Police detain 11 year of girl with a neurological disability
Discussion
V8 Fettler said:
singlecoil said:
V8 Fettler said:
Are you not capable of rational thought? I'm all for broadbrush, but to claim that the overheads for Elroy are the same as the overheads for an unknown MH professional is stretching things a bit. Different organisations operating in different sectors = different overheads.
Probably different, but not necessarily different.V8 Fettler said:
For the purposes of the cost comparison, the cost element for a bed/ward within the calculations for the charge-out rate for an MH professional should not be included unless Elroy also supplies a bed/ward.
If Elroy's issue is caused by a lack of capacity, then full cost of expanding that capacity needs considering. V8 Fettler said:
Have you not already made the link between reduction in funding and the return to pre-Peel policing?
I've made no link between pre-19th century policing and modern policing structures. V8 Fettler said:
If you don't accept the issues arising from the cuts in police budgets then what are you doing about it?
Which issues? There are consequences of reduced budgets and I am perfectly at one with them. As long as the government and public know the consequences then they can make informed choices, weighing up the pros and cons of their decisions. V8 Fettler said:
The use of Elroy in place of MH staff is an inefficient use of resources. If there's no cost implication for the NHS when Elroy steps in for MH staff then there is little incentive for NHS managers to resolve this.
That could well be true if it's reasonably in their power to do it and it's not simply demand > supply. La Liga said:
V8 Fettler said:
For the purposes of the cost comparison, the cost element for a bed/ward within the calculations for the charge-out rate for an MH professional should not be included unless Elroy also supplies a bed/ward.
If Elroy's issue is caused by a lack of capacity, then full cost of expanding that capacity needs considering. V8 Fettler said:
Have you not already made the link between reduction in funding and the return to pre-Peel policing?
I've made no link between pre-19th century policing and modern policing structures. V8 Fettler said:
If you don't accept the issues arising from the cuts in police budgets then what are you doing about it?
Which issues? There are consequences of reduced budgets and I am perfectly at one with them. As long as the government and public know the consequences then they can make informed choices, weighing up the pros and cons of their decisions. V8 Fettler said:
The use of Elroy in place of MH staff is an inefficient use of resources. If there's no cost implication for the NHS when Elroy steps in for MH staff then there is little incentive for NHS managers to resolve this.
That could well be true if it's reasonably in their power to do it and it's not simply demand > supply. The model you've described is reactive policing = pre-Peel = 18th Century.
Within the context of this thread, the issue is the misuse of police resource to step in for MH staff.
If demand for a resource (MH care) is high then effective allocation of that resource is more vital than if demand was low. Effective allocation cannot include a police officer babysitting a vulnerable person for hours on end. It should certainly be within the power of public sector management to manage resources; whether they have the competence and incentive to do so is another question.
singlecoil said:
V8 Fettler said:
singlecoil said:
V8 Fettler said:
Are you not capable of rational thought? I'm all for broadbrush, but to claim that the overheads for Elroy are the same as the overheads for an unknown MH professional is stretching things a bit. Different organisations operating in different sectors = different overheads.
Probably different, but not necessarily different.V8 Fettler said:
If Elroy's issue is caused by poor management of MH resource within the NHS then that should be resolved.
The model you've described is reactive policing = pre-Peel = 18th Century.
Within the context of this thread, the issue is the misuse of police resource to step in for MH staff.
If demand for a resource (MH care) is high then effective allocation of that resource is more vital than if demand was low. Effective allocation cannot include a police officer babysitting a vulnerable person for hours on end. It should certainly be within the power of public sector management to manage resources; whether they have the competence and incentive to do so is another question.
Demand across the whole NHS is high. Ambulances are often taking substantial amounts of time during weekends and days of peak demand. This sometimes results in the police being the 'first responders' for serious matters, as it's better than no one going. Saying 'it should be within the power', doesn't work when global demand outweighs supply for the public services. Stretching a finite amount of resources reduces the service available. You take from one area to give to another. The model you've described is reactive policing = pre-Peel = 18th Century.
Within the context of this thread, the issue is the misuse of police resource to step in for MH staff.
If demand for a resource (MH care) is high then effective allocation of that resource is more vital than if demand was low. Effective allocation cannot include a police officer babysitting a vulnerable person for hours on end. It should certainly be within the power of public sector management to manage resources; whether they have the competence and incentive to do so is another question.
The model I've described is the one in which the financial circumstances have forced police managers to undertake. Defining it and comparing it to whatever doesn't have much relevance.
La Liga said:
Demand across the whole NHS is high. Ambulances are often taking substantial amounts of time during weekends and days of peak demand. This sometimes results in the police being the 'first responders' for serious matters, as it's better than no one going.
The model I've described is the one in which the financial circumstances have forced police managers to undertake.
This ^. The model I've described is the one in which the financial circumstances have forced police managers to undertake.
IME it's not unusual now for ambulances to be responding from 30-40 miles away from where they are based, then travelling with patients aboard to hospitals they've never visited before. (I am a roads policing officer, so tend to work alongside ambulance crews quite often.)
It's also not unknown to see ambulances in queues of 8-10 deep outside A&E, and for any urgent cases to be diverted to other A&E departments that aren't so busy that particular day - though two local hospitals have had their A&E departments closed in the last five years, and they're apparently considering the fate of another. IIRC, while it's recognised that there is more than sufficient demand, there isn't enough money and not enough staff.
RogueTrooper said:
It's also not unknown to see ambulances in queues of 8-10 deep outside A&E, and for any urgent cases to be diverted to other A&E departments that aren't so busy that particular day - though two local hospitals have had their A&E departments closed in the last five years, and they're apparently considering the fate of another. IIRC, while it's recognised that there is more than sufficient demand, there isn't enough money and not enough staff.
This is oneof the most frustrating discussions in Emergency care a significant proprtion of the people who attend A+E don;t actually need an A+E department -
many of the 'minor injuries' (i.e. anything that doesn't need to admitting there and then including some Broken bones that will require operative fixation ) can be managed in urgent care / minor injuries ( and in the case of the broken bones example you can come back the next normal working day to be reviewed / seen as a day case once the Urgent care unit has made sure you are properly plastered and got the necessary pain relief ( and antibiotics / tetanus booster etc wtc depending what it is )
a lot of the minor illness stuff should be in primary care or seen in urgent care
the emergency department itself is really there for those who are clinically unstable and/or need immediate admission
even then some of these people aren;t suitable forthe 'standard' ED , if you are having some kinds of heart attack it;s a lot better to get you straight to angio , if you are havign a stroke it;s a lot better toget you straight to CT and then either thrombolysed if it;s clot based stroke or seen by a neurosurgeon for some bleeds ...
major trauma centres exist becasue the old school system of taking people to the local A+E and then secondary trnsfers / waitign for on call staff to operate ha s worse outcomes than flying / driving that little bit further but gettign those who need operating on / other procedures to the place where that procedure is available and sometimes people are literally handed from ambulance trolley to the operating table in the anaesthetic room ...
mph1977 said:
major trauma centres exist becasue the old school system of taking people to the local A+E and then secondary trnsfers / waitign for on call staff to operate ha s worse outcomes than flying / driving that little bit further but gettign those who need operating on / other procedures to the place where that procedure is available ...
I'm quite happy to accept that ^ (MTC vs local A&E outcomes.) I just wish there were a few more major trauma centres to share around the place!RogueTrooper said:
mph1977 said:
major trauma centres exist becasue the old school system of taking people to the local A+E and then secondary trnsfers / waitign for on call staff to operate ha s worse outcomes than flying / driving that little bit further but gettign those who need operating on / other procedures to the place where that procedure is available ...
I'm quite happy to accept that ^ (MTC vs local A&E outcomes.) I just wish there were a few more major trauma centres to share around the place!https://www.nhs.uk/NHSEngland/AboutNHSservices/Eme...
26 MTCs although some are adult only / children only
the obvious gap is a paed trauma centre in SW
making the Major trauma network work is part of the reason for the push to night Helimed Ops as well as more formed Mobile Medical Teams / increased level and skill of immediate care doctors ...
RogueTrooper said:
La Liga said:
Demand across the whole NHS is high. Ambulances are often taking substantial amounts of time during weekends and days of peak demand. This sometimes results in the police being the 'first responders' for serious matters, as it's better than no one going.
The model I've described is the one in which the financial circumstances have forced police managers to undertake.
This ^. The model I've described is the one in which the financial circumstances have forced police managers to undertake.
IME it's not unusual now for ambulances to be responding from 30-40 miles away from where they are based, then travelling with patients aboard to hospitals they've never visited before. (I am a roads policing officer, so tend to work alongside ambulance crews quite often.)
It's also not unknown to see ambulances in queues of 8-10 deep outside A&E, and for any urgent cases to be diverted to other A&E departments that aren't so busy that particular day - though two local hospitals have had their A&E departments closed in the last five years, and they're apparently considering the fate of another. IIRC, while it's recognised that there is more than sufficient demand, there isn't enough money and not enough staff.
No amount of fining or generalisations about management changes that.
La Liga said:
emand across the whole NHS is high. Ambulances are often taking substantial amounts of time during weekends and days of peak demand. This sometimes results in the police being the 'first responders' for serious matters, as it's better than no one going. Saying 'it should be within the power', doesn't work when global demand outweighs supply for the public services. Stretching a finite amount of resources reduces the service available. You take from one area to give to another.
The model I've described is the one in which the financial circumstances have forced police managers to undertake. Defining it and comparing it to whatever doesn't have much relevance.
You're moving the goalposts away from MH.The model I've described is the one in which the financial circumstances have forced police managers to undertake. Defining it and comparing it to whatever doesn't have much relevance.
I'm certain there are occasions where the police arrive at emergency incidents before ambulances, but - generally - how long is it before an ambulance arrives? Twenty minutes? Mk3Spitfire refers to +12 hours babysitting an MH patient. Different scale all together.
La Liga said:
RogueTrooper said:
La Liga said:
Demand across the whole NHS is high. Ambulances are often taking substantial amounts of time during weekends and days of peak demand. This sometimes results in the police being the 'first responders' for serious matters, as it's better than no one going.
The model I've described is the one in which the financial circumstances have forced police managers to undertake.
This ^. The model I've described is the one in which the financial circumstances have forced police managers to undertake.
IME it's not unusual now for ambulances to be responding from 30-40 miles away from where they are based, then travelling with patients aboard to hospitals they've never visited before. (I am a roads policing officer, so tend to work alongside ambulance crews quite often.)
It's also not unknown to see ambulances in queues of 8-10 deep outside A&E, and for any urgent cases to be diverted to other A&E departments that aren't so busy that particular day - though two local hospitals have had their A&E departments closed in the last five years, and they're apparently considering the fate of another. IIRC, while it's recognised that there is more than sufficient demand, there isn't enough money and not enough staff.
No amount of fining or generalisations about management changes that.
mph1977 said:
RogueTrooper said:
It's also not unknown to see ambulances in queues of 8-10 deep outside A&E, and for any urgent cases to be diverted to other A&E departments that aren't so busy that particular day - though two local hospitals have had their A&E departments closed in the last five years, and they're apparently considering the fate of another. IIRC, while it's recognised that there is more than sufficient demand, there isn't enough money and not enough staff.
This is oneof the most frustrating discussions in Emergency care a significant proprtion of the people who attend A+E don;t actually need an A+E department -
-
-
V8 Fettler said:
mph1977 said:
RogueTrooper said:
It's also not unknown to see ambulances in queues of 8-10 deep outside A&E, and for any urgent cases to be diverted to other A&E departments that aren't so busy that particular day - though two local hospitals have had their A&E departments closed in the last five years, and they're apparently considering the fate of another. IIRC, while it's recognised that there is more than sufficient demand, there isn't enough money and not enough staff.
This is oneof the most frustrating discussions in Emergency care a significant proprtion of the people who attend A+E don;t actually need an A+E department -
-
-
but it's safe to say that at least 1 in 5 and a bit A+E attendances probably shouldn't be in emergency care
when you throw A+E vs Urgent care / minor injuries into the mix it changes again
http://www.kingsfund.org.uk/projects/urgent-emerge...
It is important to check when references are made to 'District Nurses' whether the 'drop in number of community RN posts or nunmber of community RNs holding the DN qualification and employed as a 'District Nurse' ( as there was a drop in the number of DNs locally to me a few years ago when the as was PCT introduced 'Community Matrons' - many of whom came from 'District Nurse' posts and held the DN qualification ...
also ETA - yopu can now potentially prescribe from the full formulary as 'not a DN but holds the independent prescriber qualification' , vs the limited and increasingly outdated community practitioners forumulary with the DN qualification ...
Edited by mph1977 on Sunday 26th June 22:06
V8 Fettler said:
You're moving the goalposts away from MH.
I'm certain there are occasions where the police arrive at emergency incidents before ambulances, but - generally - how long is it before an ambulance arrives? Twenty minutes? Mk3Spitfire refers to +12 hours babysitting an MH patient. Different scale all together.
It can be a fair bit more than 20 minutes, and it's probably a more frequent occurrence with matters that aren't literally the most serious responses. I'm certain there are occasions where the police arrive at emergency incidents before ambulances, but - generally - how long is it before an ambulance arrives? Twenty minutes? Mk3Spitfire refers to +12 hours babysitting an MH patient. Different scale all together.
MH or Ambulance (the latter has a fair bit of MH involvement too), it's the same organisation and the wider point is that most issues being described here from all sides, with all public services, are going to rooted in demand > supply issues as opposed to inefficient management issues.
You're quire right to suggest there are efficiencies to be had - the same is true with any large organisation (although the private sector is a lot less restricted to make changes), but I am of the genuine belief that the core issue is one of demand > supply.
V8 Fettler said:
What fining is that then? You appear to be confusing fining with the efficient and accurate management of resources.
You mentioned financial punishments and I have suggested these are ineffective when the cause is demand > supply. La Liga said:
V8 Fettler said:
You're moving the goalposts away from MH.
I'm certain there are occasions where the police arrive at emergency incidents before ambulances, but - generally - how long is it before an ambulance arrives? Twenty minutes? Mk3Spitfire refers to +12 hours babysitting an MH patient. Different scale all together.
It can be a fair bit more than 20 minutes, and it's probably a more frequent occurrence with matters that aren't literally the most serious responses. I'm certain there are occasions where the police arrive at emergency incidents before ambulances, but - generally - how long is it before an ambulance arrives? Twenty minutes? Mk3Spitfire refers to +12 hours babysitting an MH patient. Different scale all together.
MH or Ambulance (the latter has a fair bit of MH involvement too), it's the same organisation and the wider point is that most issues being described here from all sides, with all public services, are going to rooted in demand > supply issues as opposed to inefficient management issues.
You're quire right to suggest there are efficiencies to be had - the same is true with any large organisation (although the private sector is a lot less restricted to make changes), but I am of the genuine belief that the core issue is one of demand > supply.
V8 Fettler said:
What fining is that then? You appear to be confusing fining with the efficient and accurate management of resources.
You mentioned financial punishments and I have suggested these are ineffective when the cause is demand > supply. The efficiency of the management of the supply side becomes more important where supply < demand.
How can the correct allocation of funding = punishment?
mph1977 said:
V8 Fettler said:
mph1977 said:
RogueTrooper said:
It's also not unknown to see ambulances in queues of 8-10 deep outside A&E, and for any urgent cases to be diverted to other A&E departments that aren't so busy that particular day - though two local hospitals have had their A&E departments closed in the last five years, and they're apparently considering the fate of another. IIRC, while it's recognised that there is more than sufficient demand, there isn't enough money and not enough staff.
This is oneof the most frustrating discussions in Emergency care a significant proprtion of the people who attend A+E don;t actually need an A+E department -
-
-
but it's safe to say that at least 1 in 5 and a bit A+E attendances probably shouldn't be in emergency care
-
-
Edited by mph1977 on Sunday 26th June 22:06
V8 Fettler said:
mph1977 said:
V8 Fettler said:
mph1977 said:
RogueTrooper said:
It's also not unknown to see ambulances in queues of 8-10 deep outside A&E, and for any urgent cases to be diverted to other A&E departments that aren't so busy that particular day - though two local hospitals have had their A&E departments closed in the last five years, and they're apparently considering the fate of another. IIRC, while it's recognised that there is more than sufficient demand, there isn't enough money and not enough staff.
This is oneof the most frustrating discussions in Emergency care a significant proprtion of the people who attend A+E don;t actually need an A+E department -
-
-
but it's safe to say that at least 1 in 5 and a bit A+E attendances probably shouldn't be in emergency care
-
-
Edited by mph1977 on Sunday 26th June 22:06
V8 Fettler said:
There will certainly be occasions when ambulance response times are in excess of 20 minutes, but the 95th percentile point is around 19 minutes (system indicator spreadsheet from: https://www.england.nhs.uk/statistics/statistical-... ).
The efficiency of the management of the supply side becomes more important where supply < demand.
How can the correct allocation of funding = punishment?
All the examples in the thread are statistical extremes when considering the larger samples. The efficiency of the management of the supply side becomes more important where supply < demand.
How can the correct allocation of funding = punishment?
Fining isn't 'the correct allocation of funding'.
La Liga said:
ll the examples in the thread are statistical extremes when considering the larger samples.
Fining isn't 'the correct allocation of funding'.
Unfortunately, the amount of police resource expended on MH is not at the statistical extreme.Fining isn't 'the correct allocation of funding'.
What fines? Again, there is no fining.
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