NHS management

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A little rant.

At various hospitals (which will remain unnamed), the trust will only pay for one anaesthetic nurse to be on night cover. Because of transfusion safety regulations, during the night shift, anaesthetic nurses are the only people allowed to handle and manage blood transfusions in the theatres (this is a good thing - specialization means a very low possibility of transfusion accident).

Now, a true story (but I won't say when/where this happened). Three patients were in theatre during the night and started to bleed out at the same time. But there was only one nurse who had card access to the blood transfusion machine. Long story short, there was a huge amount of panic, a lot of screaming, the swipe card wouldn't work straight away, samples got mixed up despite all the safety precautions that had been put in place, and a patient was given four units of someone else's blood. By a massive stroke of good fortune, the blood groups were a precise match, as the mortality for transfusing four units of incorrect blood is pretty much 100%.

If the patient had died, the lawsuit and subsequent compensation payout would have run into the millions (£2-3 million at least). To pay for one additional anaesthetic nurse to cover night shifts (something that doctors in the trust had been calling for for nigh on years) would cost less than £30,000 a year.

This sort of **** happens all the time in the NHS. There is cost-cutting everywhere but when mistakes happen as a direct result, the payouts are enormous, running up a ~600million a year bill. Lots of these could be prevented by having more nurses to monitor patients, or more doctors on night cover. I can think of two examples off the top of my head where a staffing shortage has led to a death or disability which subsequently led to a compensation claim. Other examples include skimping out on investigation resources (like theatre bedside ultrasound machines).

Rant over. Something in management needs to give.
 
If the patient had died, the lawsuit and subsequent compensation payout would have run into the millions (£2-3 million at least).

I very much doubt it and working in Clinical Negligence I have a lot of experience with payouts of certain negligence claims.
The big payouts are for clinical negligence cases against children who are still living and they might not get a result until after they are 18. (this is because they might not know the extent of the damage until years have passed).
 
You want to see how bad it is when you live on one trust but get treated in another (especially if you live in Wales but need to be treated in England) its a complete joke, NHS management is an oxymoron.



By a massive stroke of good fortune, the blood groups were a precise match, as the mortality for transfusing four units of incorrect blood is pretty much 100%.

Doesn't that differ from group to group though? I was under the impression that you could put type O- in anybody, and on the flipside you could put any type in a person with AB+...
 
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Mum is a receptionest to a very sought after surgeon and is on "part time hours" yet she works 8-6 tuesday-friday, then goes in over the weekend and on days off. If she doesnt people could die, she has raised this but is just told...there is no money...*shrug*

So she tried to stick to her hours and lasted 2 weeks before she was told her work wasnt up to her usual high standards...."thats because for 8 years ive been doing far more than I should have" the reply? "thats good...can you keep it up for the same money?"

I have real respect for most people in the NHS as they care to much.
 
And yet a friend of mine who works in scheduling patient transportation works in a dept. of 5 doing what is basically a 2 person job (and his boss who doesn't even need to be a management position but is basically sits on facebook all day).
 
I very much doubt it and working in Clinical Negligence I have a lot of experience with payouts of certain negligence claims.
The big payouts are for clinical negligence cases against children who are still living and they might not get a result until after they are 18. (this is because they might not know the extent of the damage until years have passed).

That was the sum that came up in the audit meeting. I'm not an expert though :).
 
A little rant.

At various hospitals (which will remain unnamed), the trust will only pay for one anaesthetic nurse to be on night cover. Because of transfusion safety regulations, during the night shift, anaesthetic nurses are the only people allowed to handle and manage blood transfusions in the theatres (this is a good thing - specialization means a very low possibility of transfusion accident).

Now, a true story (but I won't say when/where this happened). Three patients were in theatre during the night and started to bleed out at the same time. But there was only one nurse who had card access to the blood transfusion machine. Long story short, there was a huge amount of panic, a lot of screaming, the swipe card wouldn't work straight away, samples got mixed up despite all the safety precautions that had been put in place, and a patient was given four units of someone else's blood. By a massive stroke of good fortune, the blood groups were a precise match, as the mortality for transfusing four units of incorrect blood is pretty much 100%.

If the patient had died, the lawsuit and subsequent compensation payout would have run into the millions (£2-3 million at least). To pay for one additional anaesthetic nurse to cover night shifts (something that doctors in the trust had been calling for for nigh on years) would cost less than £30,000 a year.

This sort of **** happens all the time in the NHS. There is cost-cutting everywhere but when mistakes happen as a direct result, the payouts are enormous, running up a ~600million a year bill. Lots of these could be prevented by having more nurses to monitor patients, or more doctors on night cover. I can think of two examples off the top of my head where a staffing shortage has led to a death or disability which subsequently led to a compensation claim. Other examples include skimping out on investigation resources (like theatre bedside ultrasound machines).

Rant over. Something in management needs to give.

Don't you have some advanced nurse practitioner team or something that would also have access? That seems the norm these days.
 
That was the sum that came up in the audit meeting. I'm not an expert though :).

All money is paid out by the NHSLA so as soon as a Letter Of Claim comes through they are notified immediately and the Trust Solicitors will then battle it out with the Claimants Solicitors with Medico-Legal (me) in the middle.
Obviously once negligence is proved (mostly admitted) then the NHSLA use their sliding scale of payout and I file it before closing the case so I have a knowledge of what certain cases are worth.
 
The NHS is a brilliant system at the same time though. Free healthcare is a wonderful thing and there's no doubt it benefits MANY people each year. I personally think it's the best system in the world.

Having said that, it's not perfect. And it doesn't look to be getting better. There's a worrying trend of increased focus on management rather than healthcare (eg: in A&E, emphasis is on targets and getting every patient sorted within 3 hours). I honestly cannot see the need for the huge amount of management roles in the NHS, surely more medical staff would improve the system?
 
......There is cost-cutting everywhere but when mistakes happen as a direct result........

You are blatantly lieing; efficiency savings in the NHS have had no effect on frontline services, the Government have told us this so it must be true;)


Our Pathology department is stretched to breaking point because of staff vacancy freezes. Flu & Noro season is coming on top of the increased demand for the normal out of hours cover for things like CSFs and Blood Cultures. This winter there will be deaths as a direct result of the pressure.
 
Doesn't that differ from group to group though? I was under the impression that you could put type O- in anybody, and on the flipside you could put any type in a person with AB+...

People will the Oh blood type will have a reaction to O- blood, and even AB+ can have a reaction if they are negative for the duffy antigen and are given blood from a Caucasian person. This is why blood needs to be tested before surgery.
 
I honestly think doctors and all major medical staff should get more of a say on how the systems should work. They know whats wrong and probably how to fix it.

Although I don't agree with the tories, they are trying to change it too much too quickly
 
^ + this was blood that had been cross-matched to suit the patient's group. It's stored in a secure fridge and you have to pass lots of patient identity checks through a safety machine to access it. O- is used in emergency situations when there's no time for cross-matching.
 
During the day there are transfusion nurses. At night there's very limited cover.

Where I last worked you had a team of essentially ex Band 7 HDU and ITU staff who covered the hospital on both shifts. They lead the crash bleep, clinical + non-clinical emergencies etc - so they would have been able to provide something in this type of situation. Quite shocked you don't have the same. Great system - they could guide the reg's, liaise with the ITU consultants and surgeons to get things done from a position of personal knowledge and experience etc + facilitated the nurses etc.
 
its only going to get worse now the tories are in power and are basically privatising the nhs, then they will cut costs to pay shareholders and executives
 
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