Management

Margaret McCartney

The past few years “whistleblowing” in the NHS has been seen as a dramatic act somewhat separate to the common activities of the clinical day.

The truth about how unnecessarily high-risk situations are brought to the attention of management is rather more complex and subtle. You observe that your community child clinic is overworked to dangerous levels, and you note that notes are not arriving: you tell management.

There are meant to be 4 paediatricians in clinic; however, during the period 2006-2008, one was off sick, one was on special leave, and two resigned. Juniors were left to take on tasks that would normally have been done by consultant staff. During this time baby P was seen.

Kim Holt - Support for Baby P clinic whistleblower Dr Kim Holt – a consultant paediatrician, was one doctor who raised these concerns, well before baby Peter was seen.

Her observations were not acted on: instead, cuts were made to the service. Dr Holt was off sick when baby Peter attended - Great Ormond Street Hospital – senior management must take responsibility over Baby Peter – and while it is easy to blame a single doctor for not picking up his problems, it is more realistic to view this failure in the context of more generalised problems within the clinic structure.

Dr Holt remains on full pay but has not been allowed back to her job. A report has recommended that she should be allowed to return: regardless, she remains in an extra-numerary part time position while the shortage of paediatricians remains. A petition to support her is here: Support for Baby P Clinic Whistleblower Dr Kim Holt. Whistleblowing should not need to come at such personal cost.

Margaret McCartney

The northern council of the British Medical Association has sent out a press release opposing the central storage of certain medical records and the fact that patients must opt out rather than in: Summary care record 

Nonetheless, preparations are now underway to get 9m or so records on to the database. I don’t like the opt-out system (and it is very hard to opt out) or the fact that so much information is stored. From what I’ve seen, the administration side also seems to overwhelm useful clinical data.

Margaret McCartney

I am confused. The Robert Francis inquiry is a the response to the Healthcare Commission’s investigation into the higher than expected mortality rate at the Mid Staffordshire NHS Foundation Trust.

The enquiry says “many staff” expressed concerns, but were “ignored”. Nurses complained there were not enough beds to cope with the demands placed on the service, and that they were expected to deal with a workload far above what could be safely managed.

Pressures to meet waiting time targets compromised care – for example patients were moved out of A&E regardless of their clinical state and how much monitoring they needed.

There were not enough senior and skilled nurses.

Wards were made more mixed to contain more different types of cases, despite objections from clinical staff that it would compromise care.

Trained staff numbers were reduced in ward reorganisations which went ahead despite opposition from clinical staff.

Why were the savings being made? The hospital was in debt, and this is what drove staff cuts.

Alan Johnson, then health secretary, has said there was a ”a complete failure of management to address serious problems and monitor performance”. But management had in fact been doing an awful lot of what they had been told to do: sort out the financial problems, meet the targets.

We are now coming round to thinking that it isn’t just individual mistakes that should be seen as problems, but the system, which allowed them to occur.

Blaming the managers is an easy option. Isn’t it the case that the system that managed this Trust – the political structure that told it what ‘good outcomes’ were – is the one to blame?

Margaret McCartney

Part of UK NHS development has been to make some nurses specialists in their area. Some aspects of this are not new – if you keep people learning and involved in a certain area – diabetes, say, or asthma – they are going to get very familiar with management of that particular condition.

The NHS and Department of Health, though, have moved things further yet – for example, by allowing nurses to prescribe any medicine after a few weeks training. Not everyone has “done the course” however, or wants to sign their name – which means that phone calls are not unusual from, say, the pain nurse, the respiratory nurse, or the terminal care nurse asking for a patient to be given whatever drug.

Margaret McCartney

Cuts in NHS spending are looming. So we would want to be sure that the money in study budgets is being wisely and carefully spent, and with an eye on the evidence.

This course - Core Skills in Creating Excellence in Patient Experience – is not the most expensive of its type but look at how many kinds of staff it is aimed at - all administrators and lots of nurses. It could give Martin Lukes a run for his money for gobbledesense: “Lead the creation of a truly customer-centric culture of excellence … this course, designed for those taking the lead, comprehensively covers developing a patient experience excellence strategy and implementing it throughout a team, department or even a whole Trust.” All in just one day!

By Rebecca Knight

Have you ever worked for a boss who rarely took a vacation, and wouldn’t dream of leaving the office early to take her mother to the doctor, or see her son’s school recital?

I have. It was miserable. It was one of my first jobs out of university. I felt like I wasn’t entitled to a holiday; after all, if my superior wasn’t taking time away from the office, I didn’t deserve to either. And God forbid I have any personal obligations outside of
my professional ones: my boss didn’t have them, and neither should I.

Andrew Jack

With the UK government warning employers to prepare for up to an eighth of their employees to be absent from work because of swine flu in the coming weeks, some businesses could be stretched to the limit.

There again, things could get worse still if current discussions lead to recommendations to keep schools closed after the summer holidays until a swine flu vaccine is prepared and given to children. That would mean more staff staying at home to look after them - just when business is picking up after the break.

So how is your business coping with the swine flu outbreak? Is it a serious threat to the recovery of the UK economy? What is the impact of the on the workplace, and your ability to operate? Share your views by clicking here or on the link below.

By Rebecca Knight

When you have a sore throat, a sinus problem, or a sprained ankle, who do you call? Your primary care doctor. These docs are also the folks you turn to for chronic care and preventative care, and for immunisations and cancer screenings.

But the ranks of these reliable folks are thinning. The US faces a looming shortage of primary care doctors in the coming years; in fact, the Association of American Medical Colleges estimates that the overall shortage may grow to 124,400 by 2025. The numbers are worrying: as Baby Boomers age and disease rates for obesity, diabetes and hypertension rates, access to these doctors is critical.

By Nicholas Timmins

To their advocates, electronic medical records are the Holy Grail. Something not just desirable but essential for the practice of modern medicine. To the sceptics, they remain an expensive, potentially dangerous and unproven set of technologies.

Across the world, however, healthcare systems and governments are investing in electronic medical records – even if getting them up and running is proving a struggle everywhere.

That they are needed is not in question. Don Detmer, chief executive of the American Medical Informatics Association, says medicine is fracturing, with doctors becoming ever more specialised. The pace of research is such that no individual doctor can keep up. Patients are no longer treated just in primary care settings or hospitals but in a wider range of environments, by a wider range of clinicians, and for a wider range of illnesses as patients live longer, often with multiple chronic conditions.

“It used to be that medicine was pretty safe because it was mostly pretty ineffective,” says Mr Detmer. “Today it is both effective and potentially dangerous.” The record, in effect, becomes the glue that holds a patient’s treatment together: sophisticated electronic records provide decision support tools to help with diagnosis and reduce the chances of dangerous drug interactions, while providing the basis for a good medical audit of the outcome of treatment.”

But while electronic records have been around in one form or another for well over 20 years, not even the most advanced country has them operating everywhere yet – and this in a world that routinely banks, orders books, music and many other goods online and, for those with the money and technological sophistication, runs its pensions, investment and other complex financial products electronically.

Continue reading ‘System upgrade’

By Alicia Clegg

Is the size of an employee’s waistline any business of the employer?

The notion of companies concerning themselves with their employees’ lifestyles once seemed strange. But in the light of broader societal concerns about health, the role of employers in the provision of healthcare is more relevant than ever.

The economist Julian Le Grand has even proposed that large employers should be legally required to “automatically enrol their employees in a weekly exercise hour, unless the employee chose to opt out”.

Two years ago, Unilever invited its UK staff to undergo confidential health screening to assess their fitness. Now the company has launched “Fit Business”, a year-long pilot programme to encourage its people – more than half of whom were revealed to be overweight – to eat healthily, become physically active and monitor their blood pressure, body fat and cholesterol levels.

Continue reading ’The carrot and stick approach to healthier employees’

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Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog: www.margaretmccartney.com/blog

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow

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