What are your unpopular opinions? (Vol. 2)

That is interesting.

Although according to Wikipedia Coca Cola Germany stopped making Fanta in 1949, and an Italian company started making an orange flavoured drink called Fanta in 1955. Coca Cola bought the brand in 1960.

So I’m not sure modern Fanta is actually related to the German version other than sharing the same name.

Absolute nonsense!

Most people are net "beneficiaries" of Government spending so the bit about "more people taking out" is fact. The state of the Country (our public services, infrastructure etc) is poor verging on diabolical, because it's not fully funded. I don't think it's unreasonable for those doing the funding to have a greater say in how the funding is used.

Front line medical and nursing staff have been totally disempowered by successive governments and their policies starting from the 80s. The mistrust is often well placed due to institutional abuse of clinical staff by non-clinically trained people who have zero understanding of how things need to work, even down to the design of wards and buildings. Two examples for you from two different north London hospitals. More than 20 years ago, while I was a house officer (the most junior rank of doctor back in those days, straight out of medical school), one of the consultant orthopaedic surgeons in the department was called up by the management to be hauled over the coals about the cost of the joint replacement prostheses they were using compared to some of the others, and one in particular. Him being a bit of grump probably didn't help, but he had to sit and listen to a diatribe of crap and look at various cost charts and graphs before he was allowed to reply, which was simply "you do realise that the cheaper implants you're talking about are hips, and the more expensive ones I use are knees?" The even bigger nuance was that the full on knees were being compared to hip hemiarthroplasties, i.e., those where only half the joint is replaced due breaking the hip in a fall by a very elderly person in which a very cheap, half-hip implant is used. somebody spent many days trawling through a hell of a lot of data, making charts, graphs, preparing all sorts arguments to have a go at a consultant for what purpose? 1 single clinical person in a whole team of administrators would've pointed out the stupidity of the analysis, but no, they had to have their pound of flesh.

Next, I was senior house officer for 2 years at another hospital, still more than 20 years ago, doing my basic surgical training rotation. It was a brand new, PFI building. I had actually been to the old hospital during medical school as part of an attachment, but this building was now brand spanking new, everything should've worked really well. However, when the architect was designing the building and asked for information on various things, that information was sent by somebody with no clinical experience, and nobody thought to check with somebody with clinical experience either. With nothing better to go on, they just assumed that the size of a hospital bed was the same as a standard single bed. As a result, 2 hospital beds, especially those with lots of medical kit hanging off them couldn't get past each other in any of the departmental corridors, notably in the X-ray department and in operating theatres. What were patient waiting areas in X-ray had to be used as passing points in a single lane roads, and beds either had to be bounced off each other, or use recovery room as a passing point in theatres.

It's easy to say senior medical staff should be front and centre in decision making and have an input into recommendations, but after decades of being ignored, most people have pretty much given up. There's no trust left, and there's no way of getting that trust back either. I don't know what the solution is because I'm no longer in the NHS. If everyone does what I did, there'll be no NHS left.

The fact that you think neither these nor the countless other experiences I've had in the NHS support the principle of requiring clinical input is precisely why we are where we are, with no trust in managers. Of course you need clinicians' input in purchasing to understand what needs to be bought and used in particular types of operations. Give me sutures of the wrong material and size, and I can't implant the valve that needs to go inside the heart in front of me. Give an orthopaedic surgeon the sutures I would use for a heart valve, and watch his handiwork fall apart. Often we even use different types of gloves due to the different properties of the gloves and what we're doing. Different patients and different operations need different types of valves, joint prostheses, sutures, all sorts of stuff, but certain things are identical, just different names by different manufacturers, or sometimes are constructed differently but perform similarly. Even dressings for post operative wounds can be different. How the hell would somebody with no clinical knowledge know which to buy? Their sole target becomes cost savings and money, outcomes go out of the window, and it's the clinicians who have to work with 2nd or 3rd rate st. Everybody thinks they can google stuff and become an expert in anything in 10 minutes, find a cheaper supplier for X product which sounds like it does the same job as what's currently being used without a proper comparison, order a shedload of the stuff, and dump it on the end user. It doesn't have to be a clinician who does the actual ordering, but there should be some communication and sense checking, but that's currently missing and has been so for a while. It doesn't have to be doctor either, there are plenty of instances where nurses or other healthcare professionals would be more suitable, but they don't get consulted either.

Clinician managers exist, there are plenty of them. Not everyone who trains as a doctor or a nurse stays in a 100% clinical role for the rest of their career, especially as they get older and wiser, when the hectic clinical work starts to take its toll but some leave earlier for a variety of reasons. Instead of utilising their experience and wisdom, they're often seen as "the enemy" by the executive team of a hospital though.

There's no harm in an administrator being a clinician but there's no particular need as long as everyone communicates. Guess which bit is most important.

Whilst in theory you are right, in practice it doesn’t work. In my wife’s experience, the clinicians communicate their wishes and their wishes are often ignored as the manager think they can cut costs or even know better. It might be that they don’t listen. It might even be that they are incompetent.

For example, her unit was moved to a new site. She gave an extensive specification of what was clinically important. She also asked to be on the committee overseeing it. The managers kept putting her off until she, as clinical director for the trust, put her foot down. When she eventually got involved, she found innumerable mistakes had been made: not enough power sockets to run the equipment required for the clinics; doors not wide enough to allow disabled access (it is a disabled children’s centre), insufficient disabled parking, insufficient data cabling/lan points and Wi-Fi. They were all things that she’d specified at the start of the project. There was lots of shuffling of feet and “well we thought this was good enough”. The building had to be ripped apart and the project went wildly over budget and behind schedule, as basic requirements hadn’t been factored in as required and requested. The project manager left shortly after and went to another trust on a higher salary.

Were that an isolated example. There are currently plans to build a shiny new children’s hospital. AFAIUI, it will have fewer beds than the current adult one has for paediatrics. It won’t accommodate community paediatricians who care for the long term disabled.

Yes, it is lack of communication but it is just as much project managers thinking that they are in charge and letting their inflated egos get in the way.

I dealt with exactly these problem for decades in IT. Project managers do NOT make decisions on technical (or clinical) matters. Those decisions should be made by, and only by, the people that are actually going to be doing the job and the function of management is to support those decisions. Project managers are one step up from the tea boy and their function is to organise, administrate and facilitate. That is all. When they start changing that which has been specified because they think they know better and, well, this cheaper one is just the same and will be OK, that's when things go to st and the whole project ends up costing twice as much or overrunning or failing to meet the OR.

I will say that there are some, a few, project managers who I have worked with that actually know their role and do it brilliantly. The vast majority, however, are just self-important tossers.

After an extensive period of research and hours of tireless and
selfless isolation in the furtherance of my task
I have come to the conclusion that
Linda Thorson is the best and sexiest Avengers girl,

.

I like the JLC Atmos clocks!