NHS management

Pawnless Endgame · 23 Nov 2011 at 18:08

I think there is going to be a big shake up on the NHS by the coalition gov't over the next 2 years. I believe that the PCTs will be a thing of the past and that some hospital treatment will be outsourced to GP practices.

Rameses · 23 Nov 2011 at 18:19

Dolph said:
This is what happens when patient care doesn't matter to the service's success and viability...

I typed out a big moan about NHS management but you summed it up with one sentence!

rotters · 23 Nov 2011 at 18:20

Xordium said:
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.

you talking about a team of OutReach nurses. excellent service, yes they lead on cardiac arrests and other non emergency issues, If we are short in ITU we just call them for an extra pair of hands if they are available.

rotters

Wynthorpe · 23 Nov 2011 at 18:25

hayley86 said:
Id love to answer this thread but I wont it could get messy.

I too would like to add, been working for a trust for 7 years and its terrible, seen many things happen due to poor management (and lack of training), i have five Managers on Band 8a plus.

xarr · 23 Nov 2011 at 18:27

Whilst I agree with the op's sentiments it would cost far more than £30,000 a year.

An additional nursing post covered for 12 hours needs around 3.5 full time equivalent staff to be employed to be on shift 7 days a week (allowing for holiday, sick and maternity provision), this combined with unsocial hours pay (30-60% depending on the day of the week), training, pension contributions etc. makes for a far larger sum. It could be up to £200,000 if you have people at the top of band 5.

These things are not black and white but my answer to it would be, was the near miss reported, if so what did the trust put in place to ensure this wouldn't happen again. If it wasn't reported I have no sympathy, if it was and the trust's response wasn't to examine if an additional nurse was an option why have you not raised this with the responsible manager (I presume the theatre manager and someone from the transfusion lab).

joxang · 23 Nov 2011 at 18:30

Xordium said:
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.

This happened in a specialist unit that was operating through the night, and isolated from the general wards (if you work in a hospital you can probably guess what specialty this was in). The ops were urgent, but fairly routine. The problem wasn't with the surgical teams, but more to do with the fact that the trust had initiated lots of necessary protocols to make blood transfusions safer e.g. by limiting machine access, but then skimped out and refused to pay for a safe number of 'authorised' staff to enact said protocols.

joxang · 23 Nov 2011 at 18:37

xarr said:
snip

Like I said before, I'm no expert on the figures, and the ones I've quoted were reported in a meeting. Could you expand on why an extra nursing shift would require 3.5 extra full time staff - again I've got no idea about these things

.

The incident was obviously fully reported...there was a lot of angst amongst the anaesthetists who had warned about the lack of redundancy. I'm not aware of what the trust did/might do about what happened.

rotters · 23 Nov 2011 at 18:46

Wynthorpe said:
I too would like to add, been working for a trust for 7 years and its terrible, seen many things happen due to poor management (and lack of training), i have five Managers on Band 8a plus.

if you hate your job, or the situation and have done for 7 years...im not really sure what to say to you with out being insulting.

Dolph · 23 Nov 2011 at 18:48

joxang said:
Like I said before, I'm no expert on the figures, and the ones I've quoted were reported in a meeting. Could you expand on why an extra nursing shift would require 3.5 extra full time staff - again I've got no idea about these things .

The incident was obviously fully reported...there was a lot of angst amongst the anaesthetists who had warned about the lack of redundancy. I'm not aware of what the trust did/might do about what happened.

To provide an additional head each night will require more than one member of staff. 3.5 FTE sounds a little bit high to me, but it does depend on things like amount of holiday allocation, average sickness levels, but is plausible.

piggeh · 23 Nov 2011 at 19:01

There were precautions, they failed. It doesnt matter how many staff you employ, if people dont follow precautions or they're not good enough, then bad stuff will happen.

My personal view is that a strong regulatory body (ie like the CQC but properly funded, not run on a shoestring like at present) would be able to put a stop to a lot of the bad practices in the NHS, whether they be understaffed areas or poor medical practice.

Xordium · 23 Nov 2011 at 19:20

rotters said:
you talking about a team of OutReach nurses. excellent service, yes they lead on cardiac arrests and other non emergency issues, If we are short in ITU we just call them for an extra pair of hands if they are available.

They did did more than that they had another team of Band 6's who filled that role they more just lead the whole thing.

joxang said:
This happened in a specialist unit that was operating through the night, and isolated from the general wards (if you work in a hospital you can probably guess what specialty this was in). The ops were urgent, but fairly routine. The problem wasn't with the surgical teams, but more to do with the fact that the trust had initiated lots of necessary protocols to make blood transfusions safer e.g. by limiting machine access, but then skimped out and refused to pay for a safe number of 'authorised' staff to enact said protocols.

Sounds like they do need a system like what I am used to as that protocol would have had to have had that teams input and they would have demanded such access etc. Yes it is a lot of power to invest in one group but I never saw them use it irresponsibly or inappropriately. Most importantly it worked, the old school consultants of course didn't in the main like their power being so diminished but the new wave saw the benefit straight away.

Edit: I should add the only time I saw this system shall we say stretched and swamped was during a very major incident that really would have nailed anything and even then it overperformed in an area where the hospital didn't have any normal facilities.

Expecting emails now from you two saying hmm where shall I go next :-)

valerian · 23 Nov 2011 at 19:22

joxang said:
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.

u forgot to add in the 50 min break they have to have under wtd, another nail!!!

xarr · 23 Nov 2011 at 21:02

Dolph said:
To provide an additional head each night will require more than one member of staff. 3.5 FTE sounds a little bit high to me, but it does depend on things like amount of holiday allocation, average sickness levels, but is plausible.

Yup, that's about it, 7 per 24hr post is the usually quoted figure (from textbooks, not experience), though usually less are employed with bank/agency staff used to fill for more flexibility. If you look the bare minimum is 2.24 FTE (based on a 12hr shift at 37.5hrs a week), so when you factor in everything else you need to have funds avaliable to pay around 3.5 FTE.

Xordium · 23 Nov 2011 at 21:53

xarr said:
Yup, that's about it, 7 per 24hr post is the usually quoted figure (from textbooks, not experience), though usually less are employed with bank/agency staff used to fill for more flexibility. If you look the bare minimum is 2.24 FTE (based on a 12hr shift at 37.5hrs a week), so when you factor in everything else you need to have funds avaliable to pay around 3.5 FTE.

Yep that's the around the right area which is why you have to look at whether you needs such a specific role or whether it can be extended into a new role and a number of birds killed with one stone. In this case I would think that is the best option and something I do know works.