Former NHS Nurse and manager now contemplating the NHS from outside

Posts tagged ‘NHS’

Back

After 3 months of rest, recuperation, holidays, spending money and general enjoyment I am now back working for the NHS. Note the word ‘for’, since I am not actually part of it. I am now an independent contractor working on a project that was left unfinished. I am back with my ex boss and her small team. I am back in the same office, in the same building I left at the end of March. I have re-instated my nhs.net account and hopefully in the next few days I will be able to log onto work computers again. Yesterday I went into the office; it was to say the least surreal.

I used to look at the invoices of contractors and discuss with colleagues that they seemed to earn a lot of money for what they did. I am not sure that the rate I have negotiated is excessive, since I will have to pay my own tax and national insurance, but it is a reasonable amount. I am going to be working 3 days a week for the next few months and hopefully that will put me on a footing for more work in the future.

The building now contains several organisations, where in March there was one. I heard that the staff working in the CCGs are not always pleasant and friendly to those working for the CSU. I heard that already people are leaving, jobs are becoming vacant. I heard that a number of those who were made redundant, are like me, back working. I heard that those working in the CCGs are still trying to work out what exactly they are doing. I guess that is no surprise.

I found yesterday in the office a little claustrophobic. It is 3 months since I sat still for so long, since I sat in such a small office for so long. I think that 3 days will definitely be enough in one place. Mind you I will be out and about a lot, my job is to try to sort out the clinical groups so that they are fit for purpose in the future. I am going to finish off the job we couldn’t do last year and which predictably there currently are insufficient permanent staff to manage.

Still it is nice to be back in the world of work even if I will now have to juggle it around my expanding social life. But, I do still have some bills to pay even if I am now completely debt free!

Why are more people going to A&E?

That seems to be the question which is currently challenging health politicians and the media. Of course it is not a new question for those working in healthcare, since it is perfectly possible to track each and every attendance and episode of care that takes place. Even before I stopped being a commissioner at the end of 2011, senior managers were scratching their heads about the increase in ‘unplanned care’ and trying various methods of ‘managing activity’.

There is no doubt that attendance in emergency / unplanned care has increased, but why? The analysis we are given doesn’t tell us about when people attend, but in trying to answer the question, they point to changes in GP out of hours services. That suggests that there are no problems with the availability of GP services ‘in hours’. However, when a new Urgent Care Centre was opened in this County, it was discovered that faced with the chance to attend and be seen immediately rather than wait for an appointment at some of the less well run GP practices, people chose the former. It wasn’t all about out of hours services at all.

The lack of ownership by GPs in out of hours care is also blamed, but many out of hours services are literally owned by GPs as well as provided by them (it just isn’t obvious since they are contracted out). Of course, if you contact these services you are unlikely to see your own GP, therefore you might as well go to an urgent care facility. When you get there though, you might find yourself triaged into a GP service, where the same doctors providing out of hours care are also based. Funny how that isn’t mentioned.

Patients and their individual needs, are quite rightly being recognised as central to health provision. But with that recognition comes the realisation that people will use those services in the way that feels right for them. That might mean accessing emergency care for things that they perceive as needing attention now, even if those providing the care don’t think that is what is needed. If you feel you need to see a health professional and you know you have to plan to need it to attend your own GP surgery what will you do? Probably access a place you know is always ready to take you.

Then there are the telephone advice services – first NHS Direct and now 111. In deciding to change the focus of these services, a decision was made to completely dismantle the former in order to start up the latter. As NHS Direct ran down, then more people were referred to A&E. Everyone knows that assessment and triage of the patient are the most important parts of deciding what is wrong with someone, who is best placed to help them and what should be done. The more experienced the person doing this is (on the phone or in person), then the more effectively that problem will be dealt with. It stands to reason then that if you get rid of qualified staff before the new system is in place you are asking for problems.

Finally something that no one has mentioned. Children are some of the biggest users of emergency care. They become ill quickly, in an unplanned way. Parents rightly worry that they need attention right now and take them to A&E. We know that the birth rate has been rising steeply, we know school places are under massive pressure. I wonder if some of the increase in attendance relates to the increased number of under 5′s?

Like most issues in healthcare, this is complex. I doubt there is no easy answer nor a single cause. The propensity of politicians to blame in turn the previous government or GPs is simplistic and plainly wrong!

Spring has sprung

I love this time of year. Each day as I look out of the window, drive to work and back I notice that the leaves have a little more blossom, a few more leaves. The daffodils are now in full flower and to top it all we have been experiencing highly unusual sunny and warm weather. It makes you feel good. Spring is a time of new beginnings a time to clear out the cobwebs, to clean the house, to get ready for the summer ahead. This year I approach spring feeling refreshed because I have recently had 3 weeks off work; 2 in USA and 1 at home. I have taken a break from work, and from concerning myself with the problems of the NHS. Now though I am back in the mix and raring to go.

The Government must also be glad that with the advent of spring, they have finally got their Health and Social Care Bill through; it will receive royal assent within the next couple of weeks. Mind you I believe they have other worries (a budget that many felt favoured the ‘haves’ rather than the ‘have nots’, scandal over dinners with David Cameron and an impending fuel tanker strike to name a few).

Next week we start a new financial year, the last of the PCTs. This is going to be an interesting year as we head towards transition towards the new world of healthcare commissioning and provision. Already our PCT is getting ready to become a Commissioning Support Unit. Local Clinical Commissioning Groups are preparing to be ratified or whatever the process is called and everyone without exception working in the health economy faces the reality of doing more for less money (that’s just the budget but personally we face similar challenges).

I don’t agree with the Bill but enough is enough. We have to move forward, we have to prepare for new beginnings. I fear things won’t go completely as the Government would like and in a perverse way I am quite looking forward to seeing how it all pans out. It would be fun if this wasn’t public money, real lives and real jobs. What is worse is that this is healthcare; mistakes can lead to people missing out on the care they need and it can lead to death. We watch and wait.

Meanwhile I’ll enjoy the good weather while it lasts; it will turn cold by the weekend and eventually it will rain!

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