Thursday, 28 March 2013
Tuesday, 26 March 2013
The latest vote catcher is out: nurses to work as care assistants for a year during their training in order to get them familiar with washing patients, not allowing them to starve, and learn the basics of compassion. Those more credulous among the voting public will lap up David Cameron’s latest offer no doubt. I can’t think that nurses as a whole will be particularly thrilled and by it and would predict that UNISON will ensure that the initiative will not survive to see the light of day.
While the public as a whole would like to see nurses cower once more under the thumbs of Matron and her band of Ward Sisters, the reality is that the nursing profession today just has to be what they have become: competent technicians able to use computers, take critical measurements and operate complex machinery. Far better, surely, to give the Health Care Assistants some basic relevant training so that they can at least spot problems among their patients when they occur, and give a bed bath without injuring either themselves or their charges. You don’t need a third level education (which nursing always was) to make a bed, mop a floor and keep a frail person clean.
And on the matter of compassion – sorry, it cannot be ‘taught’. It is in the nature of some people to be ‘compassionate’. Others develop it through experience. A very few don’t have it at all. But for myself, were I seriously ill in hospital I would sooner be treated by a competent technician who was rather lacking in compassion than by an airy-fairy idealist who couldn’t read a thermometer. It’s not the end of the world to be short on the attribute of compassion. The genuine medical sadist of course may exist, but I have never come across one. If one is out there, then God keep me from her or his hands.
Monday, 25 March 2013
A report by The Patients Association (this appears to be an organisation that has done away with apostrophes – I just thought I would say that in case you thought it was I who were remiss) bewails its perception of GP services being increasingly difficult to get hold of. It is entitled ‘Primary Care: Access Denied’ and you can see a synopsis of it on http://www.patients-association.com/default.aspx?tabid=80&Id=108 .
Well, speaking from the perspective of a patient who was himself once a doctor at the sharp end of primary care, I can feel some sympathy. But I also know quite a bit about the constraints that bedevil general practitioners and their nursing colleagues in the community. The fact is that their political and professional masters have dumped upon them such a mountain of stuff they are expected to achieve that has nothing to do with face to face interaction with actual patients that they have far fewer hours to spend in the consulting room than they did, oh, twenty or thirty years ago when I was still hard at it: targets to be met; reports to be compiled; meetings to be held; and the complete nonsense they call ‘revalidation’ – a hugely time demanding tick-box exercise that purports to ensure that never again with a Shipman loom up among us. It is actually a joke, only not a very funny one. Harold Shipman will be laughing in his grave (we GPs know he would have passed Revalidation with flying colours).
But there are other factors too that stymie the efficient functioning and delivery of care by the NHS. For example, the monumental waste that is inherent in it, such as vast and costly IT schemes that come apart and are ditched (I was gobsmacked when I first saw a skip full of redundant computer monitors outside an office. Such a sight has become commonplace now, and I would lay odds that a goodly number of those offices are NHS premises).
But the single greatest impediment that in my view the Patients Association ought to but never does address and mean it is the way those they claim to champion actually use (and misuse) the National Health Service. What have they to say about appointments made with the GP or nurse that are never kept? What have they to say about the hundreds of thousands of pounds worth of drugs that are prescribed but never taken? What have they to say about appointments demanded by patients for the sole reason that they can get over-the-counter drugs free (paracetamol, mouth washes, moisturising creams etc.) on a prescription exempted from charge. And don’t tell me that the GP should resist such requests: as likely as not such a refusal would result in a complaint that can take hours to respond to and resolve properly. The list goes on.
There are individual instances that beggar belief. Once, when I was running a Saturday morning surgery a patient rang and asked if I could look across the street to see if the launderette was open. You don’t believe me, do you? Well, don’t if you don’t want to. The Patients Association might be happier to put it about that the reason we gave up on Saturday morning surgeries was because we wanted to spend more time on the golf course.
Believe what you want. I worked bloody hard in general practice for 40 years. Much of it I enjoyed. But like many of my colleagues, I don’t think it is a job worth doing any more.