Maintain pressure on reforms to protect NHS
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Comment on: Age profiling nurses reduces the risk of skill and knowledge gaps
Martin has pretty much covered it all in his comments. I left hospital nursing in 2000. I had been a ward manager on a medical ward for 12 or more years. In the late 90s saw a multiple increase in managers, all out to cut budgets and many without hospital experience. As a result of P2000, all student nurses, making up 50-70% of the daily workforce became college based and their replacement HCAs didn't ever materialise. Often, twice weekly on average, I would be left working with one other untrained nurse on a late shift to care for 28 pts and also expected to take admissions from A&E. When I refused to take, and I often did, I just ran up againt my managers. I regularly complained in writing, stating the various Code of Practice infringement but was ignored. I think that CARE and COMPASSION has been gradually bred out of the health service over a number of years and my fears are that it will never return. I read today that holding the hand of a patient can be comforting to them, and I also read that following the death of a patient in my local hospital from septicaemia, in future, any patient who has a pyrexia of over 37.5 c will have their observations recorded 4 hourly. The irony is that these rules and ideas are being introduced by the "diploma" trained nurses who think they are breaking new ground. These nurses, following qualification in the late 90s, did not know how to set up an infusion, and many had poor clinical skills and certainly lacked compassion. Training prior to P2000 would have seen 1st year nurses performing these tasks safely and competently. Oh, and they also CARED. In their 1st year they would have hands on experience learning about nutrition, skin/pressure care, hygene and infection control. They would have been show how to perform these tasks with compassion and empathy. Many times in those days have walked passed a student nurse, sitting holding the hand of a patient and having a quiet chat. These days, as a patient, you are ignored by almost all you come into contact with. The person responsible for our care crisis is Mrs. Thatcher and Ken Clarke. John Major attempted damage limitation by reducing a line of managers, but he left the managers to do this themselves and in true form, they removed all the effective, experienced ones and left the numpties in post. I am 63 and in the last year I have applied for 4 staff nurse posts. I always get an interview, because I suspect they don't want the ageist thing thrown at them, but that's as far as it goes. I know I can show these people how to care though and introduce some humanity back into the system.
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Comment on: David Cameron pledges radical NHS cuts 'from day one'
A Conservative government intoduced those costly "old world bureaurucratic methods" in the early 90s allowing non clinical senior managers in to the service. These managers then tripled the management structures beneath them allocating lease cars [BMWs and the like]. They did stupid things to save money like remove the out of hours service contract for the paging systems which meant that when the system failed out of hours a service engineer could not be called. As with all these ridiculous situations the people at the sharp end, Drs and Nurses, develop a system to get by with. With no cardiac arrest paging, Drs left phone messages with CCU and ITU saying where they would be. The rest of the wards had to contact CCU to locate a Dr even in an emergency. This happened to me on more than one occasion when I was site manager. When I contacted the CEO to inform him and ask for permission to call an engineer, I was spoken to like dirt and asked what other hospitals do in the same situation before he terminated the call abruptly. My A&E was expected to send a defibrilator twice a week to the Psychiatric hospital 4 miles away by taxi so that they could run their ECT clinic. Their machine had broken and our CEO decided this would be another opportunity to save money. Again, the people at the sharp end have to make it work, and they usually do and the CEO lives to see another day, or do they? More recently there has been some very disturbing accounts of poorly managed care. I think that the deterioration within the system has been going on for so long because of inappropriate management that it will be very hard to pick it ip and make it right again. Masses of money is being allocated but is being spent by non clinical managers. I need to end because I will get bogged down but before I do can I just give a for instance. When I was working in A&E in the late 80s we would sometimes get a call from one of the consultant surgeons to say that a local GP had contacted him about a patient with, say a breast lump. He had asked the GP to send her to A&E so that he could examine her. On her arrival we would page him and he would come and examine the lady. He would then arrange for her to be added to his NEXT theatre list for a biopsy which would be on a Tuesday of Friday. This meant a wait of $ days at the most. This system ended when managers tried to make the system more efficient. Theatres could not work after 5pm because of having to pay staff overtime. On the wards it became routine for a patient to be fasted, have a pre-med then have their op cancelled. These days, if a woman with a breast lump is seen within 6 weeks she's lucky and this has been reduced from 18 weeks. Mrs. Thatcher, [the de-regulator and the person who sold Westminister for a £1, AND brought about BSE], Ken Clarke and Brian Mulwhinney. Conservatives never change. They always meddle with public services then use BUPA themselves.
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Comment on: Hospitals routinely close A&E departments to ambulances, says report
The alternative to closing A&E depts. when capacity is reached is not to close them. This then brings us to the problem of where to "place" patients if the emergency room is full. The corridor springs to mind, but wait, haven't we been there?, and if you look around, this still happens all too often. I recently had two elderly patients shipped in to my day room at 9.15pm while they waited for ambulance transport to transfer them to another hospital. These two patients had each been in A&E on a hard trolley for over 12 hours, uncared for. The lady had been incontinent of faeces and the man required a dressing to his hand, a urinalysis and a prescription for antibiotics. All of this should have been carried out in the A&E dept. I suspect though because these patients were elderly and could not fend for themselves they were selectively neglected. Senior managers on duty at the time were fully aware of this situation. One of them came to my ward and told me that because A&E was full to capacity, my manager had aggreed the transfer of these patients, but on speaking to my manager the following day she knew nothing of the incident. So, is it better to close when full or keep admitting and neglect patients usually the elderly, you know, the people who once made the ultimate sacrifice to give us our "today". If A@E depts. are not running efficiently then this should be addressed. Oh, and by the way, Mrs. Thatcher with Kenneth Clarke and co. introduced the Targets system along with tiers of managers that originate from the worlds of commerce and finance. They are by definition, ruthless uncaring people who are less than honest. Like the CUCKOO, they have pushed out the decent caring vocational managers and they are just in it for what they can get.
