Tag Archives: National Health Service

Questions need to be asked about NHS – and perhaps case of Ashya King will bring these out

Hurrah – Ashya’s parents are free

But at what cost? Missing Ashya King

  • How much did the ridiculous Police hunt across Europe, pursuing the family of Ashya King cost the British taxpayer?
  • How dare Cameron bolt the stable door, and now offer a cancer expert to advise the family?
  • and Why can’t EVERYONE IN BRITAIN have the same expertise offered when they need it – not just after a massive media campaign?
  • And why did a massive NHS organisation waste so much time hounding the King family, when all they had to do was listen to the father’s very reasonable requestsWatch the family on YouTube, see for yourself, and decide it this isn’t a very articulate, caring and intelligent family, well able to ask Oncologists questions, which they seemed reluctant to answer.

Continue reading

Ashya – NHS too arrogant to help?

Will the NHS learn from this case – or will more patients be at risk?

Amongst all themedia hype, two aticles stand out.

The Daily Telegraph devotes its main page to Dr. Max Pemberton.  Pemberton is respected amongst medical journalists, and his weekly Health Feature is usually widely quoted.  He always speaks sense, and he has made me think with his article “Ashya Belongs in Britain”.  I don’t  in gree with what he says, but his is the first British medical voice that has come up with sensible, non-self justifiying comment on this sad case. Continue reading

Does NHS treat pain?

Or does any treatment have to have a ‘tick box’?

“I don’t want to make a fuss”.

How often do we hear this – as fellow patients?  And how often do you think NHS staff actually listen to what is being said – and act on this?

Not often in my experience, and I am sure others.

One awful experience

Osteoporosis affects thousands of us, but turning up in A & E doubled up with spinal pain, you would think I was speaking a foreign language (perhaps I was to those who didn’t have a good command of English).

One would have expected to be given an X-ray at the very least, to discover what had gone wrong.

Silly me – this is the new modern NHS, pledged to respect my dignity; or perhaps slide me over into another treatment stream so that A & E could tick the box that said I had been seen within four hours, then wash their hands of me.

image of pills and thermometerResult:

I was sent home with three large boxes of a drug that I should never be prescribed, and a recommendation that I would be seen by a Consultant.  I threw away the dangerous tablets, and three weeks later am still waiting to get a referral to a Consultant.

What happened?

I am not very good at handling pain, so phoned a private Consultant.  His secretary obviously could hear I was in pain, and made me an appointment to see her boss that afternoon.  Am now being treated for three Wedge Fractures of my spine, and having Hydrotherapy twice a week.  Apparently I had somehow collected three wedge fractures in my spine.  However, private treatment sorted things out, and am now walking fairly upright, and consumption of Pain Killers has almost stopped.

But what happens if your Bank Manager can’t let you have any more dosh?

A friend, in the same situation, but hers had lasted for several weeks, was fed up with “pass the parcel’ treatment in hospital clinics.  When the umpteenth doctor whom she saw spent more time tapping his keyboard than listening to her, she marched off to the hospital’s PALS.

They have improved enormously in the past year (lots of complaints to deal with, I suppose).  A PALS staff member took her complaint, told her to wait, then marched off to the Consultants’ clinic.  She came back with a Consultant in tow.  My friend was fast-tracked through all the administration, boxes were ignored, and she is now being treated.  And out of pain.

So try this next time – it might work, until the NHS finds too many of us are copying this system, and devises another way to block us getting treatment (it costs money, which the NHS says it has to save).

NHS Change Day

Next March there is yet another PR exercise, designed to make us love our caring NHS.  The idea is that everyone working for the NHS pledges to make small changes to help improve our care.  So let me suggest

1.  When we are desperate for a glass of water, FETCH it yourself to us.  How long will it take?

2.  Forget about those stupid pain league tables – ” on a scale of 1 – 10, how bad is the Pain?”  Last time i ground out between gritted teeth “10”, nurse just ticked the box and went on to the next question.  What a pointless waste of patient’s time, and unproductive.

verite@greenbee.net

NHS copies Big Bad Wolf

English: Little Red Riding Hood

Wikipedia

Like Red Riding Hood

I tend to believe people.  I even believed hospital comment websites, that used to list ‘How many Patients would recommend this hospital to their friends?’.  Which would be followed by a high percentage figure.

Until I actually read the comments – and you began to wonder what sort of friends they had, as the comments that followed were generally a litany of complaints about their treatment at this hospital.

With the Mid-Stafford Hosopital enquiry published, one wonders

You have to wonder why it is that really sensible, bright people insist on doing really daft things. Let’s face it Whitehall is full of big brain-boxes and the invisibles in Leeds are no dozers either. Degrees and professional qualifications up to the eyeballs. Number 10; awash with advisors and gurus. They can’t all be stupid can they? Is it them or is it us?

David Cameron is championing the Friends and Family Test (Killer question; Would you recommend this service to friends and family?),  This is now in operational in most hospitals, but one questions how accurate it is. Everyone who knows anything about sampling and finding out what people think will tell you; the F&F Test is meaningless.

Anyone who has looked after Gran in hospital, knows what when you say you are going to complain on their behalf, she will say “I don’t want to complain”;  petrified that she will be victimised and singled out.

Before the F & F test was rolled out, our local hospital had a meeting of those us who had been discharged recently.  40 of us turned up;  we were given official postcards to fill in, asking us how we had been treated.  Two of weren’t very complimentary, and when we asked questions we were obviously singled out – even though others just nodded their heads and dutifully ticked boxes.

Returning to the room after the meeting was over, I noticed our two postcards sitting forlornly in the middle of our table;  the others had all been collected.  But when I went on the hospital’s website and looked at F & F score for that month, was surprised to see it had received a 92% rating that people would recommend the hospital to their friends.

So why is there this culture of fear allowed in hospitals?

Dr Rachel Reeves, principal research fellow at the School of Health and Social Care, Uni of Greenwich, says ‘…it is not the right test’; lack of rigour in the methodology, opportunities to skew results, bias and just about everything else you don’t need in a sample. Even Bill Morgan, LaLa’s former special advisor, wrote; ‘…(it) … is too narrow and too crude to work as a measure for shared decision-making. Retrofitting a retail-centric measure onto healthcare feels awkward anyway.’

Known in industry as the ‘Net Promoter Score’ it is designed as a measure of brand loyalty and that’s all. As the average NHS patient has little opportunity of switching brands away from the NHS, or even the local Trust, the whole exercise is hollow. In industry the NPS is seen as useless unless accompanied by a good ‘voice of the customer’ programme and the ability to dig into customer experience dynamics. Something the NHS does not have.

Business uses NPS to drive bigger-picture questions; Is increasing recommendation really the best way to achieve success? They may want decrease volumes and increase margins. The NHS can’t do that, it is demand led, can’t cherry pick and aside from fiddling the Tariff and employing serial-fraudster coders, it’s a non-starter. They’ll ask; if I lose 35% of my customer base per year, but most of those who stay would recommend, am I really in good shape? If an NHS service scored ‘35% dissatisfied’ there would already be something seriously gone wrong and the Board should be in jail.

And, there is the mother-of-all problems compounded by the DH’s own F&F guidance. Sec 3.8, Survey Timeframe: “Patients should be surveyed on the day of discharge or within 48 hours of discharge. This will ensure that the answer given reflects the patient’s informed opinion, based on recent experience.”

Wrong!  No!  Couldn’t be worse! It falls foul of the Halo Effect.

In plain English; respondents are aware that the sponsors of the survey are the very people who are providing the service. Or, even simpler; patients are being asked about the NHS experience by the people providing it. Furthermore, questions can be asked whilst the patient is still in the care of the Trust. We know the nearer to the event a survey is carried out, the more likely it is to overstate reaction. Plus, if undertaken whilst the patient is still in hospital, most answers (particularly among older patients) will be positive for fear of retribution or reprisal and the wish not to be critical, face-to-face, for fear of confrontation.

Patients will not be able to judge the experience in its own right and usually unable to make comparisons with other brands (Trusts). The DH Guidance creates a potential 56hr window to ask questions in situ or later, perhaps on the phone. This distorts results because of a lack of consistency in question framing, timing and environment. All hopelessly skewed.

 Like Red Riding Hood,

I tended to believe the Big Bad Wolf.  So, why are the big brains using a sampling system that is flawed? Two reasons. The F&F Test can be relied upon to produce generally positive scores about NHS performance. Gold dust in the run-up to the 2015 elections. Second, by publishing results, ward-by-ward, staff will start to feel proprietorial about performance. Usually that translates into a positive impact on morale and performance.

You see; they’re not so stupid after all!

DO DEPT HEALTH EVER USE NHS THEMSELVES?

English: This is an image of Donald Berwick, w...

Berwick Report another waste of NHS resources

Scratching around for any excuse to justify poor health care, latest imported US guru – Don Berwick (imported at vast expense) –  has come up with a report, saying much the same thing that he said last time he was overpaid to tell us what is wrong with NHS.

He says what everyone else has been saying, from Gerry Robinson, Lord Darzi et al, for past decade.  And yet still the Whitehall Mandarins sign their over more scarce NHS cash to pay for what any junior doctor or nurse could point out for free.

I dread to think what the bean counters will extract from this report.  Yes – money will be found for yet another crack-pot ‘initiative’. which is so silly that it reminds one of the Emperor’s clothes kid’s story.  And by the time the ‘initiative’ is quietly dropped, yet more of our money will have been wasted.

Have just come off the phone after 30 minutes with an A & E Matron, trying to explain to me why my care was so lacking last time I was in there.  This was second waste of hers and my time, over what was a simple case of incompetent admin.  But when will hospitals realise we don’t want apologies AFTER the event – what we want is basic good medical care whilst we are being treated.

Until that day, Whitehall mandarins will desperately scratch around for anyone who can be asked to prepare a “report” that might justify why they don’t have to get off their backsides and get down to old-fashioned work.  But I fear they don’t have the brains to recognise the truth if anyone tells them getting back to basics is what the NHS needs.

But then, taking a taxi down to any hospital and asking patients (when no staff are able to over-hear) what they think needs to be improved – that’s old fashioned.

Want to know what report we have paid for says?  

Dept Health has just issued press release today, saying

“Patients Will Have Confidence In A Safe NHS And Staff Will Be Supported To Make Safe Care The Priority
NHS staff should be supported to learn from mistakes and patients and carers must be put above all else in an attempt to make the NHS a world leader in patient safety, an independent report will say today.
Professor Don Berwick, a renowned international expert in patient safety, was asked by the Prime Minister to carry out the review following publication of the Francis Report into the breakdown of care at Mid Staffordshire Hospitals.
The report, led by Professor Don Berwick, follows five months of intensive work to examine the lessons for NHS patient safety from healthcare and other industrial systems throughout the world.
His four key findings are that:
The quality of patient care, especially patient safety, should be paramount
Patients and carers must be empowered, engaged and heard
Staff should be supported to develop themselves and improve what they do
There should be complete transparency of data to improve care
Recommendations in the report include:

The NHS needs to adopt a culture of learning

IF YOU WANT MORE, GET ON TO DEPT HEALTH.  They obviously have plenty of time to issue statements repeating the obvious.

NHS Scores ‘Own Goal’ with 111 Service

111 telephone helpline provider gives up

Only a Government Minister could think that reducing the fee for a contracted NHS Service would make the service work better  – but politicians don’t live in the real world.

For years we had NHS Direct.  After a rocky start, it was starting to work well.  Patients were learning to trust it, and it was working efficiently.  But this wasn’t good enough for the bean counters.  They decided they could reduce the price paid per incoming call – from around £20 per call, to £8 – £9.  So to save money call centre staff changed;  instead of nurses we got unqualified people (some were teenagers) and ended up with the dog’s dinner that was the new 111 telephone service;

Naturally, the great British public found it didn’t work, . Sensibly, they followed what happens in poor countries.  They went to their local hospitals’ A & E Dept., fuelling the massive increase in patients handled by these emergency departments.

Progress?                                                                                                                                     Only a Minister could delude themselves this would be so. One major 111 call centre provider has just declared they are pulling out, having lost over £26 million (wonder who is going to make up the shortfall?)

Now we come to doctors.  Dare I suggest that this debacle might be their fault?  With their ‘new’ contracts, they have given up out-of-hours working and weekend cover.  They expect golf courses and restaurants to be open at these times, but heaven forbid they should provide the same service – even though they are paid a very handsome sum.

I worked in the tourism industry; we earned high salaries, but for this we knew tourists expected hotels, airlines, trains, restaurants etc. to operate up to 24 hours a day – whenever there was a need, which meant we would have to work ‘unsociable’ hours.  Tourists fall ill, or lose belongings, 24 hours a day.  When they needed help, we were expected to provide this;  no questions asked.  But the job was fun;  we were dedicated this, so got on with it.  When the current crop of doctors went into medicine, surely they underwent the long hours of training because they liked ‘dealing’ with people, and understood they would have to work when required?

So is it too simple to suggest that doctors’ practices guarantees to offer cover a percentage of ‘unsociable’ hours (in return for their vast salary?  Some practices have over 20 doctors as part of a team, so surely providing telephone answering one night out of every 10 or 20 or so, so YOUR doctor decides if you need an Ambulance, or can just take an aspirin, might be a solution?  Or is this too patient-friendly?

On yer bike                                                                                                                                   Mr. Hunt, Dame Barbara or even David Nicholson – DO something before the NHS loses even more money.  Justify the vast salaries you are paid.  Otherwise sane patients (the majority of us, Mr. Hunt) will continue to by-pass 111 and go direct to A & E.   According to Lord Howe at the Dept. Health, the service is running well – but perhaps they should listen to Andy Burnham, Labour’s ex-Health Minister.  As he points out, “you get what you pay for”.

Andy Burnham at Liverpool Biennial 2008 Openin...

Andy Burnham  (Photo credit: Wikipedia)

People Power Works!

A landline telephone

A landline telephone (Photo credit: Wikipedia)

0844    0844   O844    0844    0844    0844    0844    0844 

Company to stop marketing 0844 numbers to GPs

The latest issue of PULSE MAGAZINE, the Doctor’s in-house journal, has a very interesting story proving that ‘people power’ still has clout. It says “A major supplier has promised to cease marketing 0844 numbers to NHS organisations, due to public opinion over the use of premium numbers by GP practices.”

Now The Daisy Group, which owns the Daisy Line Surgery telephone service,
installed in more than GP 2,000 practices, has said it will stop marketing 0844
numbers to NHS-related organisations due to public pressure. Mr Andrew Goldwater, commercial director of system services for the Daisy Group said that they will bow to public opinon and stop proactive marketing 0844 numbers to practices. So in future, once there is no incentive to keep patients hanging on, you might even find you get through quicker. However, be warned!  The Daisy Group has announced they will “continue to work with our GP customers to develop
alternative solutions, supporting them by providing them with the products of their choice.
Mr David Hickson of campaign group Fair Telecoms said the Daisy Group should go
further and assist all practices currently using 0844 numbers to switch to the
equivalent 0344 number.
In which case, those of you who have BT Option 3, or similar packages, will get
these calls for free.
verite@greenbee.net

NHS shoots itself in other foot

Does anyone listen?  These loverly slogans are the latest issue from NHS to persuade us that

 Everyone Counts

Well, if the bean counters in Richmond Towers haven’t noticed, is there any hospital really operating ‘7  DAYS A WEEK’?  Or is this the latest money-wasting exercise?

LaLaLite obviously inhabits the same Alice in Wonderland country as his predecessor, when it comes to fatuous slogans that mean nothing.

Wonder how much this latest exercise cost us?

Has anyone thought if they got down to actual work, instead of writing Fairy Stories (even though it is Christmas) they could go a long way to saving the money the NHS needs.

But I suppose this will mean a lot of ‘Consultants’ will be out of work.  Well, if this is the standard of their work, a good thing too.

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NHS shoots itself in foot – again

English: NHS logo

 

Death

 

League

 

Tables

 

My Heart Surgeon leant over the desk: “now I have to tell you the risks”.   (Having just been told I needed a 7-hour heart operation, surely I was savvy enough to realise that carried a huge risk?)

“If anything happens, will I know anything about it?”

“No – you will be under anaesthetic” he told me.

“Right – then it’s your problem”, was my reply, and we went on to more sensible questions.

What Doctors are For

Drugs had produced my heart problems, and I relied on my doctor to choose the best person to operate and repair the damage.  I SO did not need ‘Choose and Book’;  faced with a list of possible surgeons, I wouldn’t have had a clue whom to choose;  but a sensible doctor would know which surgeons had a good record for survival, because they had accepted ‘last hope’ cases whom no-one else would help.

NHS Interferes

 LaLaLite (the new Health Minister, Jeremy Hunt) is showing  just as much grasp of essentials as his predecessor,   LaLa Lansley.  Latest dictat info from Richmond Towers says “surgeons will be ranked by how many people die in their operating theatres”. 

This means a junior doctor, newly qualified and only trusted with the most basic procedures, will be top of the tables;  an experienced surgeon with patients queueing up from around the world, who will operate on many ‘no hopers’, will probably be way down the bottom of these silly, time and money-wasting statistical tables.

Can we please get back to sensible health care, where one’s GP is trusted to do their best for their patients, not waste valuable time and money having to compare paper statistics?

 Does anyone listen?

After shooting itself in the foot, today’s dictat is called

 Everyone Counts.

Well, if the bean counters in Richmond Towers haven’t noticed, is there any hospital really operating ‘7  DAYS A WEEK’?

LaLaLite obviously inhabits the same Alice in Wonderland country as his predecessor.

Wonder how much this latest exercise cost us? 

Has anyone thought if they got down to actual work, instead of writing Fairy Stories (even though it is Christmas) they could go a long way to saving the money the NHS needs.

But I suppose this will mean a lot of ‘Consultants’ will be out of work.  Well, if this is the standard of their work, a good thing too.

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Cut-price care in NHS?

R. C. N. Shock Report

English: Royal College of Nursing HQ, Cavendis...

English: Royal College of Nursing HQ, Cavendish Square.  Rod Ward

The R.C. N. (Royal College Nursing) has commissioned a report to examine the training system for nurses, following a string of stories of appalling care.

NHS patients “are receiving an unacceptable level of care” from what the R.C.N. calls a ‘growing army of unqualified health care assistants who have taken over nursing roles’, an independent commission warns.

Some nursing is boring and repetitive, and a growing number are of H.C.A. (Health Care Assistants) are being trained to carried out basic  low-paid jobs by low-paid and unqualified assistants.   H.C.A. are employed for simple tasks, but are not currently trained to spot many warning signs, such rapid changes in body temperature or dehydration.

Over 6,000 trained nurses have been lost to the NHS workforce since the last election, even though nursing has grown more complex and specialised in the last decade.

Recommendations

The report recommends training all H.C.As to at least NVQ Level 3 standard;  the non-academic equivalent of A-levels, to ensure they reach an acceptable level of competence.

How to recognise HCAs

Visiting Gran in the local hospital;  whom do you talk to about their care?

Once, Sister was to be found behind her desk, fully in charge of ‘their’ ward.

Now, since the egalitarian movement which stripped all nursing staff of badges of distinction, such as caps, belt badges, etc.  it is difficult to differentiate between HCAs or Nurses.

When Gran is first admitted she will probably have a properly qualified nurse looking after.  Grab the Nurse Now;  ask questions; and realise this is probably your last chance of getting an informed response.

Then, you take your chance with an HCA.  Some can be brilliant – but often they haven’t a clue.  That’s when you actually manage to find one to talk to.   Sister?  You’ve got to be joking.  Last time I tried to talk to someone about 90-year old relative’s care, I waited three days to see Sister, until I worked out that the hospital was on an economy drive, and had ‘suspended’ the post of person-in-charge of a 24-bedded ward.

Solution?

Mind you, there is nothing to stop you paying yourself for a private nurse to look after Gran.  Officially they are not supposed to carry out medical tasks, but I have yet to hear a friend say ‘their’ nurse was stopped from helping Gran.

What we must realise is that nursing is like any job – you have to be qualified, and then you can nurse wherever your qualifications take you.

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