Hospital at Night -working well

I have already touched upon this particular issue, however the wonderful HaN scheme continues to be rolled out across the country to the 'benefit' of patients far and wide. The spin backed agenda actually has no evidence behind it that shows it will 'benefit' patients though.

The only evidence consists of four pilot studies that were rigorously implemented, however even these aberrant case studies showed no improvements in patient outcomes or care. The pilots shows no change in mortality and an increase in critical incidents, not a 'significant' increase though apparently. Based on this small sample the scheme has been trotted out in hundreds of hospitals nationwide, unfortunately there is no mechanism for assessing the impact of these HaN schemes on patient outcomes. Given that these schemes are not implemented with nearly as much thought or effort as the pilots, the potential for carnage is enormous as the scheme is used as a justification for dangerous cost cutting by under staffing hospitals at night time.

The following has been written by an anonymous consultant who speaks of the dangers of this cost cutting scheme:

"After consulting with the junior docs on the HAN rota covering six specialities, including tertiary referrals for three of them, being one doc covering all the patients at night, taking the calls and trying to do the routine ward stuff - we agreed it needed to change.

They accepted it would mean more nights per rotation but felt this was better. So we devised a parallel rota of a 1:7 with no cover, split the specialities in to two, but if one went to theatre the other would cover the wards etc till they came out. All happy and after 28 complaints about stress, too much work from guys who had seven years experience and were waiting for SpR jobs, we thought this was a good compromise for patient safety. And the FY2s who went off with stress and bullying complaints agreed.

Then a consultant who does not work in said hospital, has not spoken to anyone - deems that this is not appropriate because we will be getting Hospital at Day nurses who will help ease the work load of the night staff.

How I ask will they help with the tertiary ENT referral with a quinsy at 0300, the obstructed kidney, the thoracic pt desatting and chest drain fallen out. They will apparently.

So we go back two years, and now have a straight 1:14 rota imposed. removed the extra SHO at the weekend - deemed unnecessary and changed the FY1 hours so they can not help with the admissions on a Sunday.

I have put in writing my objections and await our first death. I am gutted that what I thought was a good piece of planning, governance, considering the juniors comments, improving working practice and safety - has been over turned by someone who knows nothing about the set up and looks at a piece of paper."

Unfortunately this is not an isolated example, this is very much the norm for HaN. The scheme 'Hospital at Night' is just an idea apparently, so the team are happy to take credit for any successes while they deny responsibility when it all goes belly up; a hallmark of New Labour's 'central credit local blame' strategy. The message is clear, do not get sick at night time.