No Wonder A&E Depts Are Bursting At The Seams.
Discussion
captainzep said:
Currently GP's don't feel it's their business to reach out into communities and find the 'hard to reach'. In fairness it's a tricky one for policy makers.
GPs don't have the time or resources to "reach out". For every person like the OP who should be in A&E there are ten who visit their GP because of a minor ailment that started that morning and needs paracetomol, fluids and rest. Their budgets are also being squeezed, with increasingly daft targets being set that bear no relationship to their local population and frequently involve repeating work that's being done by the hospitals.
GPs are as overrun with b
ks as A&E.arguti said:
Just to add the 88 year old sent in by the care home at 03h00 to get her "checked out" after she had a nightmare or
St John Ambulance rushing in a patient with a "non-visible head injury" which turned out to be catatonic schizophrenia.
Seriously, I find NHS Direct and 111 a waste of time because one person's definition of any symptom cannot be reliably interpreted/assessed over the phone by an A&E doctor let alone a non-clinical person who will invariably send them to A&E to get them checked out...sure there are the occasional ones where they err on the other side and something serious gets missed.
care home case - Residential or Nursing ? 999 or via GP OOH ? given that the 'senior carer' in a res. home might have a level 3 NVQ...St John Ambulance rushing in a patient with a "non-visible head injury" which turned out to be catatonic schizophrenia.
Seriously, I find NHS Direct and 111 a waste of time because one person's definition of any symptom cannot be reliably interpreted/assessed over the phone by an A&E doctor let alone a non-clinical person who will invariably send them to A&E to get them checked out...sure there are the occasional ones where they err on the other side and something serious gets missed.
SJA crew and 'catatonic schizophrenia' patient- how many Paramedics can diagnose catatonic states on scant history? and again what was the source of the call event , 999 or Urgent ? and if a SJA crew had not either blued or asked for a paramedic for a combative head injury and either transported them normally and put them in the waiting room ( where they subsequently deteriorated) or discharged at scene you'd be moaning ... Safe triage over priortises initally - this i the issue with NHS direct, AMPDS, Pathways any system it;s just how safe you play ( such as the NHS (re)Direct centres that used to send 999 ambulances to any caller with a cardiac history and any pain in the abdo, chest,back, neck or jaw - regardless of cause )by injecting a 'HCP RED' to dispatch...
Bill said:
captainzep said:
Currently GP's don't feel it's their business to reach out into communities and find the 'hard to reach'. In fairness it's a tricky one for policy makers.
GPs don't have the time or resources to "reach out". For every person like the OP who should be in A&E there are ten who visit their GP because of a minor ailment that started that morning and needs paracetomol, fluids and rest. Their budgets are also being squeezed, with increasingly daft targets being set that bear no relationship to their local population and frequently involve repeating work that's being done by the hospitals.
GPs are as overrun with b
ks as A&E.However, the rise of Clinical Commissioning Groups and GPs as resource allocators and planners is changing the way things work. Previously they would work to the QOF targets and had little financial freedom to do much else, with PCTs at the heart of local planning. Now they have more of a pivotal role and are decision makers within the local health economy. As I left the English NHS, they were already beginning to look at detailed activity figures at A&E and how to manage 'frequent flyer' individuals and doing micro-level analysis (street level) of health behaviour to handle more within the Practices -and save Hospital Trust invoices rolling in. Lower acute bills should translate to more Primary Care capacity. -In theory...
IroningMan said:
All these people who are calling 111 and flooding into A&E departments as a result: you do know that they call 111, not the other way around?
If it weren't for 111 they'd all be dialling 999 and A&E departments would be even further under water.
No, 111 is directly implicated in the problem; according to IoS 73 out of 93 trusts with 111 have seen increased A&E waiting times since it has been introduced whereas of the 19 Trusts where it wasn't used while 10 were worse, 9 were the same or actually better. If it weren't for 111 they'd all be dialling 999 and A&E departments would be even further under water.
And consider the A&E 'system' isn't just the receiving department at the hospital; the ambulance service is now stretched way beyond capacity running to b
ks calls generated by 111 resulting in far less resources available for genuine emergencies. OOH referrals have increased through 111 in a similar fashion with similarly inappropriate referral advice in a system that is similarly struggling.
Punters are often being advised to self-present at A&E on the back of the poor advice offered with 111.
A punter is likely to end up ringing 999 or self-presenting anyway when the 111 system crashes (as it has done frequently already)
111 is just a s
t system that has been rushed in and is very poorly executed.Sway said:
Exactly that. Everything........in one supercluster per area, with satellite stabilisation and air transfer hubs for exceptionally urgent cases (so people can be picked up by ambulance in my sleepy fishing village, stabilised en route or in a shrunken Chichester hospital prior to airlift to Portsmouth/Southampton /Brighton.
Of course the unions wwouldn't like it. Mainly because they haven't got a clue..........
what you have described is basically the regional 24 hour Major Trauma Centre (MTC) model that has been in operation in the UK for some time.Of course the unions wwouldn't like it. Mainly because they haven't got a clue..........
Nothing wrong with the model itself - it's a clinically proven one in the US & Australia. It achieved remarkable success (in terms of estimated lives saved) when it was piloted in the UK in London. However, the 'broad brush' that has been applied to the rest of the UK without taking into account & adapting the necessary regional infrastructure & resources (for example, North Yorkshire- the largest & most rural county in England- has no MTC at all; golden hour? you're f
ked if an Air Ambulance is unavailable to get you to Middlesborough or Leeds).Along with the failure to take account of what happens when you wind down the local 'tertiary' and A&E service support way beyond what was envisaged in the original model, so that the MTC's A&E depts are quickly overrun & overstretched with the fallout.
Then you've got the lack of effective alternative referral pathways, often imbecilic 999/A&E misuse by the general public, a flawed non-emergency phone triage system (i.e. 111 & to a lesser extent NHS Direct before it) - that all serve only to choke up A&E services further still & that's pretty much where we're at now.
maddog993 said:
<snip>
Nothing wrong with the model itself - it's a clinically proven one in the US & Australia. It achieved remarkable success (in terms of estimated lives saved) when it was piloted in the UK in London. However, the 'broad brush' that has been applied to the rest of the UK without taking into account & adapting the necessary regional infrastructure & resources (for example, North Yorkshire- the largest & most rural county in England- has no MTC at all; golden hour? you're fked if an Air Ambulance is unavailable to get you to Middlesborough or Leeds).
or Hull or Preston or Manchester ... Nothing wrong with the model itself - it's a clinically proven one in the US & Australia. It achieved remarkable success (in terms of estimated lives saved) when it was piloted in the UK in London. However, the 'broad brush' that has been applied to the rest of the UK without taking into account & adapting the necessary regional infrastructure & resources (for example, North Yorkshire- the largest & most rural county in England- has no MTC at all; golden hour? you're f
ked if an Air Ambulance is unavailable to get you to Middlesborough or Leeds).http://www.nhs.uk/NHSEngland/AboutNHSservices/Emer...
North Yorks is a poor example as Northallerton was never a big ED anyway (and was propped for a while by the MoD), and York's catchment area only supports a DGH clinically
there is also a fixation on distance to A+E , forgetting that even if you get to A+E in ' the golden hour' without the surgical backup there is only so much you can do ... and do you really want to be operated on by someone who does trauam surgery once in a blue moon and whose normal surgical load has been reduced to allow him/ her to take regular trauma shifts ( given the number of PAs a 24 hour trauma shift can occupy for a consultant)
air secondary transfer may be an option - it was suggested a number of years ago with regard to Lincolnshire at night as Lincs has all ways looked to Hull Royal, Sheffield, QMC for it's tertiary services ... as response to scene in a MD900 or EC135 at night is problematic even 2 pilot although it;s somewhat less of an issue than in a bolkow ( where the choice was patient or night sun ) - as some of the dual role police / EMS 135s have pushed the limits ( dual role is at the cost of single patient and no 'passenger' rather than dual patient and a limited numbers of bodies aboard ( as dedicated EMS can fly pilot, 3 aircrew 2 patients and still have weight for a 'passenger' where dual role or police has the video kit and the nitesun taking up payload )
Paeds MTC cover for the SW is a bigger issue than N Yorks (closest one is Bristol) - and adult cover is a choice of 2 ( Derriford or Brizzle)
maddog993 said:
Along with the failure to take account of what happens when you wind down the local 'tertiary' and A&E service support way beyond what was envisaged in the original model,
the MTCs are the tertiary centres - apart from some services which have allways been supra regional e.g Burns ITU ( and the RSICs aren't necessarily in the MTCs - firstly because there are fewer of them than MTCs and secondly because it's often ortho or neuro surgeons that do the acute surgical procedures where the Spinal consultants if they operate tend to do the urology / plastics / spasticity management stuff rather than acute - especially with the current professional training pathway for Spinal injuries ConsultantsEdited by mph1977 on Monday 20th May 15:08
You chaps both paramedics then?
I'm not -but am aware of a day recently in the S Wales area where 17 ambulances were stacked outside a DGH and apparently they were very close to being unable to respond to a Cat 'A' call. I think they dusted off the HART vehicle in the end to help out, having sucked in crews from other neighbouring areas.
Seen similar in your areas?
I'm not -but am aware of a day recently in the S Wales area where 17 ambulances were stacked outside a DGH and apparently they were very close to being unable to respond to a Cat 'A' call. I think they dusted off the HART vehicle in the end to help out, having sucked in crews from other neighbouring areas.
Seen similar in your areas?
captainzep said:
You chaps both paramedics then?
I'm not -but am aware of a day recently in the S Wales area where 17 ambulances were stacked outside a DGH and apparently they were very close to being unable to respond to a Cat 'A' call. I think they dusted off the HART vehicle in the end to help out, having sucked in crews from other neighbouring areas.
Seen similar in your areas?
if directed at me ? I'm not -but am aware of a day recently in the S Wales area where 17 ambulances were stacked outside a DGH and apparently they were very close to being unable to respond to a Cat 'A' call. I think they dusted off the HART vehicle in the end to help out, having sucked in crews from other neighbouring areas.
Seen similar in your areas?
No i'm not , my background is as a Nurse although I am not currently in clinical practice.
My background in Nursing in emergency care ( both A+E and out of hospital with SJA) and tertiary specialist services ...
captainzep said:
I'm not suggesting that GP's do have the resources as things stand.
However, the rise of Clinical Commissioning Groups and GPs as resource allocators and planners is changing the way things work. Previously they would work to the QOF targets and had little financial freedom to do much else, with PCTs at the heart of local planning. Now they have more of a pivotal role and are decision makers within the local health economy. As I left the English NHS, they were already beginning to look at detailed activity figures at A&E and how to manage 'frequent flyer' individuals and doing micro-level analysis (street level) of health behaviour to handle more within the Practices -and save Hospital Trust invoices rolling in. Lower acute bills should translate to more Primary Care capacity. -In theory...
Assuming things stay as they are for long enough for everyone to find their feet. However, the rise of Clinical Commissioning Groups and GPs as resource allocators and planners is changing the way things work. Previously they would work to the QOF targets and had little financial freedom to do much else, with PCTs at the heart of local planning. Now they have more of a pivotal role and are decision makers within the local health economy. As I left the English NHS, they were already beginning to look at detailed activity figures at A&E and how to manage 'frequent flyer' individuals and doing micro-level analysis (street level) of health behaviour to handle more within the Practices -and save Hospital Trust invoices rolling in. Lower acute bills should translate to more Primary Care capacity. -In theory...
captainzep said:
You chaps both paramedics then?
I'm not -but am aware of a day recently in the S Wales area where 17 ambulances were stacked outside a DGH and apparently they were very close to being unable to respond to a Cat 'A' call. I think they dusted off the HART vehicle in the end to help out, having sucked in crews from other neighbouring areas.
Seen similar in your areas?
I'm a Paramedic Practitioner mate, - vested interest & frustration in this debate in that a large part of the role is supposed to be about bringing treatment to the patient's home & provide the most suitable course of treatment according to their specific condition rather than just bundling someone to A&E for the sake of it (thereby preventing unnecessary admissions). However, at the moment - as we operate in a rapid response vehicle - more often than not we just get used as 'clock-stoppers' to help achieve the specious response time targets.I'm not -but am aware of a day recently in the S Wales area where 17 ambulances were stacked outside a DGH and apparently they were very close to being unable to respond to a Cat 'A' call. I think they dusted off the HART vehicle in the end to help out, having sucked in crews from other neighbouring areas.
Seen similar in your areas?
And in answer to your second question - absolutely; James Cook at Middlesborough, York and Darlington are all regularly 'backed up' leading to vehicles being sucked in from everywhere else.
maddog993 said:
what you have described is basically the regional 24 hour Major Trauma Centre (MTC) model that has been in operation in the UK for some time.
Nothing wrong with the model itself - it's a clinically proven one in the US & Australia. It achieved remarkable success (in terms of estimated lives saved) when it was piloted in the UK in London. However, the 'broad brush' that has been applied to the rest of the UK without taking into account & adapting the necessary regional infrastructure & resources (for example, North Yorkshire- the largest & most rural county in England- has no MTC at all; golden hour? you're fked if an Air Ambulance is unavailable to get you to Middlesborough or Leeds).
Along with the failure to take account of what happens when you wind down the local 'tertiary' and A&E service support way beyond what was envisaged in the original model, so that the MTC's A&E depts are quickly overrun & overstretched with the fallout.
Then you've got the lack of effective alternative referral pathways, often imbecilic 999/A&E misuse by the general public, a flawed non-emergency phone triage system (i.e. 111 & to a lesser extent NHS Direct before it) - that all serve only to choke up A&E services further still & that's pretty much where we're at now.
I am not involved in the medical profession in any way, but have rather a lot of experience of client delivery models. Nothing wrong with the model itself - it's a clinically proven one in the US & Australia. It achieved remarkable success (in terms of estimated lives saved) when it was piloted in the UK in London. However, the 'broad brush' that has been applied to the rest of the UK without taking into account & adapting the necessary regional infrastructure & resources (for example, North Yorkshire- the largest & most rural county in England- has no MTC at all; golden hour? you're f
ked if an Air Ambulance is unavailable to get you to Middlesborough or Leeds).Along with the failure to take account of what happens when you wind down the local 'tertiary' and A&E service support way beyond what was envisaged in the original model, so that the MTC's A&E depts are quickly overrun & overstretched with the fallout.
Then you've got the lack of effective alternative referral pathways, often imbecilic 999/A&E misuse by the general public, a flawed non-emergency phone triage system (i.e. 111 & to a lesser extent NHS Direct before it) - that all serve only to choke up A&E services further still & that's pretty much where we're at now.
From what I understand of what you have written, in my opinion the MTC model doesn't go far enough, and for the reasons you state.
I wouldn't want it for the worst cases only, I'd want it for essentially everything, segregated by triage assessment. So everything from GP duties backed up with full testing abilities/physio etc. through to the major Trauma treatment/absolute life threatening conditions.
When I say supercluster, I really do mean supercluster - a limited number of medical 'towns' far beyond anything currently existing, with the ability to do absolutely every single thing that could possibly be needed (although I recognise there is probably a case for certain absolute rare specialisations that should only be handled in a couple of world class centres of excellence).
Similar models work very well indeed in a range of other areas that require flexibility, skill, experience and world class customer service. There is no reason why it wouldn't provide the same benefits within the health care sector.
But it's a massive change, that only ever works if adopted fully, without compromise and with effective management. Something the political nature of the NHS doesn't allow, as politicians are s
te at both... Sway said:
I am not involved in the medical profession in any way, but have rather a lot of experience of client delivery models.
From what I understand of what you have written, in my opinion the MTC model doesn't go far enough, and for the reasons you state.
I wouldn't want it for the worst cases only, I'd want it for essentially everything, segregated by triage assessment. So everything from GP duties backed up with full testing abilities/physio etc. through to the major Trauma treatment/absolute life threatening conditions.
When I say supercluster, I really do mean supercluster - a limited number of medical 'towns' far beyond anything currently existing, with the ability to do absolutely every single thing that could possibly be needed (although I recognise there is probably a case for certain absolute rare specialisations that should only be handled in a couple of world class centres of excellence).
Similar models work very well indeed in a range of other areas that require flexibility, skill, experience and world class customer service. There is no reason why it wouldn't provide the same benefits within the health care sector.
But it's a massive change, that only ever works if adopted fully, without compromise and with effective management. Something the political nature of the NHS doesn't allow, as politicians are ste at both...
Its an appealing concept but the transport logistics simply don't work. Neither does the politics, as soon as a child died in the back of an ambulance (and they would, in not insignificant numbers), there would be outrage. From what I understand of what you have written, in my opinion the MTC model doesn't go far enough, and for the reasons you state.
I wouldn't want it for the worst cases only, I'd want it for essentially everything, segregated by triage assessment. So everything from GP duties backed up with full testing abilities/physio etc. through to the major Trauma treatment/absolute life threatening conditions.
When I say supercluster, I really do mean supercluster - a limited number of medical 'towns' far beyond anything currently existing, with the ability to do absolutely every single thing that could possibly be needed (although I recognise there is probably a case for certain absolute rare specialisations that should only be handled in a couple of world class centres of excellence).
Similar models work very well indeed in a range of other areas that require flexibility, skill, experience and world class customer service. There is no reason why it wouldn't provide the same benefits within the health care sector.
But it's a massive change, that only ever works if adopted fully, without compromise and with effective management. Something the political nature of the NHS doesn't allow, as politicians are s
te at both... Hence the need for acute stabilisation centres, and a much improved air capability...
I can't help but feel a significant proportion of the golden hour is spent travelling and obtaining the right specialists in a lot of cases. Those that don't have that need for specialisms other than generic high trauma/cardiac could be dealt with as effectively as now in the more local centre, prior to air or road transfer when appropriate. Others would be airlifted immediately, either in place of ambulance or through we contact air transfer as before.
This is the issue - the emotive and political aspects. I'm certain just from the experiences called out on this thread that there are a lot of children, adults and elderly dieing needlessly already, but it's unreported as it's due to the status quo...
I can't help but feel a significant proportion of the golden hour is spent travelling and obtaining the right specialists in a lot of cases. Those that don't have that need for specialisms other than generic high trauma/cardiac could be dealt with as effectively as now in the more local centre, prior to air or road transfer when appropriate. Others would be airlifted immediately, either in place of ambulance or through we contact air transfer as before.
This is the issue - the emotive and political aspects. I'm certain just from the experiences called out on this thread that there are a lot of children, adults and elderly dieing needlessly already, but it's unreported as it's due to the status quo...
Sway said:
Hence the need for acute stabilisation centres, and a much improved air capability...
I can't help but feel a significant proportion of the golden hour is spent travelling and obtaining the right specialists in a lot of cases. Those that don't have that need for specialisms other than generic high trauma/cardiac could be dealt with as effectively as now in the more local centre, prior to air or road transfer when appropriate. Others would be airlifted immediately, either in place of ambulance or through we contact air transfer as before.
This is the issue - the emotive and political aspects. I'm certain just from the experiences called out on this thread that there are a lot of children, adults and elderly dieing needlessly already, but it's unreported as it's due to the status quo...
But helicopters cost an absolute fortune. And the transport issues are much more complex than that, for example getting people back home, inability of people with limited resources to visit family etc. I can't help but feel a significant proportion of the golden hour is spent travelling and obtaining the right specialists in a lot of cases. Those that don't have that need for specialisms other than generic high trauma/cardiac could be dealt with as effectively as now in the more local centre, prior to air or road transfer when appropriate. Others would be airlifted immediately, either in place of ambulance or through we contact air transfer as before.
This is the issue - the emotive and political aspects. I'm certain just from the experiences called out on this thread that there are a lot of children, adults and elderly dieing needlessly already, but it's unreported as it's due to the status quo...
I'm not sure what you mean by "generic high trauma/cardiac" but that's a lot of expensive kit and skillsets. Do you mean that you would propose centralising specialties other than trauma and cardiac? Because trauma and cardiac are exactly what is being centralised already.
Local centres that stabilise patients and then refer on complex stuff, plus air ambulance straight to MTC for some cases, is what we already have!
I'm not trying to just nay-say all change but it is very difficult to sort out, plenty of people with more insight than you and I are trying to figure it out. As you say though, politics intervenes.
Apologies, my lack of medical knowledge is limiting my ability to effectively communicate the changes I propose.
If we take it that the number of cases that are actually pretty minor/straightforward massively outweigh the number that actually require high levels of specification/equipment/skill. Then also take it that there is an issue at the current 'emergency' (A&E) departments of people using them like a GP as the GP offering doesn't necessarily provide what the patient would like (whether they are right or not). Add in that GP provision is hampered by many factors such as delays in processing tests/physio/general nursing resource. Lastly, that the hand offs between different departments cause issues in many ways from the patient's perspective.
Keep the MTC's (but improve where the model isn't properly applied), but ADD IN an effective tiering system that covers all the routine and minor stuff. So as a patient I rock up through travelling myself, or an ambulance has triaged me and decided I'm best dealt with properly.
When I arrive, I could end up in one of say 5 'centres', all Co located. Those centres are staffed, equipped and focussed on differing levels of need. So high skillsets and beds surrounded by top end kit are not used to deal with sprained ankles, but only for those that need it. If necessary, staff can flex, and call upon higher levels of equipment or supporting department resources if they are appropriate and available. Proper economies of scale, plus improved targeting of patient care, built around their care needs (not their travel wants, which is a useless measure of care effectiveness). That's what a health care 'town' would look like (ish, and with more deliberate design than the half hour I've thought about it today). Oh, and the management structure would be by 'product family' not department. So there would be one person responsible for all aspects, staff and resources focussed on 'Level 1 Basic care', and so on, rather than archaic team and department managers constantly engaged in bickering and politics. No handout issues that way and no counterproductive, non patient led, fking around to meet 'targets'...
I'm well aware people better than us are looking at different possibilities, I have ex colleagues who've shifted across to apply the principles of what I do into the NHS!
If we take it that the number of cases that are actually pretty minor/straightforward massively outweigh the number that actually require high levels of specification/equipment/skill. Then also take it that there is an issue at the current 'emergency' (A&E) departments of people using them like a GP as the GP offering doesn't necessarily provide what the patient would like (whether they are right or not). Add in that GP provision is hampered by many factors such as delays in processing tests/physio/general nursing resource. Lastly, that the hand offs between different departments cause issues in many ways from the patient's perspective.
Keep the MTC's (but improve where the model isn't properly applied), but ADD IN an effective tiering system that covers all the routine and minor stuff. So as a patient I rock up through travelling myself, or an ambulance has triaged me and decided I'm best dealt with properly.
When I arrive, I could end up in one of say 5 'centres', all Co located. Those centres are staffed, equipped and focussed on differing levels of need. So high skillsets and beds surrounded by top end kit are not used to deal with sprained ankles, but only for those that need it. If necessary, staff can flex, and call upon higher levels of equipment or supporting department resources if they are appropriate and available. Proper economies of scale, plus improved targeting of patient care, built around their care needs (not their travel wants, which is a useless measure of care effectiveness). That's what a health care 'town' would look like (ish, and with more deliberate design than the half hour I've thought about it today). Oh, and the management structure would be by 'product family' not department. So there would be one person responsible for all aspects, staff and resources focussed on 'Level 1 Basic care', and so on, rather than archaic team and department managers constantly engaged in bickering and politics. No handout issues that way and no counterproductive, non patient led, f
king around to meet 'targets'... I'm well aware people better than us are looking at different possibilities, I have ex colleagues who've shifted across to apply the principles of what I do into the NHS!
No, I'm saying that care requirements should override travel requirements where appropriate.
Far more efficient for people to travel to care, than care providers travel to people, in the vast majority of cases...
Then there is the element of patient transport services. My brother was saved due to an easily awoken off duty nurse and the air Ambulance taking him to a specialist brain trauma centre. But that level of travel provision isn't appropriate for the vast majority.
This notion that care providers should be located as close as possible to the patient's home causes staggering levels of cost and reductions in the quality and service delivery. It should be a weighted consideration, but that weighting should be much lower than what operating model provides the best level of care/treatment and best use of resources. Ambulances are much cheaper than operating theaters. For routine supportive care such as for the elderly or disabled, the best levels of service delivery could well include this care being provided at home. Indeed my OH currently receives treatment on that basis.
Far more efficient for people to travel to care, than care providers travel to people, in the vast majority of cases...
Then there is the element of patient transport services. My brother was saved due to an easily awoken off duty nurse and the air Ambulance taking him to a specialist brain trauma centre. But that level of travel provision isn't appropriate for the vast majority.
This notion that care providers should be located as close as possible to the patient's home causes staggering levels of cost and reductions in the quality and service delivery. It should be a weighted consideration, but that weighting should be much lower than what operating model provides the best level of care/treatment and best use of resources. Ambulances are much cheaper than operating theaters. For routine supportive care such as for the elderly or disabled, the best levels of service delivery could well include this care being provided at home. Indeed my OH currently receives treatment on that basis.
Forgive me because i don't have the figures, but there is an increase in mortality with both cardiac and trauma cases, it's around 0.5-1% per mile, hence there is a balance between taking them to the MTC and taking them to the nearest A&E. The best patients to take to the MTC are the ones needing specialist expertise, but who are stable. Unstable patients get brought to the nearest A&E if they can't get to to the MTC in time. The problem is these are often the patients who go on to need the specialist input who then need transferring which takes ages, the concept to making this a regular event is terrifying, we'd end up with huge numbers of docs and nursing moving unstable patients sat in the back of ambulances.
Helicopters are fab but massively expensive, often don;t run 24/7 and don't fly in all conditions. They make sense in large sparsely populated areas, but the case weakens as the population density rises. There is also the problem that they crash, once again i don't have the number, but the german experience is there is a crash rate per hour and something like 50% of the crashes involve the loss of the entire crew and the patient, we've been lucky in the UK, but there have been some pretty close calls. Managing patients on a helicopter is also much more difficult. On the plus side it's great fun.
The concept of having units that filter, sort and then send to A&E is sound and is being looked at. The problem is who staffs them? It's really not the gps field or area of expertise ( since it would need to be 24/7 service the gps would never agree) and all your A&E docs are now in the central A&E department. ENPs don't have the experience or depth of knowledge to handle majors and resus, if they could we would have done it already. You could put A&E docs in the peripheral units but then if you're going to cover this 24/7 you need huge numbers and we have a shortage of them already as it's a crap job.
The biggest problem is patients don't like travelling a long way to hospital, either to A&E or to visit so fight tooth and nail to keep departments open that can't be justified.
Helicopters are fab but massively expensive, often don;t run 24/7 and don't fly in all conditions. They make sense in large sparsely populated areas, but the case weakens as the population density rises. There is also the problem that they crash, once again i don't have the number, but the german experience is there is a crash rate per hour and something like 50% of the crashes involve the loss of the entire crew and the patient, we've been lucky in the UK, but there have been some pretty close calls. Managing patients on a helicopter is also much more difficult. On the plus side it's great fun.
The concept of having units that filter, sort and then send to A&E is sound and is being looked at. The problem is who staffs them? It's really not the gps field or area of expertise ( since it would need to be 24/7 service the gps would never agree) and all your A&E docs are now in the central A&E department. ENPs don't have the experience or depth of knowledge to handle majors and resus, if they could we would have done it already. You could put A&E docs in the peripheral units but then if you're going to cover this 24/7 you need huge numbers and we have a shortage of them already as it's a crap job.
The biggest problem is patients don't like travelling a long way to hospital, either to A&E or to visit so fight tooth and nail to keep departments open that can't be justified.
Ok, you mentioned GPs in an earlier post so I wasn't clear.
I don't disagree with what you're saying but travel is important, especially when it comes to more minor or chronic conditions, not to mention the morale benefits to patients who need rehab etc. The DNA rate in many of the less urgent departments is already ridiculous and increasing travel times would only worsen that.
Ultimately we risk our ability to prevent disease simply because people won't take the time (and expense) to travel.
I don't disagree with what you're saying but travel is important, especially when it comes to more minor or chronic conditions, not to mention the morale benefits to patients who need rehab etc. The DNA rate in many of the less urgent departments is already ridiculous and increasing travel times would only worsen that.
Ultimately we risk our ability to prevent disease simply because people won't take the time (and expense) to travel.
Good points, both of you.
To give you an idea of where I'm coming from, my job is to transform pretty large businesses into client focussed ones. Structurally and culturally.
It seems from my perspective that the biggest issues the NHS faces aren't funding level related, but application of funds and a organisational structure that isn't intrinsically based around client service. That's not the fault of the NHS staff - i have several friends who work in health care, from hospital cleaner to consultant surgeon. The issue is that very few organisations truly look at real client experience, and are structured along traditional lines that often increases demand (due to failures, mistakes and queries), causes ineffective use of resources, and force staff to spend valuable time and effort dealing with petty bullst.
Add in the political and societal pressures and it's a tough nut to crack!
Politicos, well they are a shower of st. And there's no point actually asking people what they'd like as you end up with a mkV escort.
For me, it would be a challenge I would relish - indeed I am talking with ex colleagues about shifting out of my current job into supporting them with it, but if I'm honest I'm not sure I have the stamina for it.
The prizes for everyone are off the scale if it can be done right however.
To give you an idea of where I'm coming from, my job is to transform pretty large businesses into client focussed ones. Structurally and culturally.
It seems from my perspective that the biggest issues the NHS faces aren't funding level related, but application of funds and a organisational structure that isn't intrinsically based around client service. That's not the fault of the NHS staff - i have several friends who work in health care, from hospital cleaner to consultant surgeon. The issue is that very few organisations truly look at real client experience, and are structured along traditional lines that often increases demand (due to failures, mistakes and queries), causes ineffective use of resources, and force staff to spend valuable time and effort dealing with petty bulls
t. Add in the political and societal pressures and it's a tough nut to crack!
Politicos, well they are a shower of s
t. And there's no point actually asking people what they'd like as you end up with a mkV escort. For me, it would be a challenge I would relish - indeed I am talking with ex colleagues about shifting out of my current job into supporting them with it, but if I'm honest I'm not sure I have the stamina for it.
The prizes for everyone are off the scale if it can be done right however.
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