Hospital staff, tell us the reality

[Ihateme]

I’m am so fed up of seeing people comment on here that schools should be going back, that people should not be reporting mass gatherings in tier 4, how dare people begrudge a child their birthday party etc...

The hospitals are in a worse state now than they were during the first peak. Would any doctors or nurses care to confirm this? Maybe then these Mumsnetters will get the message.

To be honest I’ve had more bad experiences than good of being an NHS patient, including a poorly handled delivery ending in cardiac arrest (baby) and massive haemorrhage (me). I’ve also been in the situation of pleading for interventions for an unwell relative, which did not happen leading to death and subsequent coroner’s inquest.

I am also a doctor (critical care / anaesthetics).

So believe me, I have no doubt that healthcare professionals sometimes ignore people or treat them without respect or consideration.

Like any other organisation the NHS has some good, some bad. It shouldn’t be revered as a sacred cow that has no room to improve or that people should be slavishly grateful for.

Equally, it is not acceptable (as sometimes happens) for HCP to be verbally abused, physically assaulted or indeed used as an emotional punchbag for every grievance someone has in life or every bad experience they have had with healthcare. Happily I think most recognise this, though unfortunately not all.

I personally do feel “lucky” or “fortunate” to have the NHS but that is only because I sometimes work in resource poor settings and have seen a very large number of people including children die from entirely preventable conditions and I am glad not to be in a situation where basic healthcare is either not available full stop, or I have to think at the point of use whether it is affordable.

I am all for professionalism, but at the moment very many HCP are working far above and beyond what would normally be expected from them.

For example, if critical care was provided on an individual patient basis with a direct contract between patient / relatives and the clinicians, HCP could refuse to go beyond that contract.

The implications of that would be quite stark; in my trust we are currently at 1:2 ratios for ventilated patients which goes in direct contradiction to all the guidance for the last 10-15 years on safety and quality care. NHS London have recently authorised 1:3. The strain that puts on nursing staff is immense. I can think of very few colleagues who would refuse to look after patients because the ratios were not what they signed up for but I think we do have to recognise that if we are expecting HCP to put in significant extra for compassionate reasons, then we should be appreciative of the fact they are going above and beyond what a straightforward contract would require them to do.

I think I don’t use hcps as emotional punch bags and will always send a thank you when kindness or good care is given. Neither do I think it helpful when there is blanket gratitude where it is not deserved.

Weighing up the stretched services against the too frequent nonchalance and sloppiness I have seen I regret to say I sincerely think the boy has cried wolf once too often. However I do think the front line is probably stretched beyond belief at present but I question whether the back line and whether some of the management staff are fully pulling their weight. Our opposite neighbour is an elective orthopaedic surgeon. He was at home from Mid March until August. Cases here were 8 per 100k in August. Surely he could have been doing something helpful whilst on full pay?

I think those are entirely reasonable points, but I think the difficulty with these kind of threads is that the majority of people reading them are the people who genuinely are working extremely hard in what is at the moment gruelling conditions.

No one likes to have their lived experience negated, and so people become very upset and defensive and take personally any criticism of the organisation they work for because they are exhausted and stressed and doing the best they can in very difficult circumstances.

(I also agree that there are huge amounts of unnecessary red tape and admin associated with the NHS, and there would be very few clinicians who would disagree. I am still recovering from a particularly awful period as a senior registrar when I rotated trust every 3 months and was therefore required to do the mandatory Prevent / information governance / E&D training etc etc 5 times in a year because each used a different platform and none would accept each other’s certification... 🙄)

(In my own, unpaid time, I should add)

I'm so sorry you've had those experiences @RosesAndHellebores. Having to fight for your DC in hospital must have been so hard. I've seen some shocking things but as I say much more balanced with good. I did have a very bad experience in maternity care that put my life at risk (PPH), that did give me some trauma issues, and it does seem that often people's bad experiences of hospital involve maternity care. But my experience (in my case, respiratory care) has been that overwhelmingly staff do care but are very overstretched and so often can break. And I worry so much now for what they are going through :(

@missyB1

Lots of us who were working in the NHS at the time austerity was brought in tried to get the message out to the public about the damage it was doing to the NHS. Unfortunately a lot of people seemed to agree with reducing funding to the NHS, and staff were told to stop moaning as they’d had it good for years with “gold plated pensions” blah blah oh and apparently those of us in the NHS were wasting money and resources day in and day out, and if we weren’t so bloody wasteful the NHS could easily manage on less money. I can’t help thinking those same people now are the ones so fucking indignant, and so fucking shocked, that our hospitals can’t treat a pandemic and provide all the rest of the healthcare that the public needs and wants. Well who would have thought that under resourcing your healthcare system might just come back to bite you on your arse eh???

This has been going on a lot longer than that. I am extremely old in MN terms, now approaching retirement, and remember demonstrating in the Thatcher era about cuts to the NHS and telling my husband how this idea of introducing management to make us more efficient was a highway to hell

@Kidsaregrim Wasting of any vaccine doses should be taken up with your trust, that is shameful if true. Our hospital has vaccinated staff with any remaining doses as have we, in primary care, so none has been wasted at all

Me too @parallax80 but whilst I believe many in the NHS work very hard there is a bubble where complaining to stakeholders has become the norm and there is zero cognizance that others work exceptionally hard too, without the protections of a unionised environment.

Hundreds of thousands of people have lost jobs or will lose jobs. Hundreds of thousands of people are on 80% due to furlough - often the lowest paid whose bills make up the highest proportion of income. Thousands and thousands like me have had to take pay cuts of 15 to 20% and believe me I have had to work 60/70 hour weeks to save jobs but have had to make 15% redundant. If I dared complain to a client my career would be finished.

So yes the lack of sympathy hurts but so do does the lack of cognizance about relative security. Some facts about the deployment of all on the NHS payroll - on full pay and why for example every member of admin staff in some trusts are wfh even though phones can’t be diverted and websites haven’t been updated. I have too much grace to name the MH Trust.

However, if NHS staff generally had more understanding and overall made fewer excuses I think there would be far more support for a higher tax.

I have huge support for those on the front line who are working their fingers to the bone.

When all this is over I really hope there will be an apolitical root and branch review and restructuring which is wholly objective.

On a separate note to whoever mentioned GP services, was it @RosesAndHellebores? Apologies if not
I work in general practice and we have remained open throughout despite the difficulties of working remotely and a hugely increased workload of stuff passed down from the hospital (often inappropriately although that's another story)
My mother, aged 90, lives in another part of the country but recently developed a symptom which concerned me and I asked her to ring her GP. She did, was rung back and triaged by phone, a practitioner visit arranged and completed, her GP informed, a prescription issued, dispensed and delivered. All in just over 24 hours. A service which I doubt could be bettered anywhere

Yes that may have been me @QueenOfTheDoubleWide. I have said many times my GP’s service has improved tenfold since it went on-line. I have even written to them to thank them and say how fab it is.

I entirely agree with you about job security, and in fact was verbally abused myself by some colleagues earlier in the year for saying that I thought in general we shouldn’t be accepting discounts / freebies from businesses who might well be going to the wall, while we have relative financial security.

Having said that, many HCP are not well paid for the level of skill that they often have (I think Band 6 critical care nurses are particularly hard done by for the level of skill and amount of responsibility they are asked to take for managing one level 3 patient who is ventilated / on renal replacement etc etc let alone 2 or 3. There may be others of course but I can only speak from my own specialty).

As I said above the nature of the current model of the NHS means it is not a straightforward provider/client relationship. You might not dare complain to a client, but also you would probably not allow them to have 2 or 3 times the amount of work from you over what is contracted, regularly and without recompense, as that would not be a very sustainable way to run a business.

I think a truly independent review of the NHS would be fantastic, and would force some serious discussions about what people want from it, and how it would be worked out in practice.

Oh believe me @parallax80 we have exceedingly needy clients/stakeholders retained for their profile and who are heavy duty in the context of time. And should they be upset or we “fuck up” no fee will be paid. I think that’s the bit of reality the NHS just doesn’t grasp sadly.

@WiddlinDiddlin sorry to hear about your situation, very tough stuff for you.

RosesAndHellebores I fail to see how those experiences relate to the current struggle the NHS is having with the pandemic.

I was in hospital for 3 weeks last year with a life-threatening issue. I was on a surgical ward. The nurses were run off their feet, worked very hard and were extremely professional as well as kind. As I was there so long I saw how they handled all kinds of difficult patients and families.

My brother has been a critical care nurse all his life and has been utterly devoted to the NHS. He’s flagging now under this pressure and will take early retirement. I’m sure many others will.

We talk about protecting mental health of those in lockdown. My brother thinks a lot of NHS staff will have PTSD after what they’ve experienced this year.

It's interesting to read this. I think one thing the nhs and teaching have in common is that the main resource is us and where other resources that enable us to be able to do our jobs properly are slashed we're still standing there at the front line having to make it work despite more and more being piled onto us.

There's no point at which the school or hospital folds and closes up shop like a business would if it was no longer viable and clearly didn't have the resources to continue.

Then there's the reality that our school or hospital is interdependent on other public services institutions like social services for child protection or social care to be able to release patients safely and they are collapsing under the strain and cutting their services too which creates more pressure on our institutions because we can't hand over to the right services so have to manage some of their responsibility too.

Maybe frontline public servants like doctors and teachers underestimate their security (I don't personally I qualified as a teacher precisely because it was something I had an affinity for and was a secure tangible qualification that would always be needed wherever I lived in the world and one I could take time out of and pick up again). However people outside of our crumbling institutions underestimate what it takes to hold up a service and take care of people and there to be no check and balance like their would be in a business eg this model really isn't working, we're not making enough profit, we can't afford to invest in the equipment we need or can't recruit enough workers etc.

Our business is not allowed to fail and so we have to keep making it work. And it relies on people having no boundaries where they fuck off I can't fix three cars at once or hit that insane sales target during a pandemic because we work with real people who will be damaged if we don't keep taking on more and more work and responsibility.

I think that latter part is where burn out comes in. Yes we have security but we pay a high price for it.

Oh believe me @parallax80 we have exceedingly needy clients/stakeholders retained for their profile and who are heavy duty in the context of time. And should they be upset or we “fuck up” no fee will be paid. I think that’s the bit of reality the NHS just doesn’t grasp sadly.

I thought about this a lot; whether the analogy works,

Before I think further, 2 questions for those more experienced in business:

• if a high maintenance or needy client has no / minimal benefit to the company in terms of their profile would you still service them to the same extent as a high value one?

• if your business is in high demand, would there be situations that you might turn down work, to either prevent dilution of the quality of work or preserve your business integrity?

Until those bits are resolved in the public discourse, I don’t think there can be a straightforward business relationship between public and NHS, as it has too little control over client base and too few available options for flexibility in provision.

(On the first part I can understand that you might do a some stuff above and beyond for low level but elderly client Gladys, because it improves the overall corporate image to be thought of as “company that looks after granny well”, which then generates more work, and the financial value of the extra work is orders of magnitude higher than the little extra time or money spent on Gladys.

She’s effectively a loss leader.

But you have to be able to cost out whether those decisions are overall viable or not, surely? You don’t just give every client double the work / resources.

More direct analogy is would you put up with a low profile client who doesn't pay when you've got clients coming out of your ears.

Well tax obviously is a form of payment, not just income tax but VAT etc.

So one strategy would be to cap healthcare use at the calculated level of contributions for each individual.

People don’t typically seem that keen on it though.

Ha. My life would be a breeze in a model based on tax contributions. Can't see it taking off as the kids the government are most keen for us to keep in our 9-3 locked compound wouldn't qualify much of the time.

Finally got to the end of the thread. I'm very newly qualified RNA. 3 weeks qualified to be exact.
I did my training during the first wave on the ward I now work on.
I've had 15 yrs in the nhs. I'm feeling guilty I've had a weekend off. My partner is one of those deniers . I can not come home and vent. I sit alone and cry.
I've had relatives shout at me. One even asked to speak to the nurse in charge to make sure I was qualified enough to care for the relative that if they hadn't neglected wouldn't of been in hospital in the first place.
Friday. We ran out of oxygen points in the bay. Had to use cylinder. I had a 20 mins break on a 12 hr shift. The ward WhatsApp group yesterday, where do we get ppe from as they had run out.
I love my job. But I'm broke.
Love to all 💙

Oh god. Bless you drinking. Love your username btw! That could be the encapsulating catchphrase for my life back in the stuck at home with a small child at chapter of my life

So need that edit function.

@drinkingwineoutofamug

Finally got to the end of the thread. I'm very newly qualified RNA. 3 weeks qualified to be exact. I did my training during the first wave on the ward I now work on. I've had 15 yrs in the nhs. I'm feeling guilty I've had a weekend off. My partner is one of those deniers . I can not come home and vent. I sit alone and cry. I've had relatives shout at me. One even asked to speak to the nurse in charge to make sure I was qualified enough to care for the relative that if they hadn't neglected wouldn't of been in hospital in the first place. Friday. We ran out of oxygen points in the bay. Had to use cylinder. I had a 20 mins break on a 12 hr shift. The ward WhatsApp group yesterday, where do we get ppe from as they had run out. I love my job. But I'm broke. Love to all 💙

Hang in there @drinkingwineoutofamug.

We WILL get through this.
Am hiding this thread now. Absolutely disgusted, that once again, a thread on this supposedly supportive forum, where front line nurses have poured their hearts out about the desperate situations we are currently working and living through, has been hijacked again by those with an anti nurse, anti NHS political agenda. Plenty of other threads available, plenty of opportunities to start your own threads and discussions.
But hey. Jump on a thread and silence the voices of those of us who are on our knees. What heroes you are.