Saturday, 26 May 2007

Terror tales

The wonderful Hospital at Night team have brought us yet more cost cutting dumbing down in the form of 'Safer Care Safer Training' and the 'developing of the role of nurse coordinator'. It really must be seen to be believed. There is an extensive 56 page document that outlines the so called 'competency framework' of these nurse coordinators. 'Competency' is really such a great way of introducing this marvellously termed 'safer care safer training' agenda, I wonder if the lambs skipping through the green pastures come as a free bonus item?

"Implementation of the European Working Time Directive (EWTD) and the associated reduction in the working hours of junior doctors has provided impetus for new ways of working, service reconfiguration and role redesign."

translation: EWTD means we are replacing doctors with nurses

"By using these competences, Trusts can be assured of a highly effective patient focused resource, maintaining continuity and supporting the challenge of the EWTD."

translation: by listing endless competencies we shall pretend that it is safe to use nurses in a role for which they do not have adequate skills and have no had adequate training.

"There is evidence to suggest that with improved clinical co-ordination at night, this innovative model of care delivery results in better patient care"

reality: No, there is no evidence that HaN results in better patient care. In fact there is an ominous lack of any data and a rather large amount of anecdotal evidence that points to the opposite; even the well funded pilot schemes showed no improvements in outcomes, there was actually a rise in clinical incidents.

In fact only just over a half of the participants actually took up the competency framework, this leaves almost half who don't have any care for competency. This is what these nurses are let loose to do clinically:

"• Review presenting conditions and determine the appropriate intervention for an individual

• Assess an individual’s health needs and status
Prioritise individuals for treatment and care following assessment
• Co-ordinate further assessment or investigations prior to initiation of an intervention
• Develop and agree treatment plans for individuals
• Provide therapeutic care interventions within sphere of competence"


"Take a presenting history from an individual to inform assessment

Perform a comprehensive physical examination and demonstrate the ability to recognise normal, deviation from normal and abnormal findings in relation to the following systems:
Cardiovascular, Respiratory, Abdominal, Neurological

  • Interpret routinely performed diagnostic tests

  • Prioritise and refer individuals for further assessment and care

  • Demonstrate an evidence-based approach to patient care

  • Discharge an individual into the care of another service"

So how will these nurses be trained to carry out these doctor's jobs? The answer is that they will certainly not be trained to the high level of doctors, they will only receive a dumbed down and shortened training before being let loose on the public. Will these nurses have to pass rigorous examination that test their clinical knowledge and skills thoroughly? Hell no, that would be far too hard, they can simply assemble a portfolio of random evidence that proves their undoubted 'competence' to be doctors. In this way a bit of reflective practice can replace proper tests which they might fail.

In this lethal manner proper medical training is being undermined by this dumbed down 'competency' based empowerment of non-medically trained staff. The claim of 'safer care, safer training' is a cover for the reality of 'shoddy care, dumbed down fisher price training'. It simply beggars belief that staff without adequate training are being let loose to diagnose, interpret investigations and manage patients in this manner.

It goes hand in hand with modernisation program that has brought us Hospital at Night, a scheme that has no decent evidence that it is even safe, which has seen hospitals run with dangerously few doctors around to save a few quid. The pressure on trusts throughout the country, thanks to large centrally imposed deficits, is the driving force behind this program of 'competency' based cost cutting.

Lives are being lost as a direct result of schemes like this, but the government just keeps on 'modernising'.

1 comment:

Anonymous said...


In the hospital setting, the problem is the consultant. He/she is in charge of the patient. Consultants MUST stand up and be counted over this. If they truly beleive that dumbing down is unsafe, and it is, they have a duty of care that their patients are not asssessed ie full medical history / examination by anyone other than a quaified medical practitioner (ie MB ChB type of medical practitioner.) Full stop!

Everything is now creeping out of control. And soon it will be very difficult to reverse. It is dangerous. It is malpractice. A consultant simply has to say, "no" when appropriate. They could stop this fiasco tomorrow just as they could have put an end to MTAS at the very beginning.

In the hospital setting no one else can do this apart from the consultants. Administrators can't, junior staff can't. What are consultants doing? They are sitting on god damn committees designing the dumbing down protocols.

They need a rocket up their backsides!!

I can get really ratty about this during the witching hour!!!