Three years ago the College came to visit us. Everything was commended, from
the teaching, to the hands-on experience for the SHO's etc etc. However,
they decided that the night-worth-of-time-spent-in-A&E would not consitute
good training, as there is no middle/senior cover, exceptr of course from
in-house the specialties. Therefore, A&E staff went home at midnight, but
the dept remained open for business ment by other sho's on call that night.
It was the nurse's in charge job to decide which specilaty the newly came
patient would most likely belong to and he/she would it then be bleeped. The
result was a complete disaster and nightmare to run. Orthopods are covering
for surgery and vice-versa, and if they were in theatre the next to be
called, as per the "cascade" would be the medics... Now, one would certainly
ask what would the medical consultant position (and responsibility) for a
patient who was referred to his team in the middle of the night for a
non-medical problem. Conversely, the surgeons argued that their job would
not entail expertise in saving the life of somebody with aheart attack in
resus in A&E while the medics were busy in a cardiac arrest somewhere else.
There were various permutations on the same tune, of course.
However, we were revisited and "re-evaluated" by the same College, which,
when confronted with the facts supported by figures and near misses, just
said: you need to be open 24 hours a day, and we'll approve an extra SHO
post...
Closing an A&E dept at night is the potential end to an entire hospital.
This means that no ambulance stops at your door, therefore to the bin goes
peds, surgery, O&G etc.
Also, I suspect that the public of an area threatened by the closure of
their A&E dept will not swallow it at all.
Tudor
Dr. Tudor Codreanu MSc(Med)
Staff Grade Physician
Accident and Emergency Dept.
Dr. Gray's Hospital
Elgin
tel: 01343 543131 ext 67360
dir: 01343 567360
fax: 01343 552612
e-mail: [log in to unmask]
> -----Original Message-----
> From: Steve Meek [SMTP:[log in to unmask]]
> Sent: 07 January 2003 12:43
> To: [log in to unmask]
> Subject: Re: SHO supervision at night
>
> I reckon too that the college will back off. I have
> heard these threats used before and are used to exert
> pressure, often with the support of the ED Consultant.
>
> The problem is things will have to change, and lone
> SHOs at night will have to stop as it is dangerous,
> but not having an ED for 30 miles is also dangerous.
> Getting middle grades is so hard isnt it, the staff
> grade post needs reinventing on a decent salary for a
> start. A government which recognises this problem
> would tackle middle grade recruitment - I'm sure BAEM
> have told them this.
> Abergervenny is such a lovely area...if they funded
> more consultants would you not get some quality
> applicants? Not the whole solution I know.
>
> Steve
>
> --- Nick Jenkins <[log in to unmask]>
> wrote:
> > ...answering on Danny's post because he's been so
> > nice to me!
> >
> > The bit I didn't say was that their stipulation was
> > not for the whole of the
> > post but for an unstipulated time when the chaps are
> > new in their post and
> > vunerable. The aims are laudable although smack of
> > the hand-holding that
> > juniors these days need. My point however is to ask
> > should the RCS dictate
> > to our Specialty how we should staff and run our
> > Departments - is that not
> > for us (?BAEM) to decide? Also, as noted by
> > Andrew, any requirement
> > should be consistent amongst all Departments.
> >
> > It would be really good for improving quality of
> > patient care if we could
> > all provide this level of cover - the practical
> > problem is of course how do
> > we all do it (and do we, as suggested, lose our
> > good smaller Departments if
> > we can't?). I'm lucky in that I've got excellent
> > Staff Grades who share my
> > committment to the Department and to the provision
> > of high quality care.
> > They however are in the job they love for the rest
> > of their working life
> > and, as they move into middle age and beyond they
> > will not be in a
> > position to work night shifts. They would probably
> > reluctantly leave if I
> > forced them into it and obtain less enjoyable work
> > where their hours were
> > controllable. So what about the SpRs? Certainly
> > with only one at present
> > that could not be my answer for total cover - yet I
> > could do it for the
> > first week of this "vunerable"period. I'd be
> > reluctant as this strikes me
> > as SpR abuse - and sooner or later we'll be holding
> > their hands too!
> >
> > Guess I'll have to clone myself!
> >
> > So I'll talk to the Staff and some way or other
> > we'll cover the vunerable
> > period. Like all these things I simply must exract
> > every inch of good out
> > of it and use it to get more funding/staff/whatever.
> > But thanks for the
> > food-for-thought from those who've replied so far,
> > which has been very
> > useful. If anyone else has any comments I'll be
> > most interested.
> >
> > Thanks again,
> > Nick Jenkins
> > A&E Consultant
> > Abergavenny
> > http://www.ae-nevillhall.org.uk
> >
> >
> >
> >
> > -----Original Message-----
> > From: Danny McGeehan
> > [mailto:[log in to unmask]]
> > Sent: 06 January 2003 20:58
> > To: [log in to unmask]
> > Subject: Re: SHO supervision at night
> >
> >
> > > Where does the list think we stand on this one and
> > if it comes to arguing
> > it
> > > out would it be best done with Faculty, BAEM,
> > local STA or who?
> > > Thanks,
> > > Nick Jenkins
> > > A&E Consultant
> > > Abergavenny
> >
> > I share your concern, it will kill off a lot of
> > departments. The first
> > group that did it were the aneasthetists about 20
> > years ago. Closed a third
> > of hospitals within 18 months. I share your
> > concern. Middle grade cover is
> > difficult to recruit. Many in our area are leaving
> > to go into GP land and I
> > don't blame them. They earn at least an extra 20k
> > and less hassle.
> > Generous tax allowances and no hassle with HR. Many
> > PCT's are desperate to
> > recruit. What with NHS Direct telling their
> > patients to rock up to A & E.
> >
> > Anyway the writing is on the wall and I suspect the
> > hidden agenda may be to
> > close off the smaller DGH's. The modernisation
> > agency will be rubbing their
> > hands in glee. Just think of the number of project
> > managers and data input
> > clerks they can employ and sack a few A & E
> > consultants. They can even say
> > that they are improving the service and get a few
> > exploding pie charts to
> > prove it.
> >
> > I used to work with a very eminent Professor in a
> > so-called Trauma Centre
> > not too far away from where I live who was
> > advocating this very policy only
> > 5 years ago. He was recommending the closure of at
> > least a third of all A &
> > E depts. He didn't get a lot of opposition from the
> > powers that be in the
> > speciality. I often publically spoke out against
> > him hence my move 16 miles
> > to the South.
> >
> > I don't think there will be much support with the
> > vested interests out
> > there. What they will forget is that you Nick have
> > provided a first rate
> > service to the people of Abergervenny. I suspect we
> > may have the same
> > problems in Stafford. There is no way that we have
> > the funding or could
> > recruit sufficient middle grade cover to provide a
> > 24 hour service. I
> > suspect that units like ours will go to a 18 hour
> > service. Close at 10 o'
> > clock at night and just take medical admissions. I
> > could then go and get a
> > job driving taxis or in B & Q.
> >
> > You will probably have to move down to Newport for a
> > night a week. The spin
> > merchants from the various unelected agencies who
> > purport to represent the
> > speciality that we all know too well will say how
> > the service to the
> > patients has improved out of all recognition.
> >
> > Don't forget the whole philiosophy of SHO training
> > is about to change next
> > year with the foundation year. They will no longer
> > be the workforce of the
> > NHS but will have to be facilitated
> >
> > If the worst comes to the worst you can always stand
> > for parliament or even
> > President of the Faculty or Royal College. Could do
> > with some different
> > people on it for a change.
> >
> > Danny McGeehan
> >
> --------------------------------------------------------------------------
> -------------
> >
> > This e-mail (and any attachments) is confidential
> > and may contain personal views which are not the
> > views of the Gwent Healthcare NHS Trust unless
> > specifically stated. If you have received it in
> > error, delete it from your system, do not use, copy
> > or disclose the information in any way. Please
> > notify the sender immediately of this error. Further
> > communication will signify your consent to this.
>
>
> __________________________________________________
> Do you Yahoo!?
> Yahoo! Mail Plus - Powerful. Affordable. Sign up now.
> http://mailplus.yahoo.com
|