I’m an A&E doctor. This is how we’re forced to let our patients down

January 25, 2019

From the Guardian Newspaper by an Anonymous writerhttps://www.theguardian.com/commentisfree/2018/jan/05/nhs-doctor-let-patients-down-crisis

I’ve arrived five minutes early for my shift in a hospital A&E department. I walk through the corridor behind the department, already crammed with hospital trolleys. I shut them out of my mind. I’ve still got five minutes of breathing space before they become my immediate reality.

The trolleys are staffed by paramedics. They brought the patients in, there’s nowhere for them to go, and there are no hospital staff to look after them. So the paramedics wait with the patients, checking on their pain and repeating their vital signs – instead of being out there responding to the soaring number of emergency calls.

Why is the NHS winter crisis so bad in ?

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Most of the patients in the corridor today are elderly. Some clearly have dementia, and are confused as to where they are. There’s no dignity, no warmth and a very long wait ahead before the hospital starts seeing and treating them. It turns out that I didn’t manage to shut them out of my mind at all.

As I walk into the changing rooms there is chaos everywhere. A crisis has hit all the staff. The cleaners have needed to help with getting cubicles and bed areas turned around faster and faster, so the staff areas have moved to the bottom of their list. There are literally no clean scrubs or uniforms left for any of us to wear. “Don’t worry, whatever you’ve got on is fine, just start seeing patients.” The bosses are as stretched and as desperate as anyone else.

I am allocated to the “minors” area. This area was designed for ambulatory patients who could be walked into a room, seen and walked back out to the waiting room to wait for results. It is already full of patients on hospital beds, pushed two together in three out of the five consultation rooms. Some are elderly, confused, alone. Some are young, injured or very unwell. One is a mental health patient with severe anxiety. This is not the place to make her feel better. Far from it.

Over the PA system, pre-alerts for ambulances carrying critically unwell patients are announced – the ones whose condition is life-threatening. In 11 minutes, four ambulances carrying patients who need immediate resuscitation arrive. This would saturate the system on a good day. Today they have nowhere else to go.

I hear a call for “security urgently” over the PA system. The call is repeated two minutes later. We all know it’s for show. The security team are stretched and scattered all over the hospital, and can rarely answer those calls. This time a staff member had been attacked by an intoxicated patient.

What’s worse is that this situation was entirely predictable. The inadequate care we are providing is the inevitable reality of the government’s funding decisions. If you strip back funding, force hospitals to make savings they can’t afford, devastate primary and social care, and fail to invest in staffing or resources to match demand, we are forced to tell our patients: “I’m so sorry, we can’t look after you safely today.”

And for many of us, we’re tired of apologising on behalf of the ministers who have made these decisions. It’s just too much. We are too tired to keep trying to smile. We are struggling to try to make it work. We’re sorry we’ve let you down, but we’re broken and we need your help.

The anonymous writer is an A&E doctor who works in a hospital in south-east England

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Something Is Profoundly Wrong With The NHS Today

August 31, 2018

 

From the British Medical Joiurnal  2014; 

(Published 16 June 2014 https://www.bmj.com/content/348/bmj.g3935) 

348 doi: https://doi.org/10.1136/bmj.g3935  Cite this as: BMJ 2014;348:g3935

(Article by Clare Gerada who is medical director Practitioner Health Programme, Riverside Medical Centre, London, UK)

Clare Gerada says that there are serious problems with working life in the NHS and that these must be tackled if the NHS is to have a secure future

Just as the historian Tony Judt said that “something is profoundly wrong with the way we live today,” I believe that something is profoundly wrong with the NHS today. The health service’s prevailing culture is one of fear, even though its staff are meant to espouse kindness and compassion. The service is becoming a place where staff feel attacked, unloved, and abandoned by their political and managerial leaders.

A quarter of NHS staff report that they have been bullied in the past year. This is a higher proportion than in any other employment sector and is double the rate from four years ago. Surveys have shown that the main concern of NHS trust finance directors is staff morale, ahead of waiting time targets or patient experience. For doctors and nurses, high rates of mental illness, emigration, whistleblowing, suspensions, referrals to the regulator, and complaints all point to a system in serious trouble.

The causes of this distress are not hard to find. One is the industrialisation of healthcare. The move from a national state funded, state owned, and state managed organisation to a fragmented system of multiple competing providers, outsourced management, and increasingly mixed funding sits uncomfortably with the public sector ethos of many NHS staff. Increased privatisation also causes widespread anxiety.

Steve Iliffe, professor of primary care for older people at University College London, said that changes to the state’s relationship with the health service go to the core of professional self identity. He said that the role of medicine was changing from “a craft concerned with the uniqueness of each encounter with an ill person, to a mass manufacturing industry preoccupied with the throughput of the sick.”

Iona Heath, a former president of the Royal College of General Practitioners, described the commercialisation of general practice as one of the “dark forces at work behind the subversion of professionalism.” In a lecture titled Love’s Labours Lost, she described the changes that had undermined professionalism during her own career. She reflected in particular on the disappearance of “any idea of a ‘gift economy,’ where professionals could be knights but recipients could be queens—once altruism wasn’t recognised, it began to disappear.”

The second major cause of distress is unprecedented change. Over the past 20 years, the NHS has existed in a permanent state of flux. Nurses, doctors, and managers want stability, security, and safety rather than a state of constant transition. For decades, governments across the world have used reorganisation and policies of “destructive innovation” to juggle the clinical and financial priorities of health services. Each attempt to fashion a new order produces a new state of disorder. In 2008 Don Berwick, then president of the Institute for Healthcare Improvement in Cambridge, Massachusetts, commented on this in his review of the NHS. “Each change made sense, but the parade doesn’t make sense,” he said. “It drains energy and confidence from the workforce and middle managers.”

The physician and philosopher Raymond Tallis says that successive “disorganisations” of the NHS have the effect of reducing the influence of the medical profession and doctors’ ability to shape the services they work in. Iliffe goes further; he believes that the process of industrialisation of healthcare means that professionals are changing the “colour of their collar from white to blue.”

Organisations and individuals can and must change, and they must have the social resilience to adapt to external stresses and the disturbance resulting from change. But if that disturbance is big enough, a threshold will be reached where the system undergoes a fundamental shift. In 2012 the NHS was exposed to a reorganisation so large that, in the words of its then chief executive, David Nicholson, it “could be seen from outer space.” The subsequent changes in routines, customs, practices, and ways of working have destabilised the complex ecosystem of the NHS. The result is that the older generation of doctors, nurses, and managers are less able to support their younger colleagues, leaving vulnerable members exposed to developing mental health problems and other symptoms of distress.

Studies of group therapy can help us understand the destructive forces behind this distress. Like the NHS, group therapy can trace its origins to the aftermath of the second world war, when two therapists, Wilfred Bion and Siegfried Foulkes, developed the idea of treating injured soldiers in groups and sharing their experiences together.

With over 1.5 million employees, the NHS functions not as a single group but as a collection of groups within groups. It is effectively a web of interdependent systems, connected by a matrix formed through historical and cultural links and by the social solidarity and shared experiences built up over several generations.

Groups can have a positive therapeutic effect, but in times of distress they can be destructive and can threaten an organisation’s functioning. Gerhard Wilke, who trained as an anthropologist before becoming a group analyst, argues that our working groups can, depending on their circumstances, either make us safe by becoming a carer substitute or threaten our integrity by making demands that we believe exceed our inner resource. Wilke says that clinicians now feel like “naughty children, and managers as enforcers of utopian visions generated by out of touch politicians.”

Some destructive forces, if not harnessed, can destroy a group’s creative and healing potential and can undermine its foundations and functioning. Another group analyst, Morris Nitsun, coined the term “anti-group” to describe these forces. The concept of the anti-group is used in psychotherapy, and the sources of destructive forces are similarly relevant to the NHS. One force that reinforces the development of the anti-group in the NHS is the failure to create an empathic environment for staff; and the paradox of values—in which staff care for patients but employers do not care for staff—gives rise to profound bitterness. John Ballatt and Penelope Campling, authors of Intelligent Kindness, highlighted some of the difficulties that staff face in the NHS. “It is easy to forget the appalling nature of some of the jobs carried out by NHS staff day in, day out—the damage, the pain, the mess they encounter, the sheer stench of diseased human flesh and its waste products,” they said.

Clinicians have always worked alongside death, distress, and disability. They are used to hard work and long, unsocial hours, and this has not changed in recent years. What has changed is the working environment and the compact agreement between staff and employer. Doctors, especially, have seen the biggest change in their working life. Changes to training mean that the tacit agreement whereby the NHS provides sustenance, refuge, and support, and the doctor in training works as hard as possible for patients, has been fractured. Trainees are now expected to move location—sometimes every three months—with no certainty that accommodation will be found. They have little control over their working hours, space, days off, and job security, and no guarantee of support from superiors when things go wrong.

Another force that helps to create anti-groups in the NHS is, Nitsun says, exposure—which can feel shameful and humiliating. Policies are now being deliberately designed to name and shame. For example, NHS Choices and the Friends and Family Test encourage patients to post anonymous comments about a practice, clinician, or hospital online. The Friends and Family Test was described by Rachel Reeves, principal research fellow in the school of health and social care at Greenwich University, as a “foe to the NHS.” She said that the test used a methodology that was not fit for purpose and led to casual brutality being displayed towards those selected as examples of what is wrong with the NHS. Another policy designed to name and shame NHS staff is the new Care Quality Commission inspection regime. This has already created fear in those who are inspected, as well as in those doing the inspecting. One CQC inspector described taking part in the process as being more like being part of a “lynch mob, not a serious regulator.”

These policies of naming, blaming, and shaming mean that doctors can face humiliation for any alleged transgression, even if what is seen as a transgression is merely being an understandable outlier in performance, or refusing to participate in a process.

The policy is having its predicted effect. Three surgeons who were at the bottom of the league table—though this was in retrospect shown to be a result of coding errors—were named on the front page of a major newspaper, and grainy photos above their names added a hint of criminality to their situation.

The NHS is exposed daily to negative stories in the media. Its staff are accused of being lazy, cruel, and uncaring, and the service is blamed for failing to meet necessary standards. Doctors, nurses, and managers are seen as villains and are berated by journalists, who overlook the fact that the NHS still tops the list of what makes the public feel proud about being British. This barrage of negative stories corrodes trust, saps morale, and creates defensiveness. It also ignores the good work done by most NHS staff and the fact that the NHS delivers, in monetary terms, vastly superior services to many comparable health services.

In his plan to save the NHS David Owen, the former health secretary, said that the NHS was a vocational service and that, in order to continue, it must retain a generosity of purpose, philosophical commitments, and a one to one relationship with patients, who must be central to its purpose.

To do this, politicians have a moral responsibility to support those charged with caring for the most vulnerable people in our society; and they must be tasked with urgently improving the health of the NHS and those forces within it that are contributing to its destruction. If they do not, then we will all be the losers, and NHS staff may leave for pastures new.

Competing interests: I have read and understood the BMJ policy of declaration of interests and declare: I am medical director of the Practitioner Health Programme, a confidential London based health service for doctors and dentists.

References

  1. Judt T. Ill fares the land: a treatise on our present discontents. Penguin, 2011:1.
  2. Briefing note: Issues highlighted by the 2013 NHS staff survey in England.www.nhsstaffsurveys.com/Caches/Files/NHS%20staff%20survey_nationalbriefing_2013_FINAL-1.pdf.
  3. Fullfact.org. Demoralised and bullied? What the figures show about NHS staff.https://fullfact.org/live/2014/may/demoralised_bullied_nhs_staff-32243.
  4. Iliffe S. From general practice to primary care: the industralization of family medicine. Oxford University Press, 2008.
  5. Heath I. Out of hours primary care—a shambles? BMJ  2007;334:341.
  6. Royal Society of Edinburgh; Heath I. Michael Shea memorial lecture organised in partnership with the International Futures Forum. Love’s labours lost: why society is straitjacketing its professionals and how we might release them. 10 September 2012.
  7. Berwick D. A transatlantic review of the NHS at 60. BMJ  2008;337:a838.
  8. Tallis R. Hippocratic oaths: medicine and its discontents. Atlantic, 2005.
  9. Peters M, Hasan O, Puddester D, Garelick T. Doctor’s health: taking the life cycle approach.BMJ  2013;347:f7086.
  10. 10.Martin E. Flexible bodies: science and the new culture of health in the US. In: Williams SJ, Gabe J, Calnan M, eds. Health, medicine and society: key theories, future agendas. Routledge, 2000:125-45.
  11. 11.Practitioner Health Programme. The first five years of the NHS Practitioner Health Programme 2008-2013. http://php.nhs.uk/wp-content/uploads/sites/26/2014/05/Five-Year-Report.pdf.
  12. 12.Wilke G, Freeman S. How to be a good enough GP: Surviving and thriving in the new primary care organisations. Radcliffe, 2001.
  13. 13.Nitsun M. The anti-group: destructive forces in the group and their creative potential. Routledge, 1996.
  14. 14.Ballatt J, Campling P. Intelligent kindness: reforming the culture of health care. Royal College of Psychiatrists, 2011.
  15. 15.Reeves R. The friends and family test is a foe to the NHS. Health Serv J  7 August 2013.www.hsj.co.uk/comment/the-friends-and-family-test-is-a-foe-to-the-nhs/5061906.article#.U42zytwoLG4.
  16. 16.Soteriou M. CQCs inspections reducing GPs to tears, LMC warns. GP Online  2 December 2013. www.gponline.com/News/article/1223403/cqc-inspections-reducing-gps-tears-lmc-warns/.
  17. 17.Calkin S. Exclusive: “exhausted” inspectors raise concerns about unsustainable CQC regime. Health Serv J  3 June 2014. www.hsj.co.uk/5071554.article?WT.tsrc=email&WT.mc_id=Newsletter2#.U429Z9woLG4.
  18. 18.Chorley M, Davies E. Hospital doctors who refuse to release details of their track record will be named and shamed. Mail Online  13 June 2013. www.dailymail.co.uk/news/article-2340703/Doctors-perform-badly-hide-track-record-public-farcical-league-table-loophole.html.
  19. 19.Borland S. The surgeons whose patients were up to 30 times likelier to die. NHS to publish death rates of doctors for the first time. Mail Online  28 June 2013.www.dailymail.co.uk/news/article-2350376/The-surgeons-patients-30-times-likelier-die-NHS-publish-death-rates-doctors-time.html.
  20. 20.Ipsos-MORI. State of the nation 2013. 14 January 2013. www.ipsos-mori.com/researchpublications/researcharchive/3111/State-of-the-Nation-2013.aspx.
  21. 21.Commonwealth Fund. 2013 Commonwealth Fund international health policy survey. 13 November 2013. www.commonwealthfund.org/publications/surveys/2013/2013-commonwealth-fund-international-health-policy-survey.
  22. 22.Owen D. My plan to save the NHS—in the nick of time. 28 January 2013.www.theguardian.com/commentisfree/2013/jan/28/my-plan-to-save-nhs-ravages-market.

Clare Gerada medical director Practitioner Health Programme, Riverside Medical Centre, London, UK

Click the following link for the original document: 

http://careers.bmj.com/careers/advice/view-article.html?id=20018022

NHS: The National Death Service – A British Dignitas

July 13, 2018

https://www.share-talk.com/share-news/nhs-the-national-death-service-a-british-dignitas/?utm_source=linkedin&utm_medium=social&utm_campaign=SocialWarfare

 

NHS: The National Death Service – A British Dignitas

 

First Class Cost / Second Rate Service

The NHS offers us and continues to offer us second-rate service at a first class cost – something which is echoed in other bloated semi Government organisations such as the BBC, and most utilities, infrastructure and transport. HR, regulations and over management has weighed them all down.

In fact, anyone waiting in a corridor with their sick or injured loved one in a queue of trolley beds might think they have been placed in a time warp in the Blitz rather than well into the 21st century. So perhaps a third rate service?

This institution is a cross between a white elephant and a sacred cow, manned by unnecessary fat cats whose salaries could be used to pay for more Doctors and Nurses. But then what would be the point of that? There are no performance criteria for the NHS, it is just a factory line.

 

by Zak Mir

 

Did Dr Jane Barton Murder Her Patients ?

June 21, 2018

 

Is   Dr Jane Barton a perverted medical doctor  who mis-used her position to become a murderess just like the notorious Dr Shipman ?

It looks like it. She seems responsible for the deaths of many, many, NHS patients under her care.

She willfully prescribed lethal does of heroin to patients  who had no need whatsoever for such a dangerous, destructive, murderous drug.

When is this nasty, evil person going to be prosecuted for the murder of hundreds of her patients ?

The NHS is full of disgusting, incompetent, venal medical staff. The NHS is a sick joke.

The Truth About Religion 

June 14, 2018

 

I, like virtually everybody, just did as I was told when growing up and that meant going to church & listening to the rubbish spouted by priests and all those other religious idiots. 

As a child you believe in your parents and other adults, you believe they tell the truth about things and don’t lie like mentally damaged, demented, paranoid schizophrenics about delusions about dead people becoming alive in some imaginary World they call ‘Heaven’. 

And weird invisible people called ‘God’ & ‘Angels’  & ‘Saints’ etc roaming around in outer space somewhere with occasional visits to Earth which they are supposed to be secretly running every part of,  and in total control of absolutely everything that is going on on the planet – controlling every living creature from microbes to Man and every plant and even the weather.

So, children are simply ‘brainwashed’ into  believing in and going along with religion; children just accept it because simple evolution requires & makes children have belief in their parents. So if parents and other adults spew manic, lunatic gibberish about delusions of coming alive after death and all the other religious nonsense, children simply believe it to be true.

I, too used to believe in Religion because I was brainwashed as a Catholic for my first six years of life and then after that brainwashed by the  Catholic’s rival gang of deluded and mentally challenged Anglican ‘Protestants’.

All religion now just makes me angry & disgusted because of the incredible harm it causes – including some of the very worst violence and bloodshed, torture and murder the human race has ever indulged in. Religion is pathetic, deluded and nasty.

The worst religion seems to be that branch of the disgusting ‘Christian’ religion created by a fantasist called Mohammed or Mahomet a few hundred years after the idiot ‘Jesus’ or ‘Christ’ started ‘Christianity’.

This evil fantasy religion with it’s various rival ‘factions’ of ‘Catholics’, ’Protestants’ and ‘Muslims’ is currently responsible for wholesale murder and bloodshed and destruction of the lives of millions of people, and even whole cities in the Middle East.

Religion is disgusting and religious people are pathetic, deluded, inadequate, mentally backward fools causing immense suffering and harm.

THERESA MAY’S APPALLING, FASCIST BEHAVIOUR OVER WINDRUSH WEST INDIAN IMMIGRANTS

April 28, 2018

 

I have had a rough, very rough day with some very, very mindlessly stupid & ignorant local government issue/people –  i.e my local council behaving like a total idiot & demonstrating all that it pure evil and destructive about bureaucracy.

It’s very similar to the revolting Windrush issue currently making the news where Theresa May was  previously in charge of the Home Office and directed it to behave in an execrable way towards various immigrants & in particular West Indian ones from the 1950’s. What happened there demonstrates how nasty & dishonest government really is; it just takes your breath away really !

All Theresa May was interested in when she was the Minister in charge of the Home Office was her personal gain of political ‘Brownie Points’ & more voters for her political party. So her focus was entirely on  throwing any immigrant out of the country she could lay her hands on & she organised mobile advertising hoardings on trucks with  threatening messages towards ‘illegal’ immigrants, by which she meant anyone in this country without paperwork proving who they were. This might include virtually anyone and possibly  vast numbers of people who had lived here for decades or even been born here & lived their entire lives in this country.

The advertising was so implicitly racist too it positively takes your breath away with it virtually saying ‘go home you illegal immigrant black bastards; otherwise we’ll find you, instantly arrest you  and throw you out of the country immediately’. My wording here is almost exactly the same as the actual ads which did not actually have the word ‘bastards’ but it’s absence only made it more potently spring out of the ghastly, primitive and ugly fascist wording of the ads and the behaviour being demonstrated at Theresa May’s command.

What she did was immoral, entirely unlawful, nasty, brutish  and downright wicked, just like any good Fascist.  But like all typical bureaucrats she didn’t care at all. I’m just doing my job she said and lied to Parliament about it recently. But the Press found out she lied & now she is in big trouble about it and is busy making the current Home Secretary, Amber Rudd, who is now  in charge of the Home Office, take the blame for her own miserable, awful, appalling, dishonest behaviour.

But what idiot Theresa May did not do when she was in charge of the Home Office and it was neccessary to reduce the increasingly silly  tidal wave of immigration into the UK as it was rapidly getting out of control and would ultimate end up with about a billion immigrants from the most poverty struck areas  of the World all wanting to live in the UK & swamp it with their potentially limitless numbers, was for her to do anything intelligent at all in simply doing all the obvious things to control it. The UK has a ruddy great water filled moat around it which makes controlling immigration relatively easy if you apply a bit of common sense to the problem.

But, of course, common sense is something bureaucrats lack. Personal integrity is another thing it is essential bureaucrats do not possess as that would make it difficult for them to do their ‘job’ in the mindlessly stupid & ignorant way they frequently do.

Theresa May is an incompetent fool, a proven  liar, and a disgrace to Parliament and the Conservative Party.

Apparently, we used to have  population of about 60 million and gradually falling a few short years ago in the UK and it has now shot up to about 68 million as a direct result of recent uncontrolled  immigration.

With eight million more people to house it isn’t surprising the cost of housing has shot up too so that now  a home costs about four times ( in real terms) what it cost about twenty years ago. Homes used to cost about three times a person’s  annual income. Now it’s rapidly approaching twelve times in some areas. There simply isn’t enough housing to go around.