Dr John Crippen
I feel stressed just reading about it all.
I have never seen a pressure sore before, but having seen that I cannot imagine how a hospital can send someone home when their backside looks like that.
John,
Sorry that you are having such an awful day.
If it's any consolation, I've seen pressure sores worse than that. An MS patient, when I was an Aux, who had pressure sores on his hips (whilst his wife was still caring for him at home), both right through to the bone; the largest had a diameter of about 4" (though I am glad to say that he was one of my "named patients" (and, yes, I used to dress the wounds twice a day) and it had shrunk to half that by the time that I left 10 months later). Our hoist didn't work either, so we bloody well turned our patients by lifting them ourselves, because, damn it, this kind of stuff shouldn't happen.
All of the nurses and Auxes working with that poor guy should be beaten to within an inch of their lives. There is simply no excuse for the kind of neglect that you are describing. We were always understaffed, and always exhausted, but we did our jobs well because when you are doing nursing, in any form, you are responsible for another human life, damn it!
I'm just getting cross now...
DK
Hi Aimee.
Nor can I. But it was a Friday evening, and we then move into 72 hours of "hospital at night" which is the cover up label for lack of medical care. Always a big turf out on Fridays
John
HI DK
Yeah, makes you spit. But I must say I do feel a bit better for venting it here.
Worse pressure sores? Well, I have seen worse, but only once or twice in 20 years. By and large you can avoid them with decent nursing care - and yes, MS patients and paraplegics are more at risk.
The thing that REALLY pisses me off about this, it that this is a THREE STAR HOSPITAL - I kid you not. But of course, when then sent him home they scored points, beauses sending people home is deemed to be a successful outcome.
John
Have seen really bad pressure sores recently, from a nursing home.
Can't say any more, but it made me really angry, and sad for the poor gentleman involved.
Simply put, it's wrong. Wrong, wrong, wrong.
That is appalling. I'm sure there must be a newspaper willing to print that photo alongside some of Mrs Hewitt's spin.
Dr. Crippen, that picture made me cringe..I'm in the states and I remember taking care of my grandmother who was a stroke victim. She was completely paralyzed on her right side..I didn't have any hoist at home, to lift her, but I sure as hell turned her every few hours to aviod these sores. Once when she came home from the hospital she had a pressure sore, (not near as bad as your patients) but I was so upset about it. They are nasty to get rid of and they shouldn't even happen.
I'm happy your patients atleast have you to look out for them.
Jesus F*cking Christ! I've never seen or read anything like your case of the gentleman with the sacral pressure sores! Doubtless, if you sent the photos and whole sorry tale to the apalling Mrs Hewitt they wouldn't get past her first layer of defence.
You must be a far milder man than me - I'd have firebombed the chief executive's office by now.
Truly beyond belief. I think I'm going to start collecting strong barbiturates for my dotage.
I second the proposal that the staff responsible be whipped within an inch of their lives. I really hope that the hospital has to pay humungous damages; and, please God, may the blessed Patricia end her days in a grubby nursing home, unfed, unturned, with pressure sores.
I am glad to tell you, though, that your post is currently being aired on the Democratic Underground Forum (UK bit).
I am sixty, I have limited mobility, and I am terrified.
Jeff, Chairwoman, others....
The sad thing about this one, though a bad example, it is not an isolated incident. It goes on all the time. I have had two bad ones today alone.
I sit with my partners and we discuss how scared we are about the idea of being admitted to hospital and not being in complete control. I hate the need for private health insurance...but I have taken it out.
John
I have been reading your posts for some time now. I am sadly never shocked by any of the topics you highlight. I have too much experience in the NHS. I used to be shocked, now I am despondent. I am no longer associated with the NHS I am retired. I just hope for everyones sake that 'your' St Jude has not forsaken this particular Lost Cause.
I feel ashamed to belong to the same profession as the so called nurses who allowed this to happen.
This is probably a stupid comment but should this level of neglect be reported to police?
Everywhere I go I end up seeing this. The problem with the hoist is that if it isnt working on their ward, either the nurses dont seem to have the time or inclination to ask another ward for theirs, or the other wards dont dare lend them because they'll disappear. Nurses cant risk back injury by turning them manually, so theres no alternative.
A more disturbing aside that i've seen was with a general med/health care of the elderly ward where the nurses didnt seem to see the point of turning the patients who were for 'TLC'. Maybe the likelihood of dying on the ward makes pressure sores unimportant?
'Nurses cant risk back injury by turning them manually, so theres no alternative.'
I meant lifting them. Agh.
(Buries head back into textbooks).
What do you mean nurses can't risk back injury by turning them without a hoist? Come on! Thats completely ridiculous..I have arthritis in both knees and hips and just had a total knee replacement, send me to the UK and I will turn this man every few hours. Wern't nurses trained there on the proper way to lift patients without get injured? Anyway, he doesn't have to be lifted just TURNED..Nurses there are pathetic.
Dear John,
Im really sorry that your day has been so bad.
I trained as a nurse back in the 70s, when nurses DID nursing!! I was absolutely disgusted and shocked. when I saw the pressure picture. We were always taught that treatment was preventative, when we went round the ward with the "back trolley" and doing hourly turns to preent this. In my past years of nursing I have NEVER seen anything so bad. Do they not use sheepskin rugs and booties any more to help stop this?
Im not going to harp on with being proparly trained, but John, WHAT DO THEY TEACH THE NURSES THESE DAYS?
As for the nurses not being able to speak english, how the heck can they do their job? As for feeling infirm patients that WAS our job, knowing the importance of nourishment and healing.
The nurses seem too posh to do anything. Im absolutely disgusted! Id rather die at home rather than going into hospital, however ill I was.
God for Bid!
"This is probably a stupid comment but should this level of neglect be reported to police?"
Not such a bad thought, the police and the CPS certainly pursue doctors enthusiastically enough, for manslaughter.
When I was a Houseplant, in 1984, the sister on my ward would never let someone be discharged with a bedsore, she would see it as a professional slur.
Nowadays it is routine.
Charging the nurses with neglect is missing the point: it's the number and quality of nurses that needs to increase.
Dr C
Unbelieveable. absolutely disgusting but so sadly just what i have come to expect from a medical ward.
what do you do? i try really hard not to admit anyone when on call (never possible obviously) unless i know they are going to a specialist ward because it seems that it is only on cardiac/renal/haematology do the patients get decent care.
i walked into a side room today on one of the general wards and it was dark, smelly and filthy, an old soup cup lying on the floor in the corner.
what do you do?
Absolutley unbelieveable.
What a fucking national disgrace.
You wouldn't treat a dog like this and if you do you would be prosecuted.
If Dr Crippin cares to start a fund to get this poor man some decent care I will donate £500 immediately.
Let me know.
Quite right, what do you do. 'You' alone cannot do anything, just as one nurse cannot lift a patient. Two people are stronger and three people well, the proverbial crowd. How many people have commented on this post. How many have commented on previous posts. It makes 'us' feel better, we have 'contributed' to the debate and vented our frustration so that we can carry on tommorow as normal, nice people. If we want things to change, we have to SHOUT at the right people, to get their attention.
How can we make change really happen?
The documentaries have already been done (I think) and that hasn't changed things. What's the next step?
"we went round the ward with the "back trolley" and doing hourly turns to preent this."
Not allowed to do this anymore as seen as task allocation and not individual holistic care! (though never stopped me doing a back round even if I had to do it on my own!)
And never mention meths on heels or sheepskins to tissue viability or infection control nurses because research has shown - blah blah blah!
"we went round the ward with the "back trolley" and doing hourly turns to preent this."
Not allowed to do this anymore as seen as task allocation and not individual holistic care!
Stuff the "holistics", these patients are in hospital to be cared for. We are talking about basic nursing care, not farting around wondering about holistics. This could have been prevented, and all first year student nurses were taught this before they went onto their first wards. God knows what theyre taught now..boxes and ticks, and management?? This does not make for good nurses.
Bulldog,
That is very kind indeed. And I have had two emails with similar offers.
This case is real. The photo was taken at 11.30 today by the district nurses.
The gentleman is now back in hospital, and I just hope after all the furore that this time something will be done.
The problem is not so much lack of caring. There just are not the nurses to do the job. Talking to the medical registrar who finally took him, he said they are 173 nurse shifts short for the hospital, and so they only have one trained nurse on each ward, with some auxilliaries.
This was a bad case. But this sort of thing is going on every day in most hospitals in the country. The most galling thing is that the goverment is pretending that all is well, that all targets are met.
We are dealing here with a THREE STAR HOSPITAL. And remember, when this man was sent home, the hospital scored points. Discharge home is a successful outcome. A case that has been satisfactorily closed.
John
John,
I despair!!
Um Dr Crippen, I presume that photo of the sacral sore is not of the same patient but just a photo of some generic sacral sore (or of course the patient gave you consent to use the anonymised image in your non-educational blog).
Yeah, nursing care can be pretty atrocious especially on the elderly 'care' wards. I don't entirely blame the nurses either as they are so disastrously understaffed. I've worked on wards where there was only one trained nurse on at any one time in charge of 28 patients.
Aimee, this is not about television, or media telling 'us' what is happening. This is about joe public, you and I speaking up. Not just because we are outraged, shocked, upset, but because we have a responsibility to care for those who for whatever reason cannot speak, shout, or care for themselves. The reason most people end up in hospital is because they are too ill to help themselves at that moment. We are merely their allies and advocates. If everyone who comments here were to lobby their MP, write to their newspaper that would be a start. However if you do so with one voice, ie under one banner you become an army. Dr Crippin you started this, what does your banner say?
I've got to stop reading this blog! as we near retirement, when we won't be able to afford our private insurance any more, I get more and more alarmed. My admission last November to an NHS hospital scared the life out of me, it was thought to be an emergency so I had no choice.
I too will be saving the pills against the day I might become incapacitated, mentally or physically, and need long term care and have informed all my close relatives and carry a living will.
It breaks my heart reading these awful stories, I don't know how you stand it, my blood pressure rises just reading about it.
The NHS was never like this years ago, I know there are a lot more treatments and people live longer but I never had any complaints about care during the 60s, 70s and 80s. We took out medical insurance around 1986 as my husband was self employed at the time. Even in 1991 when my mother died in a geriatric ward, she was well cared for although it was a really old hospital it was clean and the nurses were very good. Where has it all gone wrong?
Likewise, this is unbelieveable. How can they think he was well enough to go home in the first place?
AS was said before - I'm not rich, but if there's any chance of helping that man towards some private medical care... just say the word.
Emma2000, please don't give up on the NHS yet. There are a lot of very good GP's, Hospital Doctor's and Nurses. The comments you have seen addressed here are a small sample. The NHS does have a huge burden, and in most cases they carry it well.
St. Jude, If your country allows one person to leave their hospital in the condition this man is in, the NHS is not carrying its burden well at all. Not only that but for his condition to have been caused by neglect while under the NHS care is shocking.
Doc; it's easy to see that you are trying to instill in folks mind that maybe this is just a pic of a bad sore and not the real person in question. Dr. Crippen already explained this was his actual patient and this pic was taken at 11:30 this AM...
A US Army podiatrist once told us that it's considered a court martial offense for a soldier to present with frostbite of the feet. It is assumed by the Army that each soldier has been given enough training and sufficient admonitions to avoid such an outcome.
It seems that at the NHS it may be necesary to institute the equivalent of a "court martial offense" for any nurses who permit pressure sores to occur on their wards.
Thanks for your encouraging words St. Jude. Apart from the terrible food, a woman died in the four bed ward, this was only noticed by a visitor. A patient had MRSA and was opposite from another with open wounds from cancer surgery, she was only moved when the patient protested - she was involved in local politics so I think that helped. Only one qualified nurse from India who said she had less patients to look after in India, the rest were HCAs. I was messed about with scans having one, the fourth, arranged, drinking all that water then being told I didn't need it. Went to the loo then they porter came to fetch me for it. I said I was going home and would come back for it next day which I did. After four scans and four x-rays I still don't know what was wrong, nor does my GP who received very little information, less in fact than I managed to get from a very good junior doctor, the only bright spot.
Mixed wards, a lot of dementia patients, especially one man who used to stand at the bed at night! as many were noisy, confused and rang the buzzer all night it was hard to sleep, especially as the buzzer was ignored by the staff who said she did it all the time.
I know compared to some of the terrible things here these may seem like minor inconveniences but it was the first time I had stayed a couple of nights in an NHS hospital for about 20 years and I am not yet that old , articulate and educated and I was horrified at the difference, not just from my experience in private hospitals - I expected that, but from my last time in an NHS hospital. Then the place was clean, nursing excellent and although there wasn't a lot of food it was perfectly edible. It is what lies in store I am worried about.
PS I meant to add that I am perfectly happy with my GPs although I feel sorry for the frustrations they have to put up with.
Dr. Crippen ... you're living a nightmare. I simply can not believe the way things are over there.
How on earth are you able to just keep plugging?
It's amazing that things can get that bad.
Hang in there, my friend!
Leaving the country might be a better option for those who are able - we did. You will probably get better care in a hospital or nursing home in Spain (where I know many UK retirees go).
I'm really sorry to read about how bad things are getting in the NHS, because when we were there, I was really impressed by the good qualities of most doctors and nurses I met. England has a lot of social problems - I was disgusted by how the different classes in England hate each other, and also by the various unsavory traits (such as devious work-shy-ness, loutishness, or hoity-toityness) that different classes seemed to take on, which made it easy for me to learn to hate then, too. Not the environment I wanted for my children. The bright spots for me were really the people involved in professional service occupations such as medicine, and also the older generation.
On reading your comments about Patricia Hewitt, Hitler, and so on, it struck me that she is really showing a lot of Maoist tendencies - a tendency to pursue targets that fly in the face of reason, at the expense of good care, etc. The reason she is angry with doctors is that many of them are both intelligent and sensible, and they resist her crazy schemes. This must be very frustrating for her.
A section from the fascinating biography written by Mao's personal physician, Dr. Li Zhisui (The Private Life of Chairman Mao):
Aug./Sept. 1958: "China's steel production was set to double within a single year. Most of the increase would come through backyard steel furnaces. ... immediately the whole country was building backyard steel furnaces. Mao wanted to see them. ...
"I saw the first such furnace - a makeshift brick and mortar affair, four or five meters high - in the courtyard of the offices of the Anhui provincial party committee. The fire was going full-blast, and inside were all sorts of household implements made of steel - pots, pans, doorknobs, and shovels - being melted down to produce what Zeng assured Mao was also steel. Zeng Xisheng picked up a hot nugget from the ground, plucked from the furnace only moments before, to show Mao the fruit of the mill, and nearby were samples of finished steel, indisputable evidence of the success of the backyard steel furnace. Mao had called upon the country to overtake Great Britain in steel production within fifteen years, by using methods that were quick and economical. Even now, I do not know were the idea of the backyard steel furnaces originated. But the logic was always clear: Why spend millions of dollars building modern steel plants when steel could be produced for almost nothing in courtyards and fields? The "indigenous," or "backyard," steel furnace was the result.
"I was astounded. The furnace was taking basic household implements and transforming them into nuggets called steel, melting down knives into ingots that could be used to make other knives. I had no idea whether the ingots were of good-quality steel, but it did seem ridiculous to melt steel to produce steel, to destroy knives to make knives. The backyard steel furnaces were everywhere in Anhui, all producing the same rough-looking ingots."
elsewhere:
"All the able-bodied males, the real farmers of China, had been taken out of agricultural production to tend the backyard steel furnaces. The backyard furnaces had transformed the rural landscape. They were everywhere, and we could see peasant men in a constant frenzy of activity, transporting fuel and raw materials, keeping the fires stoked. At night, the furnaces dotted the landscape as far as the eye could see, their fires lighting the skies." ...
He goes on to describe how much of that year's harvest was wasted, so food ran short, and how the peasants had fed all their own metal implements into the fires, and had contributed their tables, chairs, and beds to feed the fires. And the "steel" produced was useless.
Terrible misuse of available resources, and all in pursuit of targets!
"Aimee, this is not about television, or media telling 'us' what is happening. This is about joe public, you and I speaking up"
St. Jude, I was not suggesting another documentary be made necessarily, but I was saying that has already been done and it is a way in which "Joe Public's" voice can be heard.
(Look at Jamie's School Dinners, for instance, that made a HUGE impact and changed the school dinners around the nation from complete junk to edible food).
Jamie's school dinner's is a good example of political will versus publicity. In Scotland the 'Health Promoting Schools' programme was started about a year before that, and has done a lot for the standards of school food in Scotland. There was political will to do that up here, and it didn't seem to need the publicity. Yeah, there is still some crap school food going on (for example, I know of an area where they are locked into a big contract with a supplier, so they're watching them like a hawk to see if they can dump them for breach of contract).
I honestly don't know what acute medical care is like north of the Border, but would be interested to know if there are any differences.
John,
Like all of your other commenters I am disgusted and enraged by the degrading and indecent treatment this patient suffered. However, I am swiftly coming to the conclusion that expressing rage at the NHS in a comment on your posts is an exercise in futility that only serves to salve my conscience and does nothing to achieve progress in one of our country's top 2 priorities, health care (the other being education).
I will therefore write to both my own MP, to my mind a rather mealy-mouthed and ineffectual Tory, and also to the she-devil Hewitt, sending them a copy of this post (if I may?) and let you know what responses I get, if any. What else though can we do to make our voice, joe public's, heard to actually get something done and make the difference before the NHS goes to hell in a handcart? We know that we can have up to four and a bit years left of this government who have shown throughout their time in power since '97 that they are prepared to pour more money into the NHS but have absolutely no idea as to how to improve health care.
A characteristic of us Brits is to endlessly discuss symptoms of decay and never root causes.It explains why we muddle along with institutionalised incompetence.
Dare I mention the dreaded word Socialism?THAT is the elephant in the drawing room everyone is ignoring.You cannot make a silk purse out of a sows ear.Socialism is the NHS.It should have a flag and the symbol in the middle should be that bed sore.
After all the evidence that he is confronted with every day the good doctor can still say he is against private insurance and that he supports the NHS?
I need to go in a dark room with some aspirins now....(figuratively speaking)
Dr. Crippen I am curious that you regard private health insurance as good value. Obviously you want private hospital treatement should you be in need of it, but as a well-to-do type I would have thought it would be more economical to fund the cost of any treatment yourself from savings as and when you need it, as insurance is always more expensive than the cost of the event multiplied by the likelihood of it happening.
John, the capacity for human beings to show neglect for those in need astounds me every day. What really worries me though is that we are getting used to it.
As an aside, the hospital won't get points for the Friday discharge. They will lose them because he has been readmitted - they also won't get paid for the readmission becuase the PCT will argue that he should never have been discharged (assuming that you make them aware of the case - which you should purely from a quality issue for the commissioning team)...
I know that sounds counter productive (not paying someone who needs more staff) but the idea is that if they did it right first time, it would actually cost them less....
Everyone, thanks for all the supportive comments about this poor chap.
He is now back in hospital and has been there for over 24 hours.
The nursing task force has been called in, he is being "specialed" with intensive nursing etc etc and I thing now he is being turned every 20 seconds.
So, all being well, he will pull through. Class iv ulcers/sores take a long time, but they do respond.
What this case shows is NOT that the nurse involved did not care, but just that there are not enough of them. It is easy to criticise the hospital, but they are being pressurised from above.
And they were yesterday short of 173 nurse SHIFTS (not nurses as I said, so I suppose you divide by three)
But his sort of thing is going on all the time. There are not enough nurses.
Wat Tyler says we should let the market take over. Well, at the moment, even though Wat says nurses are well paid, we still cannot recruit enough.
Why is this?
What happened before every ward had a hoist?? I've not heard about this kind of stuff happening back then.
Also surely if you've got large congregations of nurses (or auxillaries, I think that's one of the jobs pretty well anyone could do!) sitting around chatting (or eating pizza..) they'd surely get enough people together to lift or turn a patient without risking a back injury. It's one thing if a ward is understaffed & everybody is constantly rushing around getting at least the basics done. It's another thing if you find them all sitting around while patients desperately need care.
your posts distress me sometimes, - no, often - and that's good. It'l lead to action. Take care - Morag
Tasha said..
What happened before every ward had a hoist?? I've not heard about this kind of stuff happening back then.
When I did my nursing, we didn't use hoists to move patients. All we had was a bath hoist. Patients were turned using 2 people, one each side. I didn't do nursing in the "ark-ages" but we didn't have a sueing culture either. Nurses were well known to have back problems, but this was minimised by lifting proparly, and the job went with the territory.
Also, in the 70s and 80s we were "short staffed". This is not a new thing, and often we had to beg steal or borrow staff off other wards. It was not unusual for the ward to have one trained member of staff and 2 N/As who were wonderful, and knew as much as we did, while sister delegated from her office, coming to check the work was being done, not being holed up as administrator, sorting about the finances.
Things in those days were not perfect, but seemed to be run better. I guess nurses were nurses, and drs were drs.
Quote: "Dare I mention the dreaded word Socialism?THAT is the elephant in the drawing room everyone is ignoring.You cannot make a silk purse out of a sows ear.Socialism is the NHS.It should have a flag and the symbol in the middle should be that bed sore."
No to hi-jack the thread of this, but what absolute garbage.
Well, at the moment, even though Wat says nurses are well paid, we still cannot recruit enough.
I am no expert, but my Big Sister has been a nurse for twenty years. She says the system is soul destroying.
I think the way targets and systems are designed, make nurses feel like they are battling the system rather than treating patients.
"What do they teach nurses these days ?"
Well, my wife is a trainee nurse. Not nursing skills for sure ; discounting placements she has done one week in 18 months.
On the ward work is useful, but it's not really training ; for some reason she is doing a lot more weekends pro rate ; I'm sure it's nothing to do with nursing shortages.
What's truly scary is that apart from her assessment (10 mins) at the end of Year 1 there is no further formal skills assessments *at all*.
The main thing she talks about appears to be "IPL" which appears to be the various professionals trying to understand each others jobs. This is viewed by everyone as pointless.
There are vast acres of nothingness, "study days", half days and so on. If it was done full time the training could be completed in 18 months IMO.
As a teacher, the course is jam packed full of pseudo educational jargon and targets, and seems to have not much content. I'm quite useful to her in that respect as I can translate the mindless gobbledegook she is required to do into English.
Also, vast numbers of students abandon the course for, in most cases, no apparent reason.
Doc- this is an appalling tale, and well done for creating enough fuss to get some action. We all have the utmost admiration for what you and your colleages try to do in your dayjobs, so it is disgraceful that you should have to spend your valuable time trying to bludgeon a path through the medico bureaucracy- you have much better things to do.
I'm left wondering if we couldn't put together a support group of people who enjoy shouting at bureaucrats. You could maybe give us a few pointers, and then refer cases like this to us to do your phoning and shouting for you. We could report back when we'd forced a breach.
I'd certainly volunteer and I'm sure you could depend on other moderate men of reason like The DK.
Hi Paul,
We started at nursing school which was in the hospital grounds. There was a principle and the tutors. We started off learning the basics for a few weeks and practiced teqniques in the clinical room. This was for 6-8 weeks and then we went on to our first ward, which we would be there for a couple of months. Being the junior you did EVERYTHING!! You either sank or swam
So training was ward, school and it went on this way. Nightduty started after a few months. All through the training the students were assessed, with aseptic technique, bed baths, caring for the dying, making beds, drugs and all the nursing care. We carried with us to each new ward a work book which was checked by the sister. Things were ticked as you accomplished each task. There was an exam at the end of the first year. If failed twice you were out. Throughout the training there was practical assessments. You either passed, deferred or failed. Defer or fail three times and you were out.
If sister had a complaint it went back to the school and your assigned tutor would come to see you, or you were hauled in front of the principle.
That was the way it was. Just thought Id live you a taster of what "old school" training was like. It was strict but we loved it.
It's appalling. Why do we have so many foreign nurses instead of English speaking nurses? I hate this idea that the patient can see a (cheaper) nurse instead of a doctor.
How much are nurses paid?
Interesting Caz, I presume you've been a nurse for a while 
I think even though it is 'strict' my wife would much rather have done it that way. It's hard work but you learn how to do things.
Of course, there are still tasks to tick, but it is about "having made appropriate analysis of a critical incident".
AFAICS every *useful* skill (i.e. practical nursing) she has learnt she has learnt on her placements on the ward.
There was a week's skills training before the first placement (which was terminated after 2 1/2 days !)
There are no exams I believe *at all* ; save for the 15 minute skills test which was very basic things (I could probably pass it ; come to think of it I could probably write the essays as well .....)
WHAT DO THEY TEACH THE NURSES THESE DAYS?
Sociology, mainly.
Hi Paul,
I was a nurse for a good few years, now retired through ill health. I am still in touch with an old friend who trained with me, and after the "old school" training she had to go to "uni" on her days off to be re-trained again, in the new way. Her news to me was abismal. I asked her what she had learnt, she said nothing, its all nurses grades now, and its a load of back-biting. Sadly she told me they were no longer able to "waste time" nattering to patients. I was horrified.
I couple of years ago my late mother who had been an NA for many years went into hospital. A nurse came along on his own to make her bed, and the bedding was going on the floor as he started to strip her bed. She asked why he was on his own, and was told they had been told it is quicker to do it on their own. My mother asked him if he knew about "envelope corners" as she didnt like her bedding on the floor and he said he hadn't heard of them. With that, she got out of bed and proceded to lecture him about the correct way of making beds. The nurse and her made her bed "the proper way", while she told him about 2 to make a bed!!
I was told about an elderly confused woman who couldnt feed herself. Mum had noticed the staff took her food away. The problem was she couldn't reach it, and was later told off by the dr for not eating her meals. Hearing this my mother piped up and told the dr what had gone on. For the next few days of her stay, my mother fed this lady. We often wondered how she got on afterwards.
Paul, what does "having made appropriate analysis of a critical incident" mean? It sounds alien to me. Is this when the job of dr and nurse overlap? We didnt analyse anything. Anything which was worrying (signs and symptoms) were reported to the dr or sister and was dealt with from there on. Decisions of any drugs, treatments and regimes was the job of the dr to write up, but Obviously observation of the patient was critical. One example..an elderly gentleman was admitted. He wanted his "mixture". He was written up for it, and became very aggitated at certain parts of the day. I mentioned to the dr that I felt he could be addicted to this medicine. The gentleman had been taking his "mixture" for years. Firstly the dr discounted this but I stuck by my guns. The dr came back the following day and said he had read up on the medicine and he realised this man was addicted.
In an ideal world, nurse and dr have got to work together, but this means (or used to mean) you didn't step over bounderies. Nursing today seems to be like a management course.
Dr Crippen shows this with nurse practioners.
So Wat, which kind of bureaucrat would you be shouting at in this case and what would you shout at them?
"having made appropriate analysis of a critical incident"
Just thinking aloud...are these weasel words which mean savvy and common sense?
Caz wrote - "Nursing today seems to be like a management course."
I agree, from the nurses courses I've seen (haven't done any, but seen friends doing them) and the management courses I've done.
And the thing about management courses is they don't teach you how to manage anyway, do they? You either learn how to manage on the job, or you don't, so what's the point of teaching nurses along those lines?
My sisters trained as SRN and SEN nurses back in the sixties, and their training was, as Paul says, strict, but informative.
Do we need another Florence Nightingale?
By the look and sound of things, I was wondering if perhaps they did nursing courses by correspondence course these days!
Where has all the money gone?
Aimee said
"By the look and sound of things, I was wondering if perhaps they did nursing courses by correspondence course these days"
......bed baths online with virtual reality patients?? You never know!! )
If an ordinary person like me comes across a situation like this, who should we complain to? Hospital manager? MP? How do we change this situation?
Letting a patient in your care develop a sore like that is unforgiveable to the point of criminal. I can't think of any criminal offence currently on the books that would fit the facts here, but I hope someone's told your patient to think about suing.
Laughing Cavalier: Where has all the omney gone?
Well, if you believe the media, it's all been spent on art (even though that was charitable donations) and bean counters.
In reality it's gone on wage increases for many staff (something which the public said was their top priority in 1997), drugs and getting rid of some waiting lists.
Higher wages aren't everything. Poor morale, constant sniping etc and violent patients/families mean that huge wages won't make much difference...
And don't get me started on nurse training/consultant nurses and nurse specialists
Katy (and others)
Thank you.
They are not going to sue. They are really nice people. What has happened now is that the SHoneT has hit the fan, the patient is surrouned by surgenns and dermatologists, the wound has been debrided, he is on i.v. antibiotics, he is being ripple mattressed/waterbedded turned every 2 seconds and getting intensive and decent nursing care. Speaking to someone this evening he is already, 36 hours down the line, vastly improved, every one is upbeat now, there is a lot of embarrassment and, yes, shame, but the general opinioin is he will get through. And certainly I have seen worse than this get through.
This is the current NHS in microcosm. It still delivers when there is a glamorous acute illness like a heart attack, and it still deleivers when there is a crisis.
It is the people in between with none glamorous illnesses (yes, like bed sores) who do not get much attention until the crisis occurrs.
We need more nurses.
It is simple as that. The intensive care this guy is getting will be at the expense of someone else.
John
Dr C
You cannot get enough nurses because you can't afford to pay them enough to put up with all the bureaucracy and target chasing.
People want to acheive something with their lives and the NHS doesn't allow them to do that.
And that's because it's a bureaucracy.
You can run an organisation as a business and burst blood vessels in trying to make patients happy or you can run it as a bureaucracy and break blood vessels in trying to meet politically set targets. There are only the two options.
Every other bureaucracy is the same - disfunctional. There is no reason for the NHS to be different.
Privatise it for God's sake.
Does your local Trust have a Director of Nursing (most acutes do)? What does she (I'm assuming she) say about it? Perhaps your local paper would like to ask her how many more nurses she needs?
Writing to the Chief Exec herself will do nothing. Advise the lady to write to her MP and have him or her write to the Chief Exec. Encourage every patient who has a problem do it. There are enough decent MPs and staff who want to blow the whistle on this kind of thing. It is a national disgrace.
Have you explored moving to the United States (or any other country)? If every disgusted UK doctor did this you'd eventually reach the point where something radical would have to change.
Im defence of out GPs and our doctors, I do feel for them. Im sure almost most of our drs went into the profession to help others. At the monent they seem to be banging their heads against a brick wall. I know they work hard, and sometimes their hard work is undermined by burocracy.
Dr Crippen, Im sure you didn't go into medicine for tick boxes and targets. I know our GPs work hard. My own GP can be grouchy, balshy and damn difficult and so on, but because the practice is at the end of my road, many times have I seen her light on way into the midnight hours. I know at times she has run ragged. As a single dr practice she carries the can. The responsibility on our drs are tremendous, while things are made harder for them
Same problems as with any other socialized system. It doesn't take a brain surgeon to figure it out, just an honest look at things.
I've had only 3 interactions with the NHS:
When I was attending Oxford back in 1999, I went in to see a doctor that was so busy that he asked me to diagnose myself. I did so, and he wrote the prescription for amoxicillin. That was cool. Quick and easy.
Another doctor looked at some sores on the roof of a friend's mouth and diagnosed him with "bad luck". No prescription.
A roommate dumped a pot of boiling water on himself. He went in and was wrapped in gauze. When he removed it in a few days, as instructed, it tore his flesh off with it.
"Where has all the money gone?"
On folders & paper for all the "targets" & "training milestones" & the time spent on working them out etc. My training folder (working in NHS lab) has about 300 things to fill in. My manager has to work through every item with me to show I've got competency to carry it out. ANYTHING from answering phone calls to how to add 2+2, clean up spills etc. The hours spent on this utter rubbish (90% is common sense & the important stuff I forget right away because I've not got the time to actually do it & learn it, because most of my time is spend on stuff like this..).
"People want to acheive something with their lives and the NHS doesn't allow them to do that."
Hmm. In our lab 3 biomed. scientists just retired or left. We haven't got enough left to do much work & cover 24h. The big bosses somewhere else have decided not to advertise for a new biomedical scientist as "there aren't enough". (It's one thing giving up AFTER trying, but to not even try...!?) Instead we'll get "near patient testing facilities" costing the NHS an extra £100000 or so. This means lots of small analyzers round the hospital, operated by doctors. This again will mean there won't be any central records of each patient & obviously mistakes will be made. Not sure if the docs are happy with the extra work either, somehow I've got the feeling they haven't been asked.
I've also got a feeling that once we've got the new equipment they won't be able to employ new biomedical scientists because they've spent all the money on it.
I could bet everybody else will pack in their job in the lab, as it will be an utterly different carreer being reduced to stocking analyzers...
I agree with the pay issue, our lab staff has just been banded, meaning a payrise of £100 a month for everyone, a lot more for others. About the same time people started leaving. I don't think a bit more pay will get more people into unfulfilling carreers, which are mostly down to bad working conditions!
BTW We also had things in our hospitals to prevent back injuries of nursing staff. Every bed had a "foot pump" which could be operated to lift the bed to a higher level & prevent bending down when making the beds. Nobody used them, as there wasn't enough time to! (Even 30 beds x just 2 minutes.. - we didn't have an extra hour before breakfast..!)
I'm so glad we don't have "free" health care in the US.
My mother has been a nurse for over 30 years, the last 10 or so of which she has been an oncology nurse. Every year she is tested on basic nursing AND on her understanding of treatment of various cancers. She has to constantly read up on the newest studies and treatments to stay current, which means her coffee table has at least one monthly oncology magazine on it any time I visit.
She recently changed employers and works at a different hospital. She gets payed more than I do and I've worked for Microsoft for more than 7 years. Her employer also matches a much higher percentage of her contributions to her retirement fund.
When hospitals compete with each other to get the best nurses, their pay and working conditions improve. This also happens to motivate more people to become nurses, because if they are successful, they too can advance to become a highly payed professional.
What is the difference between the pay of the best nurses and the worst nurses in the UK? IS there any competition for nurses between hospitals?
There is another factor to consider. If those people cannot be trusted to run a medical system, why trust their statistics? My guess is that they are systematically falsified, and that a little investigative journalism would reveal this.
Yoo-hoo! Canada! I'm talking to you, too.
I second what Douglas said above. Come over to the States. We can always use another dedicated, highly competent, caring physician, and we're far too contrary as a nation to ever let that mess of socialized medicine happen here.
So, vote with your feet, and do a farewell column for the Times or Telegraph on precisely why you're leaving. You might just accomplish more with that, then staying to fight.
Well, obviously they are systematically falsified ! The most blatant (reported by Dr Crippen I believe) was the "queue for the waiting list" in Sunderland (?).
All govt stats are like this. The govt has given up on trying to make things better, and is now spending money trying to make things look as if they are better ; the money is wasted on what is effectively political propaganda.
The crime stats are rubbish : read PC Dave Copperfield, Dr Crippen's cop equivalent on "Administrative Detections", and as for education, the "100 most improved schools", 98 of them were "improved" by dodgy courses "worth 4 GCSEs", allegedly.
"having made appropriate analysis of a critical incident"
When something happens you are supposed to reflect on it and try and learn something from it. This is good and sensible. What is not good and sensible is that you have to write this up in extensive detail using an appropriate model of reflection. For one incident. To show you can do it.
I've no doubt that she will be an excellent nurse and I would be a terrible one. I've also no doubt that I could pass every college test and essay she has done without actually having done the course.
Hi M
Come over to the USA? Well.....there is an interesting one. I have worked for a long period in Chicago, and also in Toronto. I have family in Texas and Colorado and I get over there a lot.
I love the USA. Get excited every time the plane lands. And if I were in a bad road traffic accident, bring on the American truamatologists. And, provided I am insured, the treatment for lots of other things too.
But there are problems in the USA too. And really it is the same as the UK, it is just you deal with it differently. We spread the misery thinly across the system. The NHS deals with crises well. And it deals with cancer, and in particularly the childhood cancers brilliantly; and it really is free at the point of entry for those people.
So, probably I'm going to hang on over here...you see, for all the cynicism and often light hearted approach to the UK NHS, and I am still deeply committed to it. And all is not lost. We need a change in government. I know Tony Blair is popular over there. Less and less here.
What the NHS needs to do is look at some of the strong points in the USA system, and adopt them.
The problem that both the USA and UK need to face is that NO COUNTRY can afford unlimited health care for all its citizens. Medical techology now gives infinite expensive options. Health care has to be rationed. The USA both ration it, in different ways. I do not think either system has a monopoly of wisedom. And neither country has a politician brave enough to tell the people that health care IS going to be rationed. No votes in that.
John
Hi Paul,
Yes I do read PC Copperfield. Frequently. And to anyone who has not already done, have a look at:
http://coppersblog.blogspot.com/
I agree with you entirely about nursing. The academic entry requirements are too high and are keeping out a lot of wonderful young people with practical skills who would (and used to) make excellent nurses.
John
John, I agree with Katy. The patient should sue. This should be done purely to scare the Trust and its insurers into making sure this never happens again.
There's nothing like paying for the problem, literally, to exercise the mind.
Hi Chairwoman
Well, that is one for the family. There is certainly going to be an independent inquiry as to why he was sent home in the first place.
As I have said elsewhere he is now doing really well (have not had a report yet today).
Trouble with suing is that, as the lawyers out there will tell you, you have to prove damage, and will only be compensated for damage. You won't get anything for righteous indignation, however righteous. And this family, like 95% of the UK are in the financial trap of being "too well off" for legal aid, but not well off enought to afford two years of lawyers.
John
And in any case, lady finchley and chairwoman of the bored miss the point. The problem is not that the trust management are complacently sitting there not caring about pressure sores. The problem is that the NHS is micromanaged from the centre and that the local management are extremely constrained in what they are allowed to do. Like, pay deals for all staff are negotiated centrally so you can't do what any private sector body would do and pay more to attract scarce staff. Having the "decent" MP write to the Chief Exec or successfully sueing would achieve precisely nothing in relation to the underlying problem. The decent MP would be better employed supporting the recent reinstatement of the internal market in the NHS; but lots of them don't because of an ideological commitment to socialised medicine. (BTW, the NHS has been self-insured for negligence for large chunks of the last 10-15 years, don't know if it still is at the moment).
So, if I can summarise this thread so far: this would never have happened in the 1960s or 1970s when Tony Benn was in the Cabinet and NHS league tables, internal markets, and PFIs were unheard of, and it's all the fault of socialism or perhaps sociologists.
That sensation in your head is technically known as cognitive dissonance.
Compare and contrast the other main source of medical horror stories in the UK, the nearly-all privatised "care home" industry. (Scare quotes inserted because they don't and it's not.) Will anyone be so bold as to deny that don't care homes suck even worse than the worst of the NHS?
The problem is one of aligning power and responsibility. That doesn't change in the private sector - if TescoHealth management wants to run their wards for unglamorous local gen med with minimum wage sheep, taking advantage of the fact you really can't go 50 miles away for your bedsores, it's just the same position but with a different bunch of wankers in charge.
There is never going to be meaningful competition for this kind of medical treatment as opposed (perhaps) to routine surgery - it's got to be local, and cases are wildly heterogenous. Unless, that is, we as a society decide to spend enough to have three competing local general hospitals per district doing low margin, labour intensive stuff - exactly what the private sector would rather not do.
"The problem is that the NHS is micromanaged from the centre and that the local management are extremely constrained in what they are allowed to do."
100% agree.
Funding itself is the same problem anywhere in the world. We'll never be able to pay for any medical procedure that is possible for everyone. Even in Germany they are making big cuts everywhere & people there pay a vast sum for health insurance every month. (Yet docs there are reported to emmigrate to the UK for better working conditions & pay. Strange world..)
Hi Alex
"So, if I can summarise this thread so far: this would never have happened in the 1960s or 1970s when Tony Benn was in the Cabinet and NHS league tables, internal markets, and PFIs were unheard of, and it's all the fault of socialism or perhaps sociologists."
I agree with you. The "socialists" introduced the health service and thank god they did.
This is not simplistic political dogma at all.
We MUST maintain the idea that all citizens in the UK can access a decent standard of healthcare independent of weath and statue.
We MUST NOT lose the NHS and we should be very proud of what the post war Labour govenment did.
The real reason it is not working at the moment is that no politician is prepared to think the unthinkable, to admit that health care has to be rationed. We could spend the whole GDP on health care, and still there would be more to do.
Health care IS already rationed by waiting lists, or queues or whatever Patricia is calling them at the moment. The rich do not queue.
We MUST preserve he best of the NHS and, yes, for me that means Healthcare for all. But the current Stalinist control systems are not working. We do need to let some private enterprise in, to let market forces have influence.
The idea of the money following the patient, as was starting with Fundholding in the 1990's is one way forward. Blair abolished that for dogmatic reasons. He is now re-introducing it by another name. (commissioning)
I am no rabid leftie, but no one in their right mind (in my view) can criticise what the 1945 Labour governement tried to do.
But it needs more thought now.
And I agree with you about private nursing homes. Some (not all) of them are diabolical.
John
This is what happens when a country embraces socialism, communism, or if you wish, socialized medicine. Free enterprise is the cure for this and other ailments.
Yes, Care Homes do suck less than the worst of the NHS.
The recent scare stories published by CSCI have no foundation.
What they are doing is deliberately misleading ; in the first sentence they are saying that incidents A,B,C and D happened - which I don't doubt.
Then they are saying things like "... and 50% of homes don't meet our standards on medication".
These are both true but they aren't related. CSCIs trick is to make you think A,B,C and D happen in 50% of care homes, which is a nonsense.
The reality is that CSCI's standards for care homes aren't met by *anyone* in total, private or public, largely because they vary from day to day and from inspector to inspector, and they're unmeetable (75% of staff NVQ3 isn't going to happen).
Yes, bad things happen but they're nowhere near as bad as they make out.
Why are they doing that ? For the same reason they had a pop at the public schools ; because CSCI are threatened with closure and being subsumed into OFSTED.
What they are actually doing is launching big scare stories and the message is "things will be terrible without CSCI, don't close us, you really need us". It is quangocrats indulging in job creation (again).
It's also nothing to do with private vs public. In my area, none of the LA care homes pass the standards either. This is partly covered up (the CSCI people are ex SSD inspectors in the same area), and also dodged. LAs are very keen on "homes with care provided".
The idea is rather than it being a care home, you rent the room/flatlet from the LA (also allows them to put the rent up) and they provide care. Because it's not a care home, though in practice their is little or no difference, then the rules don't apply. This is blatantly dodging the rules, but CSCI don't apparently care ; the old standard of "LA stuff is allowed to be rubbish, but Private stuff isn't" still holds.
It is also worth noting that CSCIs standards are almost entirely bureaucratic and tick box related. They do not measure quality of care, or anything like that, it is merely tick boxes. So, if you have a good medicine policy and good records they are entirely uninterested in the actuality. So there is a vast increase in pointless paperwork demanded by unaccountable bodies (sound familiar ?), none of which actually helps the carers or the cared for, but it does allow CSCI to ponce about praising their achievements, which are minimal.
Dr. Crippen:
Sir, I hate to say this, but I've seen much better care than what you have described in some third world countries. Frankly, I'm appalled that this is happening in your country.
John,
you did appreciate that when I said "letting a patient in your care develop a bedsore is criminal", I wasn't for a moment talking about you personally, didn't you?
Have beeninfo re this blog by Conservativehome. Am 71 now, retired at 65. I was a Health Visitor so missed out on the sharp end. What has gone very badly wrong was the introduction of "Project 2000" the begginning of the end of decent nursing. Remove the enrolled nurse qualification, get a bad attack of empire building, everyones a student, dont bully me, I'm here to learn, not do ANYTHING remotely like getting ones hands dirty, and as for washing them afterwards... well!! I do know of what I speak. I served on Community Health Council before New Labour chose to abolish it and replace it with PALS et al, who are NOT independent, no matter what they say. Also, must get rid of idiot managers with clip boards, Try and catch "Casualty" some Saturday night, BBC1. A superb portrayal of the breed. The actor deserves an Oscar. Now!! The cure!! How?? A Tory administration is the only hope, as Nulabour will never admit it is wrong. How do turn around those nurse managers who applied for the posts because they could not hack the front line stuff?? They are in the Community end too. I worked with some of them. Couldnt stand lateral thinking, anything that was not down on some directive, No new initiatives that had not been presented as a "Business Plan" For Chrissakes!!! What has business got to do with some poor sod with a problem? We need a medical hercules to clean out the Augean stables and gety back to some common sense. I have seen bedsores like that in the 1950s before ripple mattresses, but we made sure folks nutritional needs were met. Ward Sister surveyed the whole ward, but that cant happen now, nightingale wards are out, snug little bays are in. I could go on, and on, and on........
To the Sargeant:
I grew up on a country, which at the time was Socialist. That country, Sweden, is known as the 'cleanest country on earth'. In fact, it is so clean that it is suspected that is why there is a high allergy rate in that country due to children not being exposed to enough germs.
So, from experience I can say that Socialism does not necessarily equate with lack of cleanliness or sub-standard hospital care.
Although less Socialist these days, it is still EXTREMELY clean and I visit a close relative who lives in a hospital there, regularly. It is exceptionally clean and the care is of a high standard (so no change since Socialist days there).
P.S. This is no reflection at all on my own personal political views.
Crimeny- come to Chicago. We could use a few decent physicians.
Og,
Hi!
I did three months in Chicago as a medical student!!
John
"Startling research from the biggest study ever of U.S. health care quality suggests that Americans -- rich, poor, black, white -- get roughly equal treatment, but it's woefully mediocre for all."
Quotation taken from http://www.nytimes.com/aponline/...ealth-
Care.html
And, reassuringly in some ways, but dispiriting in others, the summary goes on to say:
"The survey examined whether people got the highest standard of treatment for 439 measures ranging across common chronic and acute conditions and disease prevention. It looked at whether they got the right tests, drugs and treatments.
Overall, patients received only 55 percent of recommended steps for top-quality care -- and no group did much better or worse than that.
Blacks and Hispanics as a group each got 58 percent of the best care, compared to 54 percent for whites. Those with annual household income over $50,000 got 57 percent, 4 points more than people from households of less than $15,000. Patients without insurance got 54 percent of recommended steps, just one point less than those with managed care."
I know that this is a comment on following recommended protocols more than nursing care, but I thought it might be relevant.
Best - Tony/Happystance
Re Phyllis - does the admin part work better in other countries with different systems? I only have experience of Australia, but what happened there was that the consultant told me that my biopsy showed recurrent cancer, told me the next thing I needed was a CT scan, and then sat there with an "over-to-you" look expecting me to go and find one. When I asked pathetically where I might do this, he got out his Yellow Pages. At least in the NHS quite often these things are organised for you.
Dammit John Crippen! You dangle Mavis in front of us, tempting and titillating us with the promise of secret meetings, smouldering glances, and stolen kisses, and she turns out to be a sodding touch typing course!
Potentilla, of course most hospitals are insured, but their insurance copmanies would be on their backs if they had to make frequent negligence payouts, and are more likely to be listened to than to you, me or Dr.C.
"John, I agree with Katy. The patient should sue. This should be done purely to scare the Trust and its insurers into making sure this never happens again.
There's nothing like paying for the problem, literally, to exercise the mind."
Do you really think it would 'scare the trust' into correcting the issue at hand?
How naive!
IT would instead cause the trust to employ a bunch of lawyers and extra 'PALS' managers to seek out problems after they arise and brown nose people out fo suing. IT will lead them to get managerial consultants in to look at the problem and identify how bes to avoid it - the answer to which will doubtless involve lots of paperwork and extra managers.
Nowhere will the common sense 'lets raise the nurses wage to attract some decent ones, and increase the places in the nursing schools' enter their minds.
Jam
I have watched Casualty, have 2 children who we needed to sponsor chairs for in A&E when they were small. Speek English and can wash my hands. THIS NOW MAKES ME OVER QUALIFIED TO NURSE
I know that any one with any sense should not be eating food on the wards at the nursing station (NHS Coffe Bar and dating area) Why did the old miltiray hospital in Aldershot have a dinning room for patients?
John,
I thought I was going to read a juicey bit of scandel and gossip with you and Mavis. I'll go sculking back to watch the tv
If anything infuriates me more than my GPs incessant typing while I'm trying to talk with her, its my GP!! Why oh why does she try to half listen to me while her concentration is with her wretched key board. I cant take it seriously. Im too polite to superglue her hands to her desk and shout "FOR GOODNESS SAKE, LISTEN TO ME".
Six monthly reviews are bundles of fun too :-(. Having dx of "ME" and waiting for Lyme results I feel ill and am not a happy bunny. Bottom of the pile these illnesses. I get asked (fingers poised on the key board, hovering and waiting for my next word) "How are you?" I answer "absolutely disgusting dr and feel like death, difficult to walk and have the same neuro symptoms, blah blah blah!!!"
Bye the end of the review, I've not been taken seriously. Well, I guess with MY dx, you wouldn't, would you! If I was an animal, she'd have given me a shot to put me down. Before I leave the room, I am asked what I am going to do today. I just look and say "going home to die dr", in which she says "Good, good, have a nice day.
All in a days work Dr!!
Jam, I'm afraid you may be right. If it's one thing hospitals don't skimp on it's staff on the administrative side.
But don't entirely blame the hospitals. I assume that NHS nurses' salaries are still on scales laid down by the government, no matter what title has been bestowed on the board that administer them.
Chairwoman, most hospitals probably AREN'T insured. The NHS has chopped and changed on this point over the years, but has mostly been SELF-insured for negligence, that it is to say paid for its own negligence costs rather than having commercial insurance. I don't know what the position is of this moment. (If you go back more than 10 years, they didn't even insure NHS vehicles; they were statutorily exempt).
Jam, you're largely wrong about what the trust would do. They can't do most of what you suggest without permission from the NHS Executive in Leeds and possibly the DoH, even if they wanted to; they don't have the budget for it. They CERTAINLY can't "raise nurses wages" - nurses' wages are centrally negotiated as Chairwoman points out. Nor can they do anything about the supply of nurses other than, to a limited extent, recruit overseas, but only to the extent that central government has not yet decided that they can't.
Chairwoman, 3% of the NHS pay bill is spent on staff on the "administrative & clerical" and "senior management" payscales. This includes the NHS Executive (which is sort of equivalent to "head office), some senior doctors doing administrative jobs, medical secretaries, IT, clinical coding, accounting & payroll, personnel etc etc etc 3% is less, in many cases substantially less, than most private companies would spend on the equivalent functions. How much do you think it should be?
Annabel: "Also, must get rid of idiot managers with clip boards, Try and catch "Casualty" some Saturday night, BBC1. A superb portrayal of the breed."
Firstly, I don't have a clip board and secondly Casulaty couldn't get much further away from portraying the reality of the NHS if it was set in Outer Mongolia. Mrs Manager has banned me from watching both that and Holby City because of the amount of abuse I threw at the screen.
Chairwoman: "If it's one thing hospitals don't skimp on it's staff on the administrative side.
But don't entirely blame the hospitals. I assume that NHS nurses' salaries are still on scales laid down by the government, no matter what title has been bestowed on the board that administer them."
Yes you are correct about the Nursing grades, all part of Agenda for Change. However, I take issue about not scrimping on admin. staff because that's certainly not my experience. Of course, if it wasn't for central diktats we might actually get those who are around to do something more productive...
Hi everyone - re: hospital administators.
I do not take the conventional view much loved in the press of "when their is a problem with the NHS, lets blame the managers."
At the lower levels, and particularly in PCTs, there is far too much padding and mediocre incompetance. A lot of lower grade administraters now are overpromoted nurses who regard themselves as too clever to look after my patients' bed sores and instead have gone into management.
At the higher levels, we should pay the managers MORE not LESS. Tne NHS is one of the biggest business organisations in the world, and needs the highest quality managers.
Look what Stuart Rose earns at M&S. do you think people of his calibre would work for the NHS?
John
potentiala.
Although i suspected trust cannot independently raise wages, it begs the question how a group of nurses managed to sue one trust for being sexist with their wages (because someone has worked out that a nurse is the female equivalent of an electrician or something like that) rather than suing the entire NHS.
Cumbria i think it was.
perhaps thats just an oddity of the legal system though. because how can you force a trust to compensate people to the sum of many millions for something outside their control...
Trusts have legal personality and are the employers of their staff (rather than "the NHS" being the employer), so if an employee is trying to do someone under equal pay legislation, it has to be the trust. On the other hand, trusts don't have very much management control over the big-ticket items. Don't forget that the non-exec trust board members are appointed by the Secretary of State (and a couple by the SHA I think). The North Cumbria case was before Agenda for Change (which amongst other things was meant to bring in "discrimination-proof" centrally negotiated payscales). It was settled out of court in order not to provide a legal precedent. It was a lot of money because it went back into the past. I don't know, but I expect that the DoH and/or the SHA had control of the negotiations rather than the trust, and maybe they were even nice enough to pay the bill.
Dr crippens,
Was consent obtained for the image (even if anonymised) to be placed in a non-medical non-educational website?
I support your medical blog and would hate to see it shut down due to carelessness on your part.
Concerned doc
Most certainly, yes.
John
PS by the way, I tried to email you about something else - your email address suggests you have a spam protector, and I would dearly like some details - sadly, your protection was so good that my email bounced back; does your email address work?
I am a nurse, (of two years) and have been horrified by your stories. I agree that something went wrong with the care that patient recieved, but I think perhaps the story was a little exaggerated. I also worry that confidentiality has been breached slightly in this case. I do wonder whether you would have been able to do a better job in their position (bearing in mind little evidence of what this is has been given).
I read with interest that the nurses "couldnt speak English" but yet all nurses must complete a standard of English before being allowed to register- so I'm not sure of the reliability of this quote.
I am saddened to read about the respiratory nurse that was visiting your patients, and the hostility you held towards her. I am sure she was just doing her job in trying to provide a service in the community.
I hear of patients waiting years to get reviews of their condition/medication. Surely this nurse can help lighten your workload?! What was it that she suggested? Was it really a pointless request?!
Having read your entry about nurses not being able to prescribe, I feel you have a rather old fashioned stance. I know you did not accuse all nurses of an inability to understand contraindications of this, but it comes across clearly to be your belief. I have been prescribing medications on my ward, and more nurses and hospitals are taking this stance.
It worries me that the information you are posting on the internet will be scaring people who cannot afford to pay for private healthcare, and the abuse aimed at nurses will only dissuade more from entering the profession.
I think you have spent too long outside of the hospital environment, and would benefit from some up-to-date experience of the NHS now.
Why do you believe that all nurses want to be doctors? Are you worried about your own job?!
However, I like your sense of humour, and the stories are useful to highlight issues. In future please present more of the facts and less of your opinion.
You're website looks very good, it was a pleasure to be on you're. Keep on the good work cheap lortab with out presc plavix et aspirine anti cialis impotence
My mother was a nurse, she's 84 now, and I'm a radiographer, only now and again these days, and I'd like to comment on the constant criticism of modern nurses.
The biggest change in my experience is the patients. I remember when a poor old 90 year old patient came into the department in the 1970s, it was rare enough for us to comment on, "amazing for his age" etc. Getting a patient who isn't over 80, especially admissions during the night, is the rare occurrence now.
A previous poster mentioned the senile, confused patients keeping her awake all night! Huh, poor her, imagine working with these day in day out.
I think the nurses deserve a blooming medal - no longer are you healing the sick to go back out into the world to lead a fulfilling life (a satisfying job)- instead you are patching up some old soul to get them home until they return with the next age related debilitating illness a few months later.
And as for care in the US (previous poster) - goodness knows what happens to senile old people there (the many who don't have insurance cover) they must be left with their relatives. God help them.
Commenting by HaloScan
