Debated about having a new thread but if I did that for every new bit of NHS-related news, it'd swamp the section.
http://www.dailymail.co.uk/news/article ... -sack.html
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| Quote: Consultants could face the sack for refusing to work at weekends as part of a shake-up ordered by the NHS’s top doctor. | |
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Subtext: fire all consultants and then rehire them on new contracts. That's what it sounds like to me at least. Big issues:
As I've said above, there's not enough doctors. So if you have a consultant who works Mon-Sun, then you need to give compensatory rest, which means no surgery/clinics/ward rounds the following week. So you'd need more doctors to cover this.
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| Quote: The changes are being brought in after research published in the summer showed that 4,400 lives are being lost needlessly in hospitals every year because of a lack of senior doctors and because key scans and tests are not carried out. | |
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Actually, key scans and tests are done at the weekends. If you have been in an accident and ruptured your internal organs, the surgical team will arrange an urgent CT scan, the senior radiologist on call will come in to supervise the scan and review the images and form a verbal report for the surgical team (and later write the report), and the surgeons will go and operate.
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| Quote: Patients are 16 per cent more likely to die if admitted on a Sunday rather than on a Wednesday, another study found. | |
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Completely agree with this but no one has looked at why. They've assumed it's down to lack of senior cover but it's much more than that. Look at who gets admitted during a weekday and who gets admitted at a weekend. Those who come in at the weekend are more likely to be poorly - they couldn't wait until the weekday to see a GP or access the appropriate healthcare (eg oncology ward for cancer patient). Hence they're much more likely to be unwell and have a higher risk of mortality.
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| Quote: But for certain operations it can be much higher. Other research showed that patients who have planned operations at the weekend rather than on a Monday are 82 per cent more likely to die. | |
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Because as above, who has surgery at the weekend? Someone with appendicitis can't wait for surgery until Monday - they need it there and then! Any emergency surgery has a higher risk of mortality than any routine surgery.
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| Quote: At weekends, patients are usually left under the care of junior doctors who may only have a few months’ experience with one or two consultants ‘on-call’ answering their mobile phones from home. | |
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Only the most junior of doctors may have a few months experience and there's usually a more experienced junior doc (registrar) between the new doctor and the consultant. The idea is that the consultant comes in if needed. You don't need a consultant to write up drug charts - the junior doc can do that and if they have to see a poorly patient and are stuck, they would contact their registrar. The same thing happens during the week!
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| Quote: The plans – which will be rolled out over the next three years – will mean all patients admitted to hospital will see a consultant within 14 hours. Some currently wait three days if they come in on a Friday. | |
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Not really - most, if not all, hospitals have a consultant on call who will overview all admissions on the post-take round. The maximum a patient waits is 24 hours and this is no different to a normal working day.
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| Quote: Critically-ill patients will have X-rays, heart scans, MRI scans or blood tests within one hour, urgent cases within 12 hours and everyone else within 24 hours. | |
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Already happens.
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| Quote: Sir Bruce, NHS England’s medical director who is also a heart surgeon, said: ‘It seems strange in many ways that we should start to wind down on a Friday afternoon and warm up on a Sunday while operating theatres are empty, outpatient clinics echo, expensive diagnostic kit isn’t being used and in the meantime people are waiting for diagnosis and treatment. | |
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And what happens to these patients? There isn't enough slack in the system to cope with just the rise in patients over winter. You need a massive increase in the number of elective beds, and if you're doing more high-risk surgery, you need more beds and personnel in intensive care and high-dependency units.
And as I've said before, you need a massive increase in social care. Lil ol' Mrs Jones who breaks her hip will get operated on within 48 hours. What happens if the consultant says "you're fit for medical discharge" on a Saturday morning? Nothing because there's no routine social services available at the weekends, you need carers and physio etc. The largest bottleneck at the moment is "bed blockers" - people who are fit to be discharged but can't because there aren't the right services in place yet. This needs attention first before you can improve things to streamline everything through.
I saw all this bollocks was going to happen back when I was a medical student and decided to get out of hospital training and go into General Practice. Whilst it isn't quite "out of the pan and into the fire", it's sure as hell as getting close.