctors, and later 111 started to send loads of unnecessary patients to EDs, whilst the ability to staff medical posts dropped due to a variety of changes enacted by Govt. And the same in GP land where pressure on appointments due to staffing and incased bureaucracy, as well as bed blockage because of reduced social provision all conspired together.

As for your 2003/4 jump, which you attribute to EU expansion, and which is obviously wildly improbable to be due to that, the King's Fund says:

In 2003/4, the number of attendances jumped – by nearly 18 per cent – to 16.5 million. This reflects the decision around this time to incorporate data relating to attendances at walk-in centres and minor injuries units (referred to as ‘type 3 units’ in the figures). These aimed to improve patients’ access to primary care, modernise the NHS to be more responsive to patients’ busy lifestyles, and offer patients more choice (Monitor 2014).

But I think you knew that.

Similar counting tricks have been played since, for example requiring GP admissions to be admitted via A&E even though they don't see a doctor there, as well as ways Trusts inflate figures to show greater levels of activity to attract funding and meet targets. Some of these numbers are not real.

The A&E crisis is NOT due to immigrants.