Part 3 of my Skeptical Approach to Medicine is planned out and en route but today I wanted to explore a slightly different topic.
There is according to the media a crisis within the A & E Function of the National Health Service – this is based on a review by the College of Emergency Medicine and discusses amongst other things staff shortages and an influx of non emergent cases into casualty departments. Details in overview can be found at : www.bbc.co.uk/news/health-22529561
I’d like to use this news story as a backdrop or context to discuss staffing levels within hospitals, focusing on nursing and how management changes could be of assistance.
Let’s start with some examples to illustrate my point.
Dec 1989 – As you may know from previous posts, before moving into the private sector I worked within the Leeds General Infirmary (LGI) for a period of time. I can confirm here for the first time on the record that on more than one occasion (most Thursday and Friday afternoons as I recall) cricket games were held in the medical records department. Groups of grown men, being paid by the public purse stopped working and spent hours throwing a tennis ball at a pile of medical notes being used as the stumps. Put simply this was because too many people were employed within departments with not enough work to do and managers either didn’t care (which was my experience) or were too weak to enforce normal rules of work.
February 2013 – Again in a previous post I mention taking a relative into A & E at the LGI around 10.00pm on a Saturday night. This was a real reminder to me of the lax deployment of staff both clinical and non-clinical is within the NHS. Reception was manned by three people on arrival who were essentially sat doing nothing and chatting. Within the assessment area there was a constant flow of technicians, nurses, support staff and doctors in a ratio of around two staff to each cubicled patient – we waited three hours before my relative was given pain relief for severe back pain but the admitting administrator, two triage nurses and two doctors knew what the problem was within 2o minutes of our arrival. Importantly there was a lot of chatting within the department – I’m not by nature a nosy person but I can confirm very little of the chat was about patients. The issues of non relevant discussion and time wasting is you might note becoming a theme.
I will provide the same back note to the above point I made in a previous article – there is nowhere in the world you could go for free on a Saturday night and receive this medical treatment other than the NHS. So the NHS is a great instituion but this in and of itself does not make wastage right or a good thing.
October 2011 – I spent a great deal of time at Pinderfields Hospital in Pontefract in October and November of 2011. A different relative spent several weeks in intensive care and recuperating in their geriatric department. As a consequence I have I feel a unique insight into the world of vending machine stocking at this hospital. You see I spent many a long hour sitting in the relatives waiting area outside ICU and three times a day a man would appear with a trolley full of crisps, chocolate bars and cans of fizzy pop and each time he would spend an average of 15 minutes (I eventually timed him) opening the machine, checking the content, replacing used items and shuffling items around within the shelves of the machine. His routine never varied, nor did it ever take any more or less time, regardless of how full the machine was (sometimes it had literally not been used between visits – again I was there long enough to know this for a fact). Lets run the maths – assume there are four floors within this hospital, four vending machines on each floor – that’s sixteen machines, each with 15 minute re-fills three times a day – that works out at 12 hours per day. I would imagine therefore that in fact there were probably two or three people exclusively performing this one task across the hospital to take into account break/lunch times and the need for holiday cover – three people to do a task which, lets face it any sane, normal person could manage in less than 120 seconds – or even in zero time – if the machine is full it doesn’t need opening up and messing about with – you go on to another task – I could have replaced that team of three people myself and performed the entire task in three or four hours. But this is not the NHS way apparently.
Obviously the above calculation does not take into account someone coming along to empty the cash from the vending machine, which I never saw but presumably they paid someone else to do this !
2008 – In a previous role I worked within a business that employed two teams of nurses to support a range of people on the telephone. I have sat within the office of that business and listened to the nurses work. I would guestimate that around 30% to 40% of their working time was spent just chatting – obviously they’re no longer NHS employees but this goes to the culture of allowing time to pass within the NHS and how this is ingrained in all employees within the sector – they are paid to be there and not be there, working.
2004 – From the late 1990’s into 2005 my wife and I were treated within the Leeds Assisted Conception Unit (ACU) based at the LGI’s Clarendon Wing. I have one very vivid memory of arriving for an early morning appointment. Their appointments were 15 minute slots, four per hour (obviously) but multiple couples were booked for each slot, on the basis that whilst one nurse was taking details from one couple, another would update notes, whilst a third would perform actual treatment, injection or scan and so forth. It was unusual not to see three or even four different nurses on any given appointment.
We always tried to arrive well before our allotted time on the principal that it was first come first served and arriving early meant you got started first. So on the day in question we arrived ten or fifteen minutes before out appt. time. Let’s say that our appointment was for 8.15 am and we arrived at 8.00am. We were noted as arriving by the receptionist and added to the list for attention by the nursing team. We were old hands by this time and knew most of the nurses by sight or first name and we could see the nursing lounge both through a shoulder height window and whenever the lounge door opened we could see them sat around their coffee table chatting. Now, if the first appointment is 8.15am I think it’s great that the team are there early, catching up on whatever they want to discuss. However, none of them emerged from their lounge to see patients until well after 8.30 pm – they did however make a significant dent in tea and biscuits. They may well have started work much earlier than 8.15am I hear you cry – I understand they could have been prepping for the day, writing up notes etc but what are the chances of four or five nurses breaks coinciding with the start of clinic time plus if breaks are allowed to be scheduled over clinic times then there is something wrong with the management of this team. As an aside, although ACU is part funded by the NHS, all but one of our IVF treatment cycles were at least part privately funded – this means that over several years we spent upwards of £ 10,000 being treated within this unit.
If I were managing hospitals and clinical and non-clinical staff I’d suggest implementing the following change :
A member of staff (nurse, doctor or administrator/technician/cleaner) works a set number of hours per day. Within that time period they have breaks as required by law – for food, rest and the obvious toilet needs – other than that they work, simple as that. In the private sector you just can’t spend hours of the day chatting or doing unproductive tasks.
The biggest crime to me is of taking the salary and just using up time – as I mention above – being there but not being there to work.
The current system is a nonsense. I’m no fan of adding in layers of management into the NHS but someone needs to take control of who’s doing what and like everyone else who doesn’t work within the public sector when they are at work they need to focus on the key tasks of their role.
The nature of the point I am making above is to offer extreme or perhaps you might argue silly examples. I understand to many within the NHS is a vocation but the system is broken and it needs fixing.