To ask what YOU would do to help save the NHS?

[TamiTayorismyparentingguru]

I don’t care if you’re an HCP or not, I don’t care who you vote for, I don’t care what you think about Brexit - all opinions welcome.

Opinions on practical suggestions on how to save the NHS only though.

Our local hospital is getting worse and worse with regards to staff shortages and waiting lists getting longer and longer. I will say that our GP is really great and we’ve never really had a problem with getting appointments etc, but as soon as you are referred to the hospital things go massively downhill. (We did have a GP misdiagnose/miss DH’s cancer which was pretty shit - but I wouldn’t say that was a particular problem with the system - more just one of those unfortunate things that happens, that really shouldn’t happen, but that are just a matter of course.)

The hospital is a different story though - wait lists for some departments are insane (current wait time for an initial cataracts appointment is 42 weeks and then up to 18m for treatment, paediatric dermatology is a min of 30weeks, paediatric podiatry is approx 30weeks also. I have been on a wait list for max fax for 14mths so far. I also had an 8week wait for an appointment at the breast clinic after seeing the GP with a noticeable lump.)

DH has also had to fight for every single appointment since his cancer treatment last year - instead of the 4-weekly appointments he’s meant to have had, most of his appointments have been 7-8 weeks apart and have been cancelled at the last minute (sometimes just an hour before) at least 4 times in the last year.

It’s awful and yet I do trust that the doctors, nurses, receptionists etc etc are all doing everything they possibly can.

What’s the solution?

No nights or emergencies and no weekend cover for medical specialists in Oncology. I would have thought this was one area it was needed.

Because an Oncologist and not a junior A&E doctor should be dealing with an emergency in this field. Someone who understands the side effects of chemo and radiotherapy treatments. Do you think it is ok that someone should wait hours in A&E to be admitted or to be seen.

Show me the accountant or lawyer this could happen to.

www.bbc.co.uk/news/resources/idt-sh/the_struck_off_doctor

I would say there are many more accountants sent to jail for tax fraud than there are doctors sent to jail for manslaughter. Here are some accountants who committed fraud who have gone to jail. Scott London was an audit partner who went to jail for insider trading. The only reason the audit partner from Enron didn't go to jail was because they gave evidence which secured the conviction of the management team responsible for the fraud. People on the audit team should have known and should have reported their findings. Apparently an audit manager was suspicious and reported his suspicions.

Steve Denison hasn't been jailed yet but he has basically been banned and forced from his partnership at PWC in the wake of the collapse of BHS. News reports said he worked for 2 hours on the audit binder when he signed off. Having worked in audit I don't know a single audit partner who signs off after 2 hours of work. It never happens that way ever. I wish it did. It just doesn't. The profession have banned him for 15 years. The morrisons accountant who stole personal data was jailed for 8 years.

I could go on. Of course the case you post the doctor has been supported by colleagues. Personally I don't know how. She should have asked for help much earlier on. Reflective practice of what went wrong is not how I ran my audit teams. I checked in on my teams multiple times a day. I checked their work and would open up the files they were working on to make sure work assigned was understood. Why wouldn't a consultant open up the notes? I also don't understand why the consultant wasn't jailed alongside her.

There is something massively wrong with a culture where the consultant in charge double books himself and thinks it acceptable to fail to put in place any cover. If there was no cover the training should have been cancelled. At worst he should have been called back as soon as it became evident.

The woman was a scapegoat but nevertheless was part of a sick culture of poor conduct where there is abject and ingrained failure to speak up about poor practice and poor overall standards.

Oh and bluelady no it wouldn't happen to an accountant or lawyer. Action would be taken long before matters reached those proportions in a decent firm.

I run a public sector department. If my department were running on empty I'd write a summary rusk assessment and make my ceo clearly aware of what could and couldn't be covered. This doesn't seem to hapoen in the NHS.

MorbidlyObese you should read the court transcripts for that case, not the media’s summary.

It shines a whole different light in how that poor doctor ended up in that situation. And yes her consultant should have been in the dock too.

I don’t believe it’s appropriate to compare accountants acting fraudulently and criminally with a a doctor doing their job in a broken and failing system.

Been thinking about this a bit more and the service I work for seems to be time efficient and weed out the time wasters so this is how our service runs:

1. no-one can get a gps appointment without going through nurse triage, we are gate keepers not receptionists so anyone requesting an appointment is automatically directed to us.

Between 09:30 and 10:30 we look at patients notes, and anything that can be resolved without the patient being seen will be.

Between 10:30 and 12:30 we carry out nurse triage. Those that have come with very minor problems are given self care advice and informed they will not see the doctor. Those needing examination will have a head to toe assessment carried out by a triage nurse.

After examining the patients with more complex needs we either
A) request a prescription from the doctor
B) refer to the appropriate service
C) request a Gp appointment and tell the doctor how quickly they need to be seen.

All appointments are not fixed times, we give a time window and people come and expect to wait. The time is convenient to the service and not the patient.

If you'd read the transcripts, you wouldn't be saying that. What was she supposed to do? Walk out and refuse to work in an unsafe situation? She was thrown under the bus, before and after that child died. Her record was spotless and her ability was very highly regarded. Medicine is the only profession in which this situation could possibly arise.

I run a public sector department. If my department were running on empty I'd write a summary rusk assessment and make my ceo clearly aware of what could and couldn't be covered. This doesn't seem to hapoen in the NHS

This absolutely does happen in the NHS in my experience. I've completed incident forms related to staff shortages every single day this week (agency bstaff cancelling at the last minite is a real problem here) and these go to the director of operations as well as a whole host of other managers. I have also, in a previous role, contacted the CEO out of hours to inform them I was being forced by the bed manger to admit a patient in unsafe circumstances (the admission was put on hold until the morning).

I don't work high enough to know what happens with this information but those of us on ground are absolutely highlighting when we are working under unsafe circumstances.

What that conveniently lacks is context.

It was her first day back from mat leave in a new job for which she had received no induction. Handover was interrupted by a cardiac arrest. She was covering the work and responsibility of three doctors. The IT system allowing her to access test results was down for five hours. The consultant "forgot" he was on call and didn't answer his phone. The radiologist failed to report the results of a chest X ray.

It was the perfect storm for catastrophe. The Trust has admitted systemic failure. The consultant has since resigned.

She wasn't blameless but there was no support for her whatsoever that night. She will work in the NHS again, her registration was restored in June and the massive shortage of doctors ensures she will get a job, if she hasn't already.

I worked out previously that if all she did the whole time she was at work was just do a ward round on current inpatients she’d have less than 8 minutes per patient. 8 minutes to review notes, investigations, organise scripts for people going home and talk to parents and write in notes. That’s pretty impossible as a starting point. No consultant- where was he?

Except it was worse than that because she also had a load of new admissions, including sick ones (Jack) and presumably the child she performed an LP on.

It’s an incredibly unsafe working environment, made more so by the broken lab system and the hapless consultant.

This case has been widely discussed in Australia as an example of how the NHS threw its staff under a bus and the main medical defence group here has made it clear that doctors working under such untenable conditions would not have been prosecuted.

Re the enalapril - the general impression here was that the inquest was sparing his parents by not implicating it.

Didn’t he arrest about 30 minutes after his mother gave it in spite of Dr BG correctly saying it should be withheld? Hugely dangerous giving a drug that lowers blood pressure and impairs kidney function to a septic patient recovering from hypovolaemic shock. Breathtakingly stupid rule that the hospital had about parents being able to self-administer drugs.

Unfortunately Dr BG didn't add an express instruction not to administer the enalapril on his drugs chart. The mother was apparently very insistent with nursing staff that he had it. The Trust no longer allows self administration of drugs.

We've all heard that saying "The law is an ass". She didn't stand a chance. It should have been the Trust on trial, not her. She may technically be a convicted criminal but no prospective employer will perceive her as such.

Fruitcider I thought you were a MH nurse in a prison. What happens there cannot posdibly be applied in the NHS generally. Indeed I have had expefience of MH nurses through CAMHS. They were not capable of reaching cceptable clinical decisions. My dd recovered because we paid for her to see a consultant psychiatrist who recognised there was and underlying neuro developmental disability.

I agree with Dr BG being a scapegoat. It's like convicting an audit manager of gross negligence. No it's the audit partner who is responsible. They are the person who runs the ship. The consultant and management should have been in the dock not Dr BG. It was their failures that led to mistakes being made and a person dying. Dr BG wasn't blameless but she was put in an impossible position because of lack of supervision and inept management.