Dr No raised the possibility that it might have been more than coincidence that the Care Quality Commission report ordered by Andrew Lansley was released on the day after The House of Lords second reading of the Health and Social Care Bill.
Something fishy, thought My Black Cat, as did Dr No and others.
Dr Phil, in one of the comments on Bad Med, remarked:
“I was a bit disappointed that other bloggers were not interested by our recent health scandals.
Don’t be too disappointed, Dr Phil, this witch is interested, and reading, and listening. Indeed, she had something to say about it some time ago.
It seems no-one was listening to her then. It seems the consultants did not sit down with the nurses in charge of the wards and do some simple mathematics with The Abacus.
Or maybe they did.
Maybe they found deficiencies but didn’t know what to do next?
For pities sake, do you need spoon fed?
You write letters!!!
It seems in certain hospitals together they did not write letter after letter to those in the most senior management positions if stupid staffing ratios seemed to be the problem. (This is of course not always the problem but it is surely one of the first things to be addressed).
If a nurse who is not a manager feels too vulnerable to write or co-sign a letter, then damn it, the consultant in charge of the patients who could not be fed, or watered or toileted properly should send the letter himself or herself directly to the most senior medic and most senior nurse in the Trust. If there is no immediate written reply or they are fobbed of by the promise of “it will be put on the agenda of some future committee or another” then then you are being subjected to Yo-Yo management. The letters then need to bypass the Yo-Yo system and be propelled further up the establishment. Letters. Not conversations, not moans, not emails. But formal snail-mail letters that are NOT on first name friendly terms and have several cc’s at the end including cc file (for lawyers if necessary).
My dear non-witchy consultant colleagues, the patients in your care cannot be expected to respond well to your treatment if they are starved, dehydrated or suffering from infected sacral bedsores.
The following was the advice this witch gave you in November 2009:
NURSE ANNE IS DOING HER NUT!
And quite right too!
Nurse Anne, in the view of the witching community, is doing an essential service for patients, in bringing to the attention of the world, the way it really is in many wards in the UK during this wonderful age of “Change” and “Modernisation” and “Diversity” and “Talent” and “Leadership” and “Contestability” and “Plurality” and now “Polysystems” with “spokes” and all the other meaningless jargon that was ushered in by Tony Blair and his “Third Way” cronies that surrounded him and followed him and are still following him.
Nurse Anne is having a go at the doctors including The Witch Doctor.
In fact, The Witch Doctor agrees with most of what Nurse Anne says in her post apart from the implication that UK doctors are a cocaine snorting bunch, and The Witch Doctor’s views on apprenticeship. The Witch Doctor has a post on the topic of apprenticeship and the creep that will follow. This post is likely to appear sometime soon during The Witching Hour. The other thing is that, as a doctor, The Witch Doctor does not feel threatened by the “dumbing down” that the Skills Escalator is intended to produce. No. It is as a patient she feels threatened by this, not as a doctor.
So, why exactly do we witches feel that The Witch Doctor thinks Nurse Anne is quite right to do her nut about doctors?
Well, The Witch Doctor frequently does her nut about doctors too, albeit not in the same illustrative language of Nurse Anne.
If you are a hospital consultant, then we witches suggest that at some point over the weekend, you pour yourself a coffee, sit down by the fire and spend an hour or so reading through Nurse Anne’s blog.
We witches think every single hospital consultant in the land should read it.
We think every single hospital administrator should read it too.
We think every member of The Department of Health should read it.
No. Forget the last sentence. That would be counterproductive.
Consultants should read it because they should be supporting these nurses who are struggling against all odds in certain pockets of the NHS.
Consultants are not supporting them.
Ask yourself whether you have seen any of Nurse Anne’s accounts happening in your ward (if you have a ward that is – your patients are probably scattered all over the place nowadays, but that is a separate issue that you as consultants should have dealt with long ago).
And then ask yourself, does it bother you that patients lie in wet beds, are undernourished and don’t get their medications on time.
Well, Does it?
If it doesn’t worry you, then let me know who you are so that all the witches will avoid you like the plague when they are ill.
If it does worry you, have you asked yourself why it is happening?
Do you know the headcount of nurses in your unit?
Qualified nurses. Health Care Assistants. Cadets.
Have you watched them in a cluster talking about Big Brother instead of attending to patients? (Some do, Nurse Anne, I have watched closely. On the other hand, most don’t.) Most are excellent nurses who are run off their feet trying to nurse to the best of their ability but can’t. They are being asked to do an impossible task much of the time. The Witch Doctor has watched carefully and has done some simple arithmetic.
As a consultant do you trust your Trust Administration in not to squeeze the last ounce of flesh out of the nurses in your ward?
Come Monday morning, here is an exercise that all consultants could do for the benefit of their patients.
Get The Abacus out.
How many patients in your ward need help with toileting?
How long does it take to deal with each patient?
How long do patients in your ward (if your have one) wait for a bed-pan or commode?
How many patients in your ward need help with feeding?
How long does it take to feed a patient?
How long does it take to do the drug round?
How many times is the nurse in your ward interrupted when doing a drug round?
Do multiplication sums.
Lots of them.
Do the figures tie up with staff numbers that are appropriate to the level of expertise of each member of staff?
No?
Then what are you going to do about it?
Let me tell you.
You sit down with the nurse in charge of the ward. Not the one who is straddling the barbed wire fence between government administrator and nurse.
You say to him or her.
These are our patients. We have responsibility for them.
Together we will sort this out.
And do it.
That is what you are being paid a consultant salary to do. To ensure your patients are diagnosed, treated, and if possible cured. If that is not possible then you ensure your patients are cared for, comfortable and safe. You know that.
The medical and nursing professions need to work as one.
Together, both of you – the “hands on” senior medic and “hands on” senior nurse, with the help of The Abacus will carry great clout.
This government wants you divided.
They do not want you to have clout.
If you do not do this as consultants, you are letting nurses and patients down.
And for pities sake, if you are a hands-on consultant, don’t go bleating to your clinical director and medical director that “something will need to be done.” Ignore the hierarchy. As a consultant you can do this. You are an independent practitioner. These people are hindered because they have chosen to straddle the painful barbed wire fence.
See to it yourself.
Do you not know that you, the hands-on consultant, and the hands-on senior nurse, are The Leaders?
If you take on your rightful role together as The Leaders, this will never happen again.
a red apple ……………………
The Witch Doctor – Link to a random page
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LINK TO MISSING PERSONS WEBSITE
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The Witch Doctor 
An excellent post Witch Doctor, but yet sad in that you are having to address consultants again and advise that they sit down with their abacus, do the maths and then write letters to those who exist in the higher echelons of management ignorance.
Will they (the consultants) take notice this time?
Sadly I fear not, for it is all too easy to do nothing other than mumble “These damned nurses are too post to wash” when they won’t (or more accurately can’t due to pressure of work) abandon all to take part in the ward round. It is easy – unless you take time to investigate – to join the merry, ignorant bandwagon that see all failures of the NHS as that of failures in nursing care.
There is also the prevailing attitudes of many of us that the elderly are unimportant, irrelevant, a burden on society and easy victims for cruel humour (there is a post somewhere in the medical blogosphere – if you should care to look – that perfectly illustrates how acceptable it has become to poke fun at the elderly).
Anna :o]
By: hypercryptical on October 16, 2011
at 2:24 pm
Oops! ‘too post to wash’ should of course be ‘too posh to wash’!
Anna :o]
By: hypercryptical on October 16, 2011
at 2:32 pm
Dear WD and Anna,
In many ways it is a fair cop. In other ways it is a passing of the buck. We are all responsible practitioners, and are all responsible, not just Consultants. Consultants are not the “sir Lancelot Spratts” of fiction and history, but also vulnerable to the cosh of others. Revalidation and job planning have the implicit threat that we must all tow the company line.
One thing attractive about my current post is that Borchester General Hospital actually seems to care about these issues, and in my own unit I see very little patient neglect, though I think that on some other issues we could improve significantly.
Resources are always going to be tight, but one curiosity of the CQC report is the variation between wards in the same hospital, with similar caseloads and staffing. Some wards seem to have a different and more positive culture than others.
Dr Phil
By: drphilyerboots on October 16, 2011
at 11:19 pm
In spite of revalidation and job planning, I think consultants are less vulnerable than other groups when they address staffing issues and that it is possible for them to put their concerns firmly in writing in a way that will highlight and hopefully help solve the problem so that patients in hospital at least receive the most basic needs.
Regarding patient neglect, staffing levels and basic needs seem good places to start because in many ways they are the simplest to correct. Attitudes and ‘creep’ are related in a way but maybe best regarded as a separate and complex issue that perhaps needs to be addressed incrementally, but resolving staffing issues first may set the scene for further improvements.
By: Witch Doctor on October 18, 2011
at 7:58 am
Correct witch doctor. “Bad attitudes” are a direct result of short staffing and feeling helpless and scared. Nurses are exploited and abused. Beat the shit out of a dog and see if it stays friendly.
By: Nurse Anne (@MilitantNurse) on January 27, 2012
at 6:26 am