Avoid medical interventions on a Friday.

[IanA2]

As above, try to make sure you keep in good health Friday to Sunday, if you are so inconsiderate as to get ill, make sure it's a Monday.

Joking aside I have seen some worrying figures, ranging from 12% to 24% increased mortality rates on weekend admissions/interventions.

Mr Hunt is now insisting that Seniors should be available seven days a week. So that will fix it. As I understand it the plan is to spread resources more evenly through out the week. Better access to tests and ancillary services. Good idea.

However, I have yet to see any mention whatsoever, of increased resources. Aside from how long it takes to train a doctor (though that's being cut too and a whole other debate). So what's the grand plan?

Is it to even out the mortality rates so that we have a consistent mortality number every day of the week? Mind you, in doing so, without more resources, the overall rate will go up. But I suppose as long as there are no obvious spikes that the Wail, Groaner or Torygraph can point out, our politicians can say they have improved things.

As an aside, but not entirely unrelated to the current NHS situation, I hear so much rubbish about how terrible the US health system is, but again that's another debate. What is not widely known is their per capita spend on public medicine, is actually considerably higher than ours. Also, I'd put money most of the US healthcare senior managers/CEO's/board directors not being nurses and PAM's, as they are in this country.

My thoughts are with all those in Hospital over the festive period. i know what it's like.

 

[grober]

Sounds an eminently sensible redistribution of resources without necessarily spending more. Problems evidently arise because experienced senior clinical staff are simply unavailable over the weekend. Access to advanced diagnostic facilities such as MRI/ CT and laboratory work ups are also unavailable because they are not manned or there is no one senior enough present to authorise them. Apart from anything else these invaluable and costly facilities should be humming with activity 24/7. No-one needs to work any more hours - just different ones. While this might just spread out the mortality rate over the week as suggested it would seem prudent to try it. In fact its been suggested that earlier patient assessment and intervention may in fact shorten patient stay, free up beds and end up costing less money.

 

[IanA2]

Sounds an eminently sensible redistribution of resources without necessarily spending more. Problems evidently arise because experienced senior clinical staff are simply unavailable over the weekend. Access to advanced diagnostic facilities such as MRI/ CT and laboratory work ups are also unavailable because they are not manned or there is no one senior enough present to authorise them. Apart from anything else these invaluable and costly facilities should be humming with activity 24/7. No-one needs to work any more hours - just different ones. While this might just spread out the mortality rate over the week as suggested it would seem prudent to try it. In fact its been suggested that earlier patient assessment and intervention may in fact shorten patient stay, free up beds and end up costing less money.

Maybe, but it doesn't seem to take into account the fact that many/most trusts are currently operating at overcapacity. Nor does it factor in the huge number of seniors who are working way way in excess of their contracted hours in an attempt to soak up the ever reducing hours juniors are allowed to do (and trusts can be fined if they make them work over). My guess is that if they start put seniors on shifts (already do in some A&E's) the last vestiges of goodwill will go out the window and they will clock off on dot. Time will tell.

 

[HR17]

Also, I'd put money most of the US healthcare senior managers/CEO's/board directors not being nurses and PAM's, as they are in this country.

We have way too many managers who's only experience is clinical. Commonly very inexperienced clinicians too. Its commonly who you know as opposed to what you know in the NHS. As they move up the ranks, they employ people like themselves below them, and then you have a whole hierarchy of poor managers who know no different, but are happy to scratch each others backs. The NHS is failing itself by failing to realise what actually goes on within it. Its this type of culture that deters whistleblowers, and promotes secrecy. Its only when something goes wrong that these managers are quietly removed, often with compensation, only to resurface somewhere else in the NHS.

 

[markjay]

Working shifts is fine, even night shifts, but nurses and technicians can 'switch off' when they go home, while consultants are expected to be available at all times?

It will be very difficult to draw more people into the medical profession if it turns into a 24x7 job throught one's career...

 

[Charles Morgan]

It is rather odd in this day and age to have outcomes dependent on which day and time of it you fall ill. However, as Ian says, unless you increase resources you might easily increase overall mortality. I recall my consultant physician getting immensely vexed that his workload had gone up by 50% because of the botched training schemes of a few years ago, and the nonsense of the working time directive and junior doctor training means for certain that the consultants of the future will have had less training and experience (should I dare mention increased recruitment of women doctors?).

 

[IanA2]

The senior workload has gone up for lots of reasons, including the famous fcuk up of the botched changes to recruitment/training a few years ago. The main cumulative reason is that year on year the regulations regarding what juniors can and cannot do, along with the hours in which they can do it, have reduced on a steady basis. Added to this, the shorter training period and reduction to clinical exposure is producing new breed of "consultants" who are more akin to second year senior registrars of ten years ago. Indeed there is recurrent talk of creating a new class of "junior consultants"

If nothing is done, and frankly I cannot see average Trust/Franchise managers having the skills/abilities to sort it, my guess is that whole sections of clinicians will up and leave en masse and set up in chambers a la barristers. There has been a fair bit of chatter along those lines already. At that will cost the franchise holder a lot more than it does at present.

Talking with a friend the other day she said that one of her kids wanted to be a hospital consultant. Be a GP said I, a lot less training, a lot more money, and half the hours. But then they are self employed.

 

[Apial]

(should I dare mention increased recruitment of women doctors?).

And what would you like to say? 70% of UK medical student applicants are female according to an Oxford admissions interviewer. The question posed was how would you encourage more male applicants?

Worryingly, 67% of doctors employed by the NHS are foreign, yet places at medical schools are massively oversubscribed. Uk schools just can not provide sufficient trained doctors. This problem is not unique to the UK. The USA has a similar problem, and trained doctors are in a shortage worldwide. We should have increased training decades ago.

 

[Dryce]

And what would you like to say? 70% of UK medical student applicants are female according to an Oxford admissions interviewer. The question posed was how would you encourage more male applicants?

As I left the education system in the 70s it was being realised that girls did better in single sex schooling and that in mixed schools the education system served boys better.

So they (quite rightly) tinkered with the system.

Net result is girls now do better.

I think however they maybe overadjusted. Just as the system used to inherently disadvantage girls perhaps it is now tipping the balance to inherently disadvantaging boys.

 

[IanA2]

In fact whilst the healthcare sector is staffed overwhelmingly by females of which there is a very large BME contingent, it's management is overwhelmingly male and white.

I can't recall the exact figures for male/female doctors, but it is projected that females will be in the majority within three years.

No prizes for guessing which gender will be over-represented with merit awards and senior positions.

 

[IanA2]

Worryingly, 67% of doctors employed by the NHS are foreign, yet places at medical schools are massively oversubscribed. Uk schools just can not provide sufficient trained doctors. This problem is not unique to the UK. The USA has a similar problem, and trained doctors are in a shortage worldwide. We should have increased training decades ago.

I think the figure that would be interesting is what percentage of the 67% are locally trained. Whilst training in this country is reasonable robust, that cannot be said of all countries. Also, health has many complex cultural aspects. Someone's place of birth would not concern me, but their place of education might.

 

[grober]

From the Doctor Foster website:-
Why our health service must work as a 24/7 operation
October 24, 2012

There has been much debate about the reasons for high weekend mortality rates in hospitals, as evidence of the problem has accumulated. In some cases, it is due to lack of care in the hospital. In others, it is due to lack of care outside the hospital. But, in almost all cases, it is down to the fact that our health services do not work as a 24/7 operation.
There is no really good reason for this. Fire services do not operate with slimmed down crews on Saturdays and Sundays. Why should hospitals?

Weekend admissions more likely to be fatal for stroke and kidney patients | Society | theguardian.com

https://www.gov.uk/government/uploa...ent_data/file/229710/DDRB_CEA_Cm_8518__3_.pdf

 

[IanA2]

Sure it needs to be a 24/7 operation. To do this needs a significant increase in resources. There has been a deathly silence on this issue. Not a peep from the Franchise holder.

 

[IanA2]

Interesting article here explaining why 10,000 new GP's will be required to run a 7 day service. Of note is the fact that existing GP's are working 11/12 hours a day.

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I wonder what the number will be to have seniors available for a 7 day week in hospital?

 

[tonyc280]

Am glad i had my "Heart Attack" on a Monday morning!!!

 

[IanA2]

Am glad i had my "Heart Attack" on a Monday morning!!!

Best time

 

[stevieb15]

Interesting article here explaining why 10,000 new GP's will be required to run a 7 day service. Of note is the fact that existing GP's are working 11/12 hours a day.

Loading...

I wonder what the number will be to have seniors available for a 7 day week in hospital?

The GP I play golf with doesn't work 11/12 hours per day, unless he starts at 4 in the morning.

 

[IanA2]

The GP I play golf with doesn't work 11/12 hours per day, unless he starts at 4 in the morning.

Is he part time, is he salaried, is he a principle, does he have an afternoon off in lieu of weekend/evening work. Some GP's work nights only these days which might give folks the impression that they have a lot of free time in the day.

 

[grober]

‘We know our colleagues are working 11 to 12-hour days, and that is really difficult to do day after day when it is a job you need to be on top form for. ‘They are feeling pressurised and besieged and looking for a bit of respite.’

Seriously ? If it was Len McClusky saying that how credence would it be given ? Can't see much difference between the Chief shop steward [ Sorry Chair] of the RCGP and General Secretary of Unite on this one sorry.

"No the lads are exhausted driving the tube trains all week ----- all that responsibility for the lives all those thousands of passengers hurtling down those narrow tunnels day in day out. Its a tremendous strain That's why the tube doesn't run on the weekends any more. Different shift patterns so the trains could run on weekends???? Naw mate you will have to hire 5,000 new drivers otherwise its never going to happen right" .

 

[IanA2]

‘We know our colleagues are working 11 to 12-hour days, and that is really difficult to do day after day when it is a job you need to be on top form for. ‘They are feeling pressurised and besieged and looking for a bit of respite.’

Seriously ? If it was Len McClusky saying that how credence would it be given ? Can't see much difference between the Chief shop steward [ Sorry Chair] of the RCGP and General Secretary of Unite on this one sorry.

"No the lads are exhausted driving the tube trains all week ----- all that responsibility for the lives all those thousands of passengers hurtling down those narrow tunnels day in day out. Its a tremendous strain That's why the tube doesn't run on the weekends any more. Different shift patterns so the trains could run on weekends???? Naw mate you will have to hire 5,000 new drivers otherwise its never going to happen right" .

I'm not quite sure what you are saying here. I do know that a tube driver working 60 hours a week (not that they would be allowed to as it would be unsafe) would take home more than a salaried GP.

Do you really want to be treated by tired doctors?

PS Two interesting points.

1). I read the other day that Romania and Estonia have more employed doctors per head than the UK

2). The US spends more per capita on Public Health Medicine than we do in the UK