The madness of the NHS

R

redhead

At the Start
Joined
Mar 1, 2008
Messages
2,103
Today we all received a stern message from the Chief Executioner telling us what ourTrust is going to do to reduce costs and balance the books.

One of the points he laid out had us all gasping in disbelief at the short-sigtedness and missed opportunity for increasing delivery of service whilst keeping the costs down:

"... reduce the bed complement at Gloucestershire Royal Hospital to reflect the better discharge arrangements which have seen a reduced length of stay and therefore need for beds."

What planet are these people on? With people staying for shorter times there are more beds being freed up to get the next lot in - we have targets to meet after all!

If patients get frustrated, how the hell do they think that we feel having to work with ridiculous decisions like these?

A couple of years ago our Booking Office was closed down and centralised in Gloucester to deal with all referrals made by Gloucestershire, Worcestershire and Herefordshire GP's whose patients required more specialised treatments based here and in Gloucester.

Now there is talk of decentralising the Booking Office because it actually causes a delay of up to 4 weeks in the patient being seen, rather than sending the letters directly to the Consultant or his secretary.

Having requisitioned the old booking office for other purposes, we now have to find new sites at different hospitals to accommodate the returning booking office staff!

I could go on but there are too many instances of short-sigthedness and bad planning.
 
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The NHS's costs, we're told, are supposedly controlled by its vast layers of non-medical management - people with degrees from universities, which, one imagines, require them to demonstrate some sort of acumen. Sadly, whatever their textbooks told them seems to be binned the moment they assume their highly-paid management pozzies in the Health Service, because year on year, there are tales of the woeful mismanagement of resources. Everything you've just noted above seems to be a catalogue of such idiocies, Redhead.

Sadly, it's never, ever the workers at the coalface who are asked for the input, who attend brainstorming sessions, and who can tell managers what really is needed, and what isn't, and why a change here or there would be most likely to improve, or derail, the current situation, whatever it is.

I feel desperately sorry for everyone trying to do their best in the face of what is, to an outsider, an endless rota of mindless short-sightedness, of ignorance of the way things are really done and of how processes do - or don't - work. It has to be exasperating and demoralising. But thank God medical staff still want to do it!
 
Krizon - you've hit the nail on the head. I have an honours degree in Business Management and would be eligible for the NHS Fast-track Management Training Scheme. I prefer to do some real work.

The problem is that they take young people with little or no work experience, put them straight into junior management positions and within 2 years they are regional directors - without ever having seen just how things really work. Textbooks and theories are all very well, but they take no account of human beings and the things that can go wrong, both with the human body and its surroundings.

We currently have a brilliant situation whereby any child who falls sick out of hours in Cheltenham has to sit around for hours waiting for transport to take them to Gloucester because ... they've centralised the Paediatric Service! So if anyone's got a sick kid anywhere other than Gloucester ...
 
Colin Phillips said:
Too many suits - not enough nurses.

Too many nurses with degrees who are 'too posh to wash'.
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Yet another valid point.

I was up on a ward the other day and nearly died of shame because of the way one young nurse treated an elderly gentleman. I don't normally tell tales, but I was really angry and told my boss about it because it affected that poor man's health and dignity.

My boss has a bad reputation amongst nurses - because he has a bit of a temper and doesn't mince his words. In reality, he is one of the kindest and most considerate people I have ever met and really does care about the patients.

What was it Rommel said about British troops? Something along the lines of "lions led by donkeys" - very applicable here in the NHS, sadly.
 
I'd be inclined to put managers through at least NVQ levels in basic nursing training, if there is such a thing, Redhead - make them work for a day a week at it alongside their managing job, or in a care home. I think that once they'd got used to cleaning up the poop, pee, and puke of the desperately sickly or old, they might respect how time goals can't be achieved in terms of N + Y = X. There are too many random distractions, such as dealing with someone who's just fallen over, keeping a nurse on bedwatch for a dementia patient who crawls all day - that sort of thing.

My eyes were opened to some of the periphery to 'real' nursing when my Mother was admitted to hospital with a broken hip (three weeks after breaking a wrist), following a series of falls. The geriatrics ward was full of the not-with-it: a 24/7 bed crawler, a wanderer who fiddled with patients' bedclothes and muttered all day (and night), a howler, an occasional screamer, and so on. And most of these in nappies, since they had no idea when their bodily functions needed attention. The hospital (East Sussex) was 'exposed' by one of the nurses a few years ago as one of the worst in terms of 'kindly' care, attention and cleanliness, but in all honesty, this particular ward required a constant battery of cleaners, sudden shifts in attention to an unexpectedly wild patient, and any number of random occurrences which would never fit into some tidy, mathematical formula, which is what the NHS's management seems to think is reasonable and rational.

Not when you're dealing with thousands of non-reasoning and non-rational patients every hour of every day and night! Let alone the dynamics of an A&E ward. Yes, let the managers get down among the toilers for a day a week, and then see how they think their 'best value' and 'best practice' formulae really work out!
 
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What it all boils down to was them spending the money on building contrcts then not having the money to staff them,

and while i'm on my soap box why do English people have to pay for care that Scotish people get free,

Even the Welsh get free perscipsions, all we get is waiting lists.
 
Well said, Krizon!!

Andy, I think it boils down to the Scots and Welsh spending their allocations more wisely than the English government/councils do.

Even the Scots pay their taxes and the Welsh, until some time ago, paid much higher taxes than the rest of the UK.

Just better organised spending and planning there, Andy.

The problem as a whole is that the NHS - particularly in England, is top-heavy with managers, deputy managers, assistant deputy managers and assistants to the assistants, who hold a meeting, then another meeting about that meeting, then a sub-meeting about the meeting about the meeting. :blink:

And don't let me start on ******* targets! :lol:
 
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Who then bring in parking charges and consultants get too stressed 'cos they can't find a space and go home sick -actually happened at our local hospital.
 
G-G said:
Who then bring in parking charges and consultants get too stressed 'cos they can't find a space and go home sick -actually happened at our local hospital.
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Sounds like your consultant was too tight to pay for a parking permit G-G!

In the old days, when consultants were gods, he would either have had a reserved space or just have stormed up to the wards and got one of the juniors to shift their car.

Sadly, the motorist is now being seen as another source of income - not just in the hospitals, either.
 
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Actually it was a she and they did used to have reserved spaces, but the local trust decided to charge for all the spaces! Consultants probably could afford to pay, but whether they should, is another matter. All other staff were in the same position, and I don't think that was fair. I am not sure but if they pay the same rate as visitors which is £2 an hour is a lot of money if you have to park all day, 5 days a week. The other problem being that people starting shifts at 2 or later couldn't find a space at all because of all the visitors. On the main road outside are yellow lines, so people resort to parking on any piece of pavement/grass they can find within walking distance. The local pub and livery yard are extremely ticked off to have their spaces used, but people also park in front of the yards' gates and disappear for hours. People and horses can't get in or out some days.
 
redhead said:
The problem is that they take young people with little or no work experience, put them straight into junior management positions and within 2 years they are regional directors - without ever having seen just how things really work. Textbooks and theories are all very well, but they take no account of human beings and the things that can go wrong, both with the human body and its surroundings.
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Sorry, were you describing the mechanics of racecourse management there? It's not far off!

It's all a case of 'let's put people in charge of racecourses who have only worked in hotels before and don't have a fecking clue about ground on racetracks or how racing works, or what a horse is' et al.
 
Tonight on the way home from an appointment after work, I saw a man in some distress semi collasped on the pavement, being violently sick. I stopped to ask if he needed help, at the same time so did someone else. The other guy rang for an ambulance while I tried to ask what had happened. He said he had just suddenly felt faint and nauseous while walking home. He had not had an alcohol drink. The ambulance service asked various questions about his condition. Twenty minutes later we rang again - we were told we were in a queue for an ambulance as the man's condition wasn't life threatening. Ten minutes later they called us back to ask if he was any worse. I thought he was - he certainly wasn't any better. After another 10 minutes, I called 999 and said that an ambulance had been requested but that was an hour ago and the guy was still vomitting and felt worse. They said someone was on the way. When I asked how long, she said on their way but if he got worse to call them back. Twenty minutes later an ambulance appeared. The guy was still vomitting. As they pulled up the driver said 'another drunk'. I told her he hadn't been drinking. She looked like she had had a bad day, and I am sure they have to put up with all sorts of crap in a day, and it's not their fault, but it should not take 80 minutes to respond to a 999 request. I realise they receive lots of calls which are not an emergency - the driver said we have priorities. I said I am not medically qualified to say what caused this guy's condition, but he is entitled to a better standard of care than he had received. I hope he will be okay as he was in a bad way when I left.
 
Whereabouts GG? Only I know you've mentioned being in London before and I wonder if the ambulance crews were caught up at the tower block fire in Camberwell.
 
In fairness, the only experiences I have had of the ambulance service have been very good ones. It might have been 16 years ago but they were out to me within about 15 minutes when I broke my leg badly and was stranded by the side of the road in the middle of nowhere in terms of proximity to a hospital. I was within a mile of the doctor's surgery though and a doctor was with me immediately, he rang the ambulance. Granted it was a long time ago but he insisted on calling for the ambulance himself as he said calls from doctors are attended to more quickly as they don't have to work out if they are hoaxes or not. That said, when I called an ambulance for my father two days before Christmas last year two paramedics were at the door, again within about 15 minutes (we are a good 10 miles from the nearest hospital with an A&E dept).

A few years ago we had an ambulance out within 10 minutes when one of the locals keeled over in the pub having a heart attack whilst playing darts. Unfortunately Alec didn't make it and died on the floor. The emergency services kept me on the phone until the ambulance got there though, issuing instructions on CPR and what to do with him whilst asking for constant updates on his condition. A kiddie in there had recently done a first aid course so luckily for me he offered to take over and administer CPR as I was scared to do it, having not done it before but being the only person in the whole damn place prepared to do it (bar this lad).

As for the rest of the NHS, words fail me. I am on the verge of giving up completely. I'm not far from throwing the screaming ab-dabs and getting someone, anyone, involved. Or maybe I'll just call an ambulance and tell them I'm in so much pain I can't move. It's only a matter of time before I get onto my MP with major complaints about the level of care received.
 
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It's a long story that I wont go into now but I was taken by a private Ambalance paid for by the NHS, as we got there a women ran out and said a small child had colasped the crewe said they could not atend and to call 999 I told them you call they will respond quicker after 20 mins I perswaded them to take a look one was a Dr. the other an x-NHS paramedic the child was in a bad way so I told them to take it about 30mins later an NHS one turned up I tried to speak to them but they ignored me later the came back saying to each other it's just a hoax call when I explained what hapend they lookked cross I was left thinking will they come back for me 4 hours and sevrel phone calls later anoth private one tuned up once again with an ex NHS crew.
 
Shadow, I think I know what is happening in your case as I dealt with someone with a similar story yesterday. Obviously the patient-base at our relative hospitals has to be taken into account.

This lady is an "urgent" case and was put onto my consultant's waiting list at the end of April. Normally our urgent cases are in and done within 4-6 weeks, but the way things are going it will be the end of July before she is attended to.

I make a point of working closely with our Admissions Department because I believe that good communication all round makes things run much more smoothly. From what I was told I am able to deduce that - once again - ******* targets are the culprits.

This lady - and yourself, presumably - have been put onto the consultant's soonest operating list with a timeslot large enough to allow for your operations. Then along comes one of the managers with a list of patients who are about to "breach" the 18-week target (incurring a 3k fine for the Trust for each patient) and everyone on that operating list gets shunted onto the next available one and off we go again.

I recently read a statement from the new Health Secretary that he wants to put less emphasis on targets and concentrate on service delivery (I will post it, if anyone is interested). Whether or not he will be allowed to, though, is a different story as there are thousands of people across the country employed just to monitor targets.

If s/he is approachable, try to get your consultant's secretary on side, we do have direct contact with them and, generally, some influence. I think you will find that your consultant is just as frustrated at the delays as you are.

Hope you get a result soon and that all goes well for you.
 
That sounds about right, redhead. However there is a little more to this as although only on the waiting list since the beginning of May (although told it will be within 2 months at the time...) marked urgent, I should have been put on it last November. It's a long story but things got forgotten about at the consultant's end so I didn't end up on it in November as I should have been.

I have spoken to my consultant's secretary, unfortunately she's new and isn't the one I was speaking to before but within less than 24 hours she rang me to say my consultant had emailed the waiting list office and told them to treat me as 'very urgent' and she thought I'd hear from them soon. Nearly two weeks later I still haven't heard but I don't want to badger my consultant's secretary again as she's done what she can and won't know where I am on the list anyway. It'll end up being another half dozen messages left on the waiting list office's answerphone, hoping they reply to one of them again, I guess.
 
G-G - I hope the chap you helped is okay, too, but thank goodness for thoughtful people like you. You hear so much that's negative about people not wanting to help strangers, that it's lovely to know that there are folks like you who'll take time to do so.
 
krizon said:
G-G - I hope the chap you helped is okay, too, but thank goodness for thoughtful people like you. You hear so much that's negative about people not wanting to help strangers, that it's lovely to know that there are folks like you who'll take time to do so.
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One thing I found odd was that dispite helping someone they wont tell you how they are if you ring the hospital to find out.
 
Patient confidentiality, Andy. By law we are not even able to tell a spouse his/her partner's test results.

This even extends to staff. A colleague of ours had a baby recently. The Maternity Unit is just down the corridor and we know most of the nurses, but when she was admitted they couldn't tell us any more than that she was well and having her breakfast - which we took to mean was code for "she's had it and is okay".
 
Mutiny is brewing amongst the Orthopaedic Admin staff. As most of you will recall, many of us work extra hours to ensure that all of our work is cleared by the end of the week and that all information (clinic notes, operation notes, ward round notes etc) are all typed (correctly) and filed on the patients' notes ready for their next visit. When patients have attended a Fracture clinic, the turnaround on the notes is 4 days.

Imagine our horror when all our hard work to eliminate a backlog of work (some departments have 6 weeks' worth) has been rewarded by even more work.

Some pillock who has been promoted beyond her actual capability has decreed that, because she and her accomplices have overspent to the tune of some 23 million (we were 8m in the black when our old CEO left 2 years ago) the admin staff will bear the brunt of the cost cuts.

We have now been told that bank secretaries (temps employed by the Hospital) and agency secretaries are no longer to be used - even in a fast turnaround department like Trauma and Orthopaedics. In place of this we are being inflicted with a "Buddy" system whereby we are teamed with another secretary in the department.

In the event of illness or holiday, my "buddy" will (in addition to her own large workload):

pick up all my telephone calls;

collect all the patient notes after a clinic - some 60-odd sets (more in a crisis);

log them into my office (which is on the the other side of a large wing of the Hospital);

type any of the urgent stuff - which often means listening to a whole tapeful of clinic notes before you find the urgent one;

type all the op notes and ward rounds (my boss does 2 lots of each a week);
file the above directly onto patients' notes (involves visiting the wards and Clinic prep areas - all spread about the Hospital) which can take over an hour;

get back to her own office and do her own work.

Some of us already work 10 hours a day (2 1/2 hours unpaid) to accommodate the increase in clinic sizes caused by Government targets.

We all feel that this is a kick in the teeth from management but know that if we left our places would be taken by lower grade (therefore cheaper) "secretaries" who are really only typists put into posts that they are not quite equal to. This means that the ultimate service delivery - to the patient - will suffer even more. We have had below-standard secretaries in posts here before and some of them were not just incompetent but downright bloody dangerous in their inability to grasp the seriousness of some cases and in view of some the major mistakes that they made - repeatedly.

We are not just typists - anyone can type a bloody ward round - it's what you do with the information imparted that is important.

My own role not only includes the above, but I am also responsible for the rotas of the entire medical staff. Extra work for which I am not even recognised, let alone paid.

My boss is appalled and astounded by the short-sightedness because, in the long run, it will mean that patient care and delivery of service will suffer. If my work gets behind, it will be so much longer before notes are available for clinics; operation notes will not be available for wound/plaster checks so the staff will not know how to treat a particular patient. The potential for damage to patients is limitless.

Why can management not realise that increasing clinic and theatre work means increasing the administration that goes with it? Our consultants at least recognise that they would drown in paperwork without us, much less not being reminded about meetings and training courses and having their juniors and registrars educational meetings organised.

The public too, we find, are more likely to be hostile to the admin staff, not realising that without us that important operation never gets beyond the paper on which the letter is written, because we are responsible for getting them onto the waiting lists in the first place.

I am not asking for sympathy, but the recognition that not all of us working for the NHS are a bunch of lazy jobsworths who just exist to make life difficult for you, the public. Yes, we could leave, but what we would be replaced with would be even worse than what you have now.

We didn't mis-spend the money, those who did should be the ones to pay not us, and ultimately you, the customer.

Rant over. Gosh, I feel better already.

Thanks for listening, folks. :)
 
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Just come into office to find boss here before me! :eek:

He's seething.

For those not familiar with hospital hierarchies, a Consultant's Registrar is his/her right-hand man/woman. S/he is a fully-qualified surgeon/physician who is undergoing another 7 years of training in order to become a consultant in his/her chosen speciality. All that they lack in qualifications is a licence from the BMA to practice medicine or surgery privately and to teach.

When a consultant is on-call, it is actually his/her registrar who is present in the hospital and dealing with any emergencies that crop up during the night. Anything that requires a higher decision than the Reg's means that the Consultant will be called.

Some fresh-faced little pen-pusher has devised a table which shows that the on-call Reg in Gloucester is rarely operating while the on-call Reg in Cheltenham is. They go on to point out that there have only been 16 occasions when both OCR's have been in Theatre at the same time during the last year.

The proposal is that there is only one Registrar on-call for the whole of the County. :lol:

If it wasn't so ridiculous and potentially dangerous it would be funny.

This means that the less qualified doctors on-call that night will be left to deal with cases that are probably beyond their capabilities and we have quite a few who have not yet learned to recognise their limitations. Therefore the poor patient is likely to get treatment that is not up to the standard required, due to the lack of experience of the doctor/surgeon on-call.

The OCR, meanwhile, will be going about his business in whichever hospital he is based, Cheltenham or Gloucester (all the other hospitals in the County feed into those). If there is a case requiring surgery in Gloucester and the OCR is based in Cheltenham, he will have to race 12 miles to get there (probably incurring points on his licence). Then, if another case crops up in Cheltenham, back he goes.

I fail to see how much money this hare-brained idea will save as the Theatres in both Hospitals still have to be open and staffed.

It also means that there will only one Anaesthetics Reg on-call and standard practice is to have the patient completely knocked out before they even enter the Theatre. If the AR is in Gloucester with the surgical Reg, who is dealing with the patient in Cheltenham? The delay in waiting for the anaesthetic assessment (heart, lungs etc) and for the anaesthetic to kick in could be crucial in saving a limb or even a life.

It seems that they would save a lot of money if they got rid of all these people who come up with such stupid ideas. Unfortunately they are safe and have awarded themselves pay rises before the pay freeze that will affect the rest of us sets in.
 
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