Nursing By Degrees

The move to a mandatory graduate level qualification for entry to nurse training has been received with mixed response. On one side the traditionalists say a degree does not equip a nurse with the compassionate, caring and empathic qualities they need. The progressives say the change is a recognition of the way nursing has become a highly skilled role that plays an important part in the treatment process.

Its clear that medical knowledge, technology and pharmaceuticals have developed beyond all recognition; the seriously injured who would have died 25 years ago now survive; surgeons can now perform almost miraculous operations; and new drugs and treatments have brought hope to suffers of many cancers giving them every hope of a long life. All these developments have prompted changes to doctors training and greater specialisation, it would now seem the nursing profession is about to catch up with these changes.

There is a risk, however, the risk the vital tasks of personal care and the human touch that helps the sick and injured to cope with their predicament is lost. We do have care assistants, but these poorly paid individuals are often seen as little more than bottom wipers and spoon feeders. Their role needs to be grown to fill the gap left by the enhanced role of nurses. Otherwise it will be the poor patient who suffers.

Silly Season Comes To Politics

We know most Americans are born with a natural instinct to hate anything to do with communism. We also know they have great trouble understanding the fundamental difference between communism and socialism. So its not surprising that the suggestion the country embraces one of the greatest social reforms of this country, the NHS, has caused a very heated debate on the other side of the Atlantic. Of course president Obama’s plans for American healthcare does not include a model based on the NHS system, but for the republicans that’s an irrelevance.

The republican party, has been waging a campaign of miss information to persuade the American public that the NHS provides considerably worse healthcare than their system as a tactic to move support away from Obama. Of course the actual situation is far more complex, there is good and bad in both systems although the NHS does provide 100% cover were as over 55 million Americans have no or inadequate health cover. Now the republicans have an ally in the form of Tory MEP Daniel Hannan, who has derided the NHS as an anachronism.

The attack has given the labour party an opportunity to do some early electioneering claiming the NHS is better in their hands. Its not often a political issue in America spills over to the UK, but then their style of politics involves significantly more mud than over here and some of that mud has ended up on Tory faces. Respecting each others political system used to be an unwritten rule of diplomacy; but then that’s not something for which the Americans have much of a reputation.

Loosing Face To Cancer

News of the increase in oral cancer brings back memories of the horrendous impact of some facial and oral cancers. The removal of these growths can involve major surgery that leaves the patient, even with the most advanced plastic and reconstructed surgery, badly disfigured. While working for the NHS I met a man who had undergone the Commando Operation. This had resulted in the removal of almost half his face from above his right eye down to the right side of his mouth, and from the left side of his nose almost back to his right ear.

This left a large hole in the side of his face covered by skin graft around the edges and mucus membranes across the rest. The Maxillofacial Technician at the hospital had built a prosthetic to fill the hole that included a false eye. It was held in place by small magnets that had been fixed into the remaining bones around the hole. Hand crafted from a from a pliable, life like, plastic it took several minutes looking at the gentleman’s face before you realised something was different. When he wore dark glasses there was no sigh that his face was anything but normal.

For the patient, the operation had saved his life but left him so disfigured he found it almost impossible to go out in public. However, the skill of one of the NHS’s lower paid members of staff had given him back his confidence and his life. There are thousands of back room people who contribute an immeasurable amount to the work of the NHS but get little reward or recognition. Fifteen years after the Technician retired his one man department has more than quadrupled in size, a measure of both the increased demand for their services and the improvements in prosthetic technology.

Change With Change

Before I retired from the NHS there was a major change to the pay and conditions of most staff. Titled ‘Agenda for Change’, the aim was to increase the pay of staff in return for new working practices which would increase efficiency and productivity. The Public Accounts Committee has reported that the whole exercise has been a waste of time and money. The average 10% pay rise has not resulted in no savings and no improvement in productivity.

Well I’m not surprised, nor should our MPs or NHS management be surprised. Getting things to change in the NHS is one of the hardest jobs around. There are too many self interested groups with too much power and too many home grown managers who lack the skills needed to get the changes through. In addition staff get demoralised with all the criticism levied against the NHS and its managers.

There is a view that by bringing back hospital Matron and putting doctors in charge will solve all the problems. Wrong; the NHS is many times larger and complex from the times when the Matron could wander the hospital corridors checking on nurses uniforms, the tidiness of hospital wards and exchange pleasantries with patients. Each government tinkers with the NHS instead of leaving the hospital just to get on with the job and sort out their own problems and pay the price if they fail.

Too Many Old Boys

I am shocked but not surprised at the reports of the problems at Stafford Hospital A&E. There has been a long history of failure in the NHS due to the unwillingness of clinical and nursing staff to openly criticise colleagues who perform badly. The heart surgery scandal at Bristol went on for many years before action was taken to prevent poor performing surgeons operating way beyond their capabilities. The same lack of willingness to act at Stafford would appear to have resulted in many avoidable tragedies.

In the past the old boys network has been very strong in many parts of the NHS and served to protect individuals who had a reputation for poor outcomes and post operative complications. There are more checks today, but they are no where near as vigorous or extensive as they need to be, particularly considering the devastating impact when things go wrong.

Medicine is not an exact science, doctors will inevitably get things wrong or miss important indicators. But that is no excuse for the dismal way patients get treated. If we were to treat animals this way there would be a public outrage. Some how we seemed to have become a custom to poor service, a very sad indictment of the NHS today.

Waiting in the NHS Line

Lance Corporal Johnson Beharry, who was awarded the Victoria Cross has said it was disgraceful that some veterans struggled to get treatment. He also said the army provided serving personnel with “first-class” treatment but ex-soldiers were forced to wait on the NHS.

Welcome to the real world. Mental health services are underfunded and poorly provided in many parts of the country. Whatever the cause of the problem we should all get equal access. Military personal choose to do a job that they know will put them at risk. It takes courage to go into action and we all owe them a great debt. But treatment must be based on clinical priority not employment history.

If there is a problem, its with the MOD not the NHS. The MOD should ensure services are in place to support ex-service personnel. The NHS has a very difficult job, balancing resources against totally uncontrollable demand it does not need Lance Corporal Johnson Beharry to make things worst.

Here’s Your Pills, Now Sign Up For A Better Life Style

In the days I worked for a living I undertook a study of emergency and elective hospital admissions. The results showed over 60% of hospital patients were admitted because of lifestyle related illnesses. Substance abuse in the form of smoking, drinking and drugs together with poor diet and sedentary lifestyles were the underlying cause of most of the ill health treated by GPs and hospitals. Treating this self abuse costs the NHS a significant proportion of its annual budget.

Its interesting to think the founder of the NHS, Nye Bevin, thought the demands on the NHS would slowly reduce as the service healed the sick and improved the nation’s health. The increase in demand on the NHS from the obese is a continuation of the problem of self inflicted health problems. There seems to be little point in patching up someone who does not attempt to eliminate the very habit that has caused the problem in the first place. It has been suggested in the past that patients should sign a contract to improve their life style in exchange for the care and treatment they need to get back to good health. To a limited extent something like this happens now. Many surgeons will not operate on excessively overweight people simply because it’s unsafe.

The suggestion that those who create their own health problems because of their lifestyle choices should act to help themselves always brings a predictable response from politicians and libertarians. Political chicanery, interference, abuse of freedoms and nanny state are just a few of the comments made by the critics. What they do not criticise is the way so many people abuse the system and there own health. The NHS is not an inexhaustible resource a fact needs to be accepted by everyone. The sooner those who abuse their health are taken to task, the better for the NHS and the nation as a whole.

Playing The Numbers Game

News that health service managers have been sacked over fiddling the books is no surprise. I don’t condone their actions but can well understand how the pressure to perform could drive some people to make a few adjustments in their favour. The NHS has become more and more obsessed with figures and targets. Most are meaningless as there are too many variables in the system, one odd occurrence can change apparently good performance into bad. Few targets and the figures produced to determine if they have been achieved truly reflect what has happened.

Of course it’s a bit rich for the government to complain about the problem when they are one of the main causes and are quite happy to fiddle the figures themselves. Every time an index starts to portray a Government failure they change the way the numbers are counted to make it look good again. It’s a habit that has become so ingrained its hard to know whether what as measured yesterday is the same today.

There is also a huge delay in publishing much of this information. There is little point knowing the performance of a service two years ago. You need to know how it’s performing now. Modern technology is more than capable of providing up to the minute information. But that would be too risky. The government would not be able to massage the figures to their benefit and hide the truth.