NHS - just a couple of things over the last few days.

[skeggysteve]

Not a moan really just a 'how do they manage to get things so wrong' yet can manage to so many things right.

Wife has bad back and last week the pain management guy said how about trying acupuncture, wife says OK.

I'm at home and get a phone call yesterday from acupuncture people saying they have a short notice appointment can my wife call them back asap.

I say yes, I'll get her to call you back asap - I get given, when my wife rings it, a fax number.

........................

Second thing - wife gets a letter to go to a breast screening thing, letter says if you want to change the appointment call this number or email us.

The email address is not valid and so bounces back and the phone number, at 10am, has a recorded massage saying please call back between 9.30 and 16.30.

[jules_s]

I know what you mean...

The telephone numbers seem to change randomly from week to week for me.

In fact, the last time(s) I've successfully booked an appointment it's been via a receptionist who used a computer (circa 1990) which was accessing a program which looked like it was written on an 80's BBC

[smiffy180]

Well on Tuesday took my OH to hospital at 10:30, she was given a needle for drip, not one glass of water or drip even for that matter. We left at 5pm when everything was sorted only to be asked if she wanted a drink (shift swap)

To me that's a massive fk up especially since it was 30 degrees outside and no aircon inside

[CC07 PEU]

I got out of hospital on Sunday after spending ten days in there as a result of a broken hip bone sustained in a cycling accident. It was the worst experience of my life.

The things I noticed were:

- the ambulance took 30 mins to turn up. It could have been worse but when you're lying on the ground in agony
and unable to walk, a sharper response would have been appreciated.

- I had to sit with a broken hip for 2.5 days while waiting on a slot in the operating theatre so that surgery could commence. This meant I was "nil by mouth" for those 2.5 days which meant I was not only in agony but I was starving for most of the time too.

- the level of patient service was appalling. This was probably due in part to lack of staff resource but I also got the impression some of the nurses hated their jobs and would much rather be doing something else. E.g. there was an electronic buzzer that you could use to call nurses. Sometimes the nurses would just reset the request so that you'd be forgotten about, the other times they would turn up half an hour later, they'd say they were going to do something to help you then another half an hour later nothing would have been done about your request.

- it was extremely noisy at all hours of the night - the nurses didn't appear to make any effort to keep their voices down in respect of the sleeping patients. It was by no means a comfortable environment in which to make a recovery from a serious injury and operation.

- there was no air conditioning in the hospital and there was only one fan available per ward meaning that I was in agony, starving, and sweating away in the stifling heat to the extent that skin started flaking off my back and arse cheeks...

- the ward windows only partially openened for health and safety reasons meaning there was no way of effectively ventilaing the ward during one of the warmest summers we've had for years.

- the "Hospicom" television service was a pile of fking ste - it was very expensive and NEVER worked.

- No Wifi. I appreciate Wifi is not an automatic entitlement but in this day and age it's a very inexpensive service that could be provided with an inordinate benefit to patients i.e. a link to the outside world.

- the food was absolutely awful - imagine cheap, stodgy school dinners from the 1950s.

Overall, I think it gave me a taste for what it may be like to be a wounded soldier stranded in a hot rainforest with a 2.5 day wait for the next helicopter out of the jungle to be taken to the nearest hospital to be operated on...

When I get back to work I will be signing up to the private healthcare scheme on offer to at least try and minimise my exposure to the services of the NHS.

[George111]

CC07 PEU said:

stuff

I see you're from London. Try being ill elsewhere next time, it's much better up here in Hertfordshire I've heard London hospitals are poor, probably because of the population density. My last experience of the NHS for an operation was Lister Hospital in Stevenage and it was great, certainly as good as my previous operation in a private hospital.

[jas xjr]

I spend a lot of time in and out of various hospitals and clinics . on the whole I reckon the nhs gets it right . the impression I do get is some departments are very low on resources .

[Victor McDade]

There seems to be a massive regional difference in levels of care within the NHS. Add to that the variation between weekday and weekend care.

From a personal point of view I've found the system excellent. I spent much of last year in hospital (3 different hospitals and a dozen different wards/units) and the level of care was fantastic. I couldn't fault it (okay I could - the food was disgusting!).

[jagracer]

CC07 PEU said:

- the level of patient service was appalling. This was probably due in part to lack of staff resource but I also got the impression some of the nurses hated their jobs and would much rather be doing something else. E.g. there was an electronic buzzer that you could use to call nurses. Sometimes the nurses would just reset the request so that you'd be forgotten about, the other times they would turn up half an hour later, they'd say they were going to do something to help you then another half an hour later nothing would have been done about your request.

They would rather be doing something else because they are so understaffed due to constant cutbacks and they keep being told they have to reaply for their jobs. Night staff are worse because they are generally agency, don't give a st and are lazy and I bet most of them came from that hot continent just below Europe.

CC07 PEU said:

- there was no air conditioning in the hospital and there was only one fan available per ward meaning that I was in agony, starving, and sweating away in the stifling heat to the extent that skin started flaking off my back and arse cheeks...

- the ward windows only partially openened for health and safety reasons meaning there was no way of effectively ventilaing the ward during one of the warmest summers we've had for years.

- the "Hospicom" television service was a pile of fking ste - it was very expensive and NEVER worked.

- No Wifi. I appreciate Wifi is not an automatic entitlement but in this day and age it's a very inexpensive service that could be provided with an inordinate benefit to patients i.e. a link to the outside world.

- the food was absolutely awful - imagine cheap, stodgy school dinners from the 1950s.

Sounds like you were in the QE at Woolwich.

[The_Doc]

jas xjr said:

I spend a lot of time in and out of various hospitals and clinics . on the whole I reckon the nhs gets it right . the impression I do get is some departments are very low on resources .

So do I, and so do I.

France, Germany, Belgium etc spend 11% of GDP on the healthcare, America spends 13% and we spend 7%

ballpark figures, but you get the point.

[Cupramax]

The_Doc said:

America spends 13%

I thought Americans didnt get free healthcare? How do they manage to spend that much if thats the case?

My only recent experience of the NHS was an overnighter due to Pneumonia, one night inside was enough to discharge myself with a large bag of antibiotics and suffer at home.

[Victor McDade]

Cupramax said:

The_Doc said:

America spends 13%

I thought Americans didnt get free healthcare? How do they manage to spend that much if thats the case?

My only recent experience of the NHS was an overnighter due to Pneumonia, one night inside was enough to discharge myself with a large bag of antibiotics and suffer at home.

America has 'free healthcare' (Medicaid & Medicare) for those aged over 65, those with disabilities and people with low incomes. This has been the case since the 60s. This covers around 100 million people. And per capita their government spends significantly more than we do on healthcare.

http://blogs.telegraph.co.uk/finance/edmundconway/...

[davepoth]

Victor McDade said:

Cupramax said:

The_Doc said:

America spends 13%

I thought Americans didnt get free healthcare? How do they manage to spend that much if thats the case?

My only recent experience of the NHS was an overnighter due to Pneumonia, one night inside was enough to discharge myself with a large bag of antibiotics and suffer at home.

America has 'free healthcare' (Medicaid & Medicare) for those aged over 65, those with disabilities and people with low incomes. This has been the case since the 60s. This covers around 100 million people. And per capita their government spends significantly more than we do on healthcare.

http://blogs.telegraph.co.uk/finance/edmundconway/...

I keep trying to point this fact out to Americans but they never believe me. I'd laugh if it didn't make me so sad.

[Oakey]

Over two weeks ago, my girlfriends grandad went into hospital complaining of a headache. A scan revealed he'd had a stroke and there was blood on his brain. They did an operation, sticking a tube up his groin to his head, to drain the blood. Now he's more or less a vegetable. Doesn't know what day of the week it is, where he is, what he's doing, etc.

[mph1977]

CC07 PEU said:

I got out of hospital on Sunday after spending ten days in there as a result of a broken hip bone sustained in a cycling accident. It was the worst experience of my life.

The things I noticed were:

- the ambulance took 30 mins to turn up. It could have been worse but when you're lying on the ground in agony
and unable to walk, a sharper response would have been appreciated.

the problem is , however due to the number of fat knackers and drama queens who have 'breathing difficulties' over minor emotional upsets and then then call 999 ... or those who call 999 because social care or Mental Health services refuse to accept their responsibilities meaning that ill prepared Ambulance Personnel and police officers are stuck with these issues.

CC07 PEU said:

- I had to sit with a broken hip for 2.5 days while waiting on a slot in the operating theatre so that surgery could commence. This meant I was "nil by mouth" for those 2.5 days which meant I was not only in agony but I was starving for most of the time too.

and the reason you got bumped was because of truly life threatening cases taking up the available operating time, also the fact that running an Operating theatre with less than 7 personnel for a op like that is dangerous ( Anaesthetist and ODP/ Anaesthetic Nurse, 2 Surgeons or Surgeon and ASP (Nurse/ ODP with additional training and education over being an experienced theatre practitioner)) , Scrub Nurse/ODP, Circulating Nurse/ODP, Runner)

plus the risks associated with doing none life threatening surgery outside of the (extended) working day of the support services like labs , blood bank ...

CC07 PEU said:

- the level of patient service was appalling. This was probably due in part to lack of staff resource but I also got the impression some of the nurses hated their jobs and would much rather be doing something else. E.g. there was an electronic buzzer that you could use to call nurses. Sometimes the nurses would just reset the request so that you'd be forgotten about, the other times they would turn up half an hour later, they'd say they were going to do something to help you then another half an hour later nothing would have been done about your request.

and then people wonder why RNs want HCAs to be properly regulated instead of 'teflon' ...

interestingly enough very few people want to believe the experience of those of use who have worked as RNs as to the amount of things we are supposed to do , plus the amount of HCA work we have to take up the slack with because we will be accountable for their laziness , recalcitrance or outright disobedience - outright disobedience tacitly supported by Nurse Managers who will not discipline HCAs and like to divert blame on to the Staff Nurses ( many of these Nurse Managers are 'teflon' - don;t have enough (or any) patient contact for their incompetence to be shown up and they are too expensive to make redundant due to being over 50 and entitled under current NHS pension rules to have thier pension 'paid up' to 40 years service ( or the service they would have at 65 if it they wouldn;t have 40 years ervice at that point)

CC07 PEU said:

- it was extremely noisy at all hours of the night - the nurses didn't appear to make any effort to keep their voices down in respect of the sleeping patients. It was by no means a comfortable environment in which to make a recovery from a serious injury and operation.

it would be so easy to run a hospital it wasn't for the patients or if the patients stuck to office hours to have problems ... Ortho trauma wards are not going to be restful environments due to the case mix, the requirements of monitoring etc etc etc ...

CC07 PEU said:

- there was no air conditioning in the hospital and there was only one fan available per ward meaning that I was in agony, starving, and sweating away in the stifling heat to the extent that skin started flaking off my back and arse cheeks...

air conditioning in hospitals ?

even in new builds it;s only areas which have a clinical need that get any form of air handling ( Theatres, Critical care, Burns unit, Isolation rooms )

CC07 PEU said:

- the ward windows only partially openened for health and safety reasons meaning there was no way of effectively ventilaing the ward during one of the warmest summers we've had for years.

how damn inconsiderate for people to have jumped out of windows to top themselves in the past. ...

CC07 PEU said:

- the "Hospicom" television service was a pile of fking ste - it was very expensive and NEVER worked.

nothing to do with the NHS ... in fact hospitals were specifically prevented from running these services in house when they were originally put out into the market

CC07 PEU said:

- No Wifi. I appreciate Wifi is not an automatic entitlement but in this day and age it's a very inexpensive service that could be provided with an inordinate benefit to patients i.e. a link to the outside world.

it;'s not inexpensive to provide that service to a hospital site and provide sufficient none clinical bandwidth when you do have such a service provided...

I am aware of a few units with Wifi for patients, these tertiary specialist services also have the advantage of large (several million pounds) independent charitable trusts that support them with capital grants as well as active support groups run by their life long patients for the benefit of those who get admitted ( whether acute or from complications) to provide funding for day to day running costs ....

CC07 PEU said:

- the food was absolutely awful - imagine cheap, stodgy school dinners from the 1950s.

Overall, I think it gave me a taste for what it may be like to be a wounded soldier stranded in a hot rainforest with a 2.5 day wait for the next helicopter out of the jungle to be taken to the nearest hospital to be operated on...

When I get back to work I will be signing up to the private healthcare scheme on offer to at least try and minimise my exposure to the services of the NHS.

if you can find a Private hospital which will take an acute case ...

Private healthcare in the UK is for Elective Procedures and may offer the opportunity to queue jump ( the all ready far shorter than at any point in the last 60 years) queues for some diagnostics

there is no private provision for acute care outside of a few hospitals in Londons who mainly deal with foreigners

there are few if any Level 2 and 3 critical care beds in many private hospitals

most private hospitals do not have 24/7 on site middle grade cover

most private hospitals do not have 24/7 on site anaesthetic cover - many of them only have an anaesthetist on site when there is an operation scheduled.

most private hospitals rely on NHS labs and NHS Blood and Transplant has a monopoly on blood and 'fresh' blood products

Edited by mph1977 on Sunday 21st July 16:52

[jagracer]

Oakey said:

Over two weeks ago, my girlfriends grandad went into hospital complaining of a headache. A scan revealed he'd had a stroke and there was blood on his brain. They did an operation, sticking a tube up his groin to his head, to drain the blood. Now he's more or less a vegetable. Doesn't know what day of the week it is, where he is, what he's doing, etc.

So is that the fault of the NHS or the fact that he had a stroke?

[mph1977]

jagracer said:

Oakey said:

Over two weeks ago, my girlfriends grandad went into hospital complaining of a headache. A scan revealed he'd had a stroke and there was blood on his brain. They did an operation, sticking a tube up his groin to his head, to drain the blood. Now he's more or less a vegetable. Doesn't know what day of the week it is, where he is, what he's doing, etc.

So is that the fault of the NHS or the fact that he had a stroke?

and i'm guessing neither Oakey or his OH were the people that the Responsible Clinician obtained consent for the produce from ...

when the risks of further bleeds etc were discussed, as was the likely prognosis without operating on an intracranial bleed , as was the risk-benefit evaluation in undertaking a procedure on some of that age ( as even if he was only in his sixties or seventies and in 'good nick' his physiological reserve will be impaired compared to if he were in his forties or fifties...

it has to be remembered that life is a sexually transmitted terminal disease and despite the best efforts of the healthcare systems everyone will die at some point, and while some of the deaths during or immediately following hospital stays are preventable not all of them are, and some of the deaths are a case of deterioration being brought forward by playing the numbers game ( i.e. intervening and the intervention failing vs leaving someone to be taken by the disease process ...)

[mph1977]

jas xjr said:

I spend a lot of time in and out of various hospitals and clinics . on the whole I reckon the nhs gets it right . the impression I do get is some departments are very low on resources .

here in lays one of the issues

1. trusts are unwilling to bring in external 'hatchet men' to do reviews of jobs becasue of the adverse publicity it raises over 'wasting tax payers money' , which leads to

2. Existing Managers EFA Political Comissars salami slice numbers and de-skill by down grading ( including in one notable case replacing band 6 Senior Staff Nurses with band 3 'advanced HCAs') to reduce the pay bill rather than remove their post and provide the Band 7 Nurse / AHP manager with a band 3 Secretary / PA...

3. Senior Nurse Managers who have no relevant and recent clinical experience waxing lyrical on what can be achieved despite the fact in some cases they have not done an honest days clinical work for 30 + years

[George111]

mph1977 said:

jas xjr said:

I spend a lot of time in and out of various hospitals and clinics . on the whole I reckon the nhs gets it right . the impression I do get is some departments are very low on resources .

here in lays one of the issues

1. trusts are unwilling to bring in external 'hatchet men' to do reviews of jobs becasue of the adverse publicity it raises over 'wasting tax payers money' , which leads to

2. Existing Managers EFA Political Comissars salami slice numbers and de-skill by down grading ( including in one notable case replacing band 6 Senior Staff Nurses with band 3 'advanced HCAs') to reduce the pay bill rather than remove their post and provide the Band 7 Nurse / AHP manager with a band 3 Secretary / PA...

3. Senior Nurse Managers who have no relevant and recent clinical experience waxing lyrical on what can be achieved despite the fact in some cases they have not done an honest days clinical work for 30 + years

How do you fix this ? Given the quality of NHS management which has been exposed in the press over the past six months, many hospitals appear to have more of a chimps tea party than a management team. They appear to be like the BBC but genuinely untouchable - by any party.

[mph1977]

George111 said:

mph1977 said:

jas xjr said:

I spend a lot of time in and out of various hospitals and clinics . on the whole I reckon the nhs gets it right . the impression I do get is some departments are very low on resources .

here in lays one of the issues

1. trusts are unwilling to bring in external 'hatchet men' to do reviews of jobs becasue of the adverse publicity it raises over 'wasting tax payers money' , which leads to

2. Existing Managers EFA Political Comissars salami slice numbers and de-skill by down grading ( including in one notable case replacing band 6 Senior Staff Nurses with band 3 'advanced HCAs') to reduce the pay bill rather than remove their post and provide the Band 7 Nurse / AHP manager with a band 3 Secretary / PA...

3. Senior Nurse Managers who have no relevant and recent clinical experience waxing lyrical on what can be achieved despite the fact in some cases they have not done an honest days clinical work for 30 + years

How do you fix this ? Given the quality of NHS management which has been exposed in the press over the past six months, many hospitals appear to have more of a chimps tea party than a management team. They appear to be like the BBC but genuinely untouchable - by any party.

there's 2 options really on a strategic level ...

a. do a Hinchingbrooke and bring in external management
b. set external management consultancies on to do a proper root and branch reform

with respect to the Nurse manager issue and it;s Nurse managers rather than Doctors as Managers, Midwife Managers or other AHPs as Managers - is to change the culture in Nursing Management - i.e. removing the culture which sees it as 'failure' if Band 7 Nurse Leaders/ Ward Managers / Senior Sister / Senior Charge Nurse actually do work on the wards

require Matrons and other Band 8 Nurse managers to undertake a certain number of clinical shifts each month.

Doctors as Managers, Midwife Managers and AHP managers are far far more likely to have planned clinical activities as part of their working week ( as Doctors will have to prove competence in clinical practice for revalidation, the midwives rules require them to do a certain amount of hands on clinical practice in each registration period / Notification of Practice period), AHP Managers seem to be more willing to undertake clinical practice than their Nurse counterparts - especially at band 7 level ...

[jagracer]

mph1977 said:

there's 2 options really on a strategic level ...

a. do a Hinchingbrooke and bring in external management
b. set external management consultancies on to do a proper root and branch reform

I was getting the impression you are a doctor but after reading a few more of your posts I think you might be a consultant and not the medical kind. I think this may be the problem, too many accountants and consultants that know nothing about the industry they are trying to sort out. Targets and accounting alone don't mend people although I admit it does keep my wife in work.
The nail was hit on the head at my daughter's graduation a few years ago when the Dean of the uni stated that they (the future doctors) need to retake the NHS and not sit back and let it go to ruin as their predecessors have done although he admitted he was probably one of the culprits.