Bad IT, grazed knees and bureaucracy: NHS staff share their frustrations

An ambulance is called for someone who has fallen over and grazed their knees

We get inappropriate calls from the public who seem to be too scared to get people to stand up after falling over. For example, a person trips in the street and grazes their knees. A crowd gathers and persuades the person to stay on the floor until the ambulance comes. People look on in wonderment as the ambulance crew ask the person if they can stand. The person stands and is full of gratitude but 30 to 40 minutes is spent on the scene doing basic checks that we have to do before discharging patients and paperwork. The person could have got themselves up and gone to the chemist for wipes and a plaster.

Paramedic, ambulance service, Wales

Clunky IT systems detract from my work in A&E

Once I have assessed people in A&E, I have to write up the medical notes by hand or on a computer system. Because I work in the community and am based at a different NHS trust I then have to duplicate the assessment information to rewrite it on my own trust’s electronic system. I have no access to the local social care notes system which can cause a delay in finding out important collateral history. None of the different IT systems are linked. It can be very frustrating when making difficult decisions about people’s care and treatment.

Senior mental health practitioner, London

A patient arrived by ambulance complaining of a sore ankle. He then stormed out of hospital on said ankle

I recently had a patient arrive to my A&E, by ambulance, with the complaint that his ankle had been hurting for the last five months. When I explained that A&E is not the place for longstanding problems such as this because we specialise in emergencies, and that he’d have to see his GP to investigate, he was incredulous. After angrily berating me for not arranging him a same-day MRI scan, he stormed out of the A&E department walking on said ankle.The patient wasted both my and the ambulance service’s time which should have been spent looking after genuinely acutely unwell patients. It is so frustrating and demoralising to then be abused by patients like this on a daily basis. The public’s expectations and understanding of different healthcare services is central to this problem. People need to be properly informed of what is appropriate for A&E, when to go to the GP, when to use a pharmacy and when to self-care.

Doctor, emergency medicine (A&E), London

Sore throats do not constitute an emergency

I see many people with urgent sore throats.

GP, Dorset

I spend time fighting other parts of the NHS over who should pay for what

This is not a direct clinical issue, but applies to how the members of the information team (a staff group that often our colleagues and the public alike are not aware of), may be called on to support bureaucratic processes – instead of contributing towards improving the running of the organisation. One particular example is in the ongoing battle for charging, taking place between the trust and the commissioning support unit (CSU).

Each month, our team is sent spreadsheets listing thousands of instances of patient care that the CSU is challenging as being incorrect or inappropriate – so called SLA (service level agreement) challenges. If we don’t answer each individual example, the trust will potentially lose any payment for that activity.

I understand that this sort of process is a necessary check to promote value for money, and of course errors do get made that need correcting. Unfortunately, in the current climate, the attitude seems to have changed from this being a check and balance, to being a significant cost saving opportunity for the CSU. As such, they apply more staff resource to scrutinise and challenge trusts – using more inventive thinking to claw back money from providers. I have heard anecdotally that CSU analysts are incentivised based on how much they can claim back from trusts.

We, on the other hand, are not in a position to hire more staff to scrutinise and check and to answer to these sorts of overheads (in fact we tend to pay equivalent staff less) – instead redirecting resources that would otherwise be spent on trying to improve how we run the organisation.

Of course, we still continue to accept and treat patients as we always have. The actual cost of seeing the patient stays the same. The administrative burden, however, inflates the more we bicker about whether CSUs should or shouldn’t pay. The trust, of course, does not hold the purse strings and does not, therefore, have a position of power in these matters. While the CSU itself may profit, it certainly feels like the NHS is spending a lot of time withholding money from itself.

Information analyst

A colleague was woken up to prescribe a sleeping tablet for a patient. When he reached the ward, the patient was asleep

A colleague was once woken up in the middle of the night to attend to a private patient. The request was to change the aerial on the patient’s TV set.

Another colleague was woken up to prescribe a sleeping tablet for a patient. When he reached the ward the patient had fallen asleep but he prescribed the sleeping tablet anyway. The ward staff woke the patient to administer the tablet and then the patient could not get back to sleep again.

Doctor, anaesthetics, London

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Bad IT, grazed knees and bureaucracy: NHS staff share their frustrations

Naming and shaming GPs for as well handful of cancer referrals will deliver NHS to its knees, warn physicians

Jeremy Hunt, the Overall health Secretary, mentioned difficult action was required to improve standards at practices with bad cancer referral rates.

He stated: “Cancer diagnosis ranges around the nation vary significantly and we have to do considerably more to improve both the degree of diagnosis and to deliver those GP practices with poor referral prices up to the requirements of the very best.”

Nonetheless Dr Baker stated the ‘name and shame’ program would decrease “the threshold for referral and result in other parts of the NHS getting swamped”.

In a letter to The Every day Telegraph mentioned: “This will eventually lead to delays in individuals acquiring treatment and worse outcomes.”

Dr Baker said that common total time GP will see about eight new cases of cancer in their common eight,000 patient consultations per yr.

3 quarters of the individuals who are identified to have cancer are referred soon after only a single or two GP consultations, she mentioned.

She additional: “To propose that GPs are causing delays and variation in diagnosis by not efficiently using the correct blood exams is not only simplistic but also does a great disservice to our occupation and is an insult to hardworking and challenging pressed GPs around the country.

“At a time when GPs are under massive and increasing pressures with patient demand far outstripping capacity, we believe that a collaborative and supportive method is far more most likely to increase the care we can give to our individuals.”

A 2nd letter, signed by above 650 GPs, explained: “If a doctor is negligent, like triggering a delay in diagnosis, there are due processes that decide regardless of whether any incorrect has been completed by way of the Basic Medical Council or courts.

“Naming and shaming GPs who miss cancer diagnoses is a bullying tactic which lacks proof of effectiveness and fails to acknowledge the risks outlined above.

“GPs will pre-empt this by referring so a lot of individuals for tests that individuals who do have cancer will get rid of out and the NHS will be bankrupted. This assault on British standard practice is not primarily based on truth.”

The letter comes after the Royal University of Pathologists backed the ‘name and shame’ plans in a letter to The Day-to-day Telegraph last week.

A Department of Overall health spokesman explained: “Every 12 months 1000′s of cancer situations are diagnosed at A&ampE, and as a nation our cancer outcomes lag properly behind the best in Europe, so we need to do far more to spot the ailment earlier.

“As component of our emphasis on better transparency in the NHS, we help in principle the idea of benchmarking GP practices against every single other on cancer diagnosis as a way of driving up requirements.”

Naming and shaming GPs for as well handful of cancer referrals will deliver NHS to its knees, warn physicians

Why "super honey" is the bees knees for wounds and infections | Rachel Masker

Surgihoney is utilized by British volunteer nurse Jill Brooks to a wounded patient in rural Uganda. Photograph: Surgihoney

The healing powers of honey have been identified about for 1000′s of years. But Surgihoney, whose normal antibacterial properties have been boosted, is proving hugely efficient at treating contaminated wounds and superbugs.

The honey is believed to perform by killing the bugs, removing dead tissue and pus, and then delivering a moisture barrier as effectively as nearby nutrition.

Honey contains vitamins, minerals, enzymes and sugars – all of which assist in the healing of wounds. Manuka is typically regarded as the most potent honey, but it relies upon nectar from a specific tree in New Zealand, limiting its supply.

That’s precisely the issue which has been solved by the developers of Surgihoney. They have designed a merchandise that can be produced from natural honey from any floral supply. They hope it will in the end turn into a worldwide wound-care merchandise that will boost lives in poorer nations.

Lead researcher Dr Matthew Dryden, an NHS consultant microbiologist, is optimistic that the sterile, health care honey can revolutionise wound care all around the world, lessen the use of antibiotics and provide an different to harsh chemical antiseptics.

Surgihoney speeds the healing of tough-to-deal with leg and foot ulcers, stress sores, trauma injuries and contaminated surgical wounds, in accordance to the analysis. Potential benefits include significantly less soreness and fewer amputations.

Dryden says: “Surgihoney is active against all the bacteria we locate in soft tissue wounds. The essential further is that it kills the bugs but doesn’t harm the tissue. Honey is a wonderful organic medication.”

Surgihoney can even tackle wounds infected with strains of bacteria resistant to antibiotics, he says, such as MRSA, E coli and pseudomonas. He describes honey as “turbo-boosted”.

Surgihoney, stored in 10g sachets, is merely squeezed on to wounds and dressed with gauze. Pilot trials (pdf) have been carried out in Hampshire in the Uk, Yei civil hospital in South Sudan, and Vailola hospital in Tonga.

Dryden was lead writer in a research that concludes: “As a wound remedy in the tropics, [Surgihoney] is an excellent, minimal-technological innovation answer which is easily stored, applied and ought to be cost-efficient.” And unlike a lot more sophisticated medicines, it does not need to have to be refrigerated.

Just before the pilot trials, Dryden’s research staff at Winchester’s Royal Hampshire county hospital carried out laboratory experiments on bacteria gathered from contaminated wounds.

The outcomes, explained in detail to the Federation of Infection Societies in November, propose that Surgihoney is far better at beating bugs than other honeys examined, such as Manuka and a medical-grade honey named Medihoney, although equal to antiseptics, silver and iodine, which can be toxic to healing tissue.

A British nurse and wound care skilled, Jill Brooks, has pioneered the use of Surgihoney in Sodo hospital in south-west Ethopia and Kisubu hospital in Uganda, in which she volunteers many instances a year.

“All the outcomes I have observed have been good some have been extremely positive with quick healing of wounds,” says the former lead tissue viability nurse for the NHS in Oxfordshire.

The normal nearby therapy of washing wounds in a weak remedy of bleach has a big disadvantage, she says. “It is quite excellent at killing bugs but is a very harsh point to use as it destroys the very good tissue and can delay healing.”

The achievement of the pilot exams paves the way for a bigger, randomised manage trial.

Surgihoney is currently being produced by businessman Ian Staples, former managing director of Halfords, the motor add-ons chain. He owned a farm in Chile with beehives that made honey from the Ulmo tree. Soon after a negative harvest, he and his son, Stuart, commissioned scientists to create Surgihoney.

The honey has been accredited for use in the United kingdom as a wound-care dressing.

Why "super honey" is the bees knees for wounds and infections | Rachel Masker