We have been down the path of NOF guidelines -also partly as a result of
external audit. We have decided not to set ourselves unachievable
standards. There was a push to say that these patients should be on the
ward within one hour of arrival. This was clearly impossible for us to
achieve and to put it in the pathway would be pointless. We have gone for
getting the patient onto a proper hopital bed - ie not an A&E trolley
within one hour. This we can and do achieve and is in the spirit of the
original recommendations. Now we need the external auditors to recognise
At 01:07 PM 11/16/99 -0000, you wrote:
>The discussion on Joint care pathways and time to treatment confirmed my
>experience in trying to improve the care of patients in my Dept:
>Excellence in the NHS costs money. If the NHS is not given the resources
>the quality of care will be mediocre with perhaps a few areas here and
>there which have above average funding and can deliver timely advanced
>complex care to all patients.
>Let me explain a bit. Our experience with introducing NOF Fast tracking
>is failing like many others because of inadequate resources. External
>audit 2 years ago in our hospital highlighted shortage of nursing
>establishment by 6 WTE in A&E. This has not been corrected. I introduced
>fast tracking Xrays and analgesia by nurses but a lot of the times it
>does not happen as there no nurses available to do it.
>Based on the Way Ahead 1988 we are short of 3 WTE SHO's This has not
>been corrected either. Our Trust is overspent by £2.5 m this financial
>year. Next year it will be £3.5m.
>We had complaints about long waits: 6-8hrs at W/Es and nights for T4/5
>pts. Shortage of nurses in the wards means closed ward beds, delays in
>admissions from A&E, which mean more nurse hrs for ward care in A&E.
>The Tust can not deliver the elective work effectively either.
>ALL THESE ARE QUALITY ISSUES WHICH WHEN ANALYSED ARE FOUND TO BE DUE TO
>LACK OF ADEQUATE FUNDS. QUALITY=MONEY
>We are failing in these quality issues not because we are not trying or
>providing leadership or not designing good care pathways but mainly
>because we are not given the resources. The picture is similar in other
>areas of hospital work (from talking to colleagues) and from talking to
>my GP wife in Primary Care too. The NHS will fail the Clinical
>Governance test if the resources are not provided.
>Adequate staffing levels ( both clinical and non-clinical staff ) and
>appropriate training at all levels and support of the staff mean revenue
>>From: [log in to unmask][SMTP:[log in to unmask]]
>>Sent: 15 November 1999 16:24
>>To: [log in to unmask]
>>Subject: Re: care pathways
>>>A database of care pathways is certainly useful to
>>>record people's experiences and could probably be
>>>achieved at little expense. Resources required would
>>>be 30-40 minutes of Dr Ryan's valuable time (sorry
>>>John...to volunteer you) in adding a facility onto the
>>>BAEM website with some QA filters.....'biggest bang
>>>for your buck'. Alternatively just use this group and
>>>the threads created.