Monday, 23 November 2009

Useless jobs in the NHS

If you have not read the most excellent Ferret Fancier’s blog and their post of how many useless managers (we would have liked to use a five letter grunt word that starts with s that had hi in it and ending with e but we thought better) are employed in the NHS in this country wasting tax payers’ money to achieve more management as opposed to the aspiration of Joe Public for decent, or even better, healthcare then we would urge you do so.

See also our photograph of this list on a wall and then think of the great new term that we love at ND Central from across the Pond called “socialised medicine” and you can see why the Americans are worried.

One of us here at ND Central went to sleep, sorry, to a local Party meeting to tell us something important (we think).

As far as we were concerned it was another example of NHS management (in)action namely creating people to do a job which does nothing useful but they (the NHS managers) will happily pay for it as if their box is ticked they get promoted. You get the idea more boxes ticked = more money wasted on more management expenditure = ultimately less patient care and therefore promotion.

A self sustaining spiral of ever increasing expense and incompetence the essence of NHS management.

Let us go back a while to a former time where there was a job called a navigator. This used to be a highly skilled and important job based on knowledge, science, mathematics and a degree of experience.

In the Royal Air Force you used to get half a wing or a brevet as a navigator the idea being you can tell a pilot, who flies a plane, how to get from A to B. Although navigation is not an exact science especially in war time when it is reckoned that only 1% of bombs hit their intended targets (WW2) having a good navigator meant that at least you could get home to fly (and die) another day.

So the local Thickerazi have rolled out a totally new and useless job called the “care navigator” which they say will help the demented patient “navigate” the “complexities” of the “patient centred” NHS to “facilitate” them accessing “world-class” care.

This will be delivered locally via 6 nurses on the frontline of health delivering one to one, “personalized” care by sitting beside a phone. Similar in a way to the couple of people employed locally to sit at a local Poliburo sponsored Swine flu help line (we jest not).

Can anyone see the problems here? “Care navigation” versus real healthcare and help? 6 nurses sitting by a phone as opposed to 6 nurses delivering one to one patient care, or boots on the ground to use the current expression.

Did the RAF use navigators based in a call centre in World War 2? No they were real human beings in real aircraft whose lives depended on many things especially the ability to find an airfield to land on always useful if you are in an aircraft just like getting the right healthcare. It might even save your life.

Remember dear reader that the answer to any problem from the Party is to create a call centre (and lots of managers to run them).

Successes include:

NHS (re)Direct
the National Swine Flu Pan(dem)ic line and of course

BT (India). Yes months on BT (India) are still delivering dial up service at home and after 5+ years a dial up service via N3 at work the later service at your expense.

So bums on seats in call centres top trumps boots on the ground every time for NHS managers with a “problem”

Given these “successes” and please bear in mind for whom the “care navigator” service is for the demented patients of the United Kingdom let us think how this might work.

A concerned relative consults a doctor, or a real nurse, who gives “the care navigator” contact details to the dement’s relative.

Dement’s relative then puts contact details, no doubt on the NHS corporately produced card, on the side of the kitchen along with messages to “shut the door”, “take your tablets” and “do not ring your doctor unless it is an emergency”, “do not reorder your prescription you already have enough drugs” and “poo in the toilet”.

So want does the average dement do?

Come on stupid they completely forget to take their tablets, leave doors open and ring the doctors every 5 minutes to re order their medication and request a visit as they feel “dizzy”. And did we mention the toilet?

However, they suddenly see the “CARE NAVIGATOR” card, and to a stirring rendition of the Dam Busters’ March from a long time ago in their minds they suddenly remember the War and the Blitz spirit.

Let us not pee and crap on our beds and wander naked in the streets at night there is a war on we must all pull together. We, the dements, of Britain, shall dig for victory and ring the Care Navigator.

That we teach the Hun and damned Bosch a lesson! (Quite right their pensioners get better healthcare than we do and they lost the War).

The relatives will of course be thinking, thank God we rang the care navigator, it was the only way we will get this bird down and into a nursing home. If only.

So lets run through this idea again.

A nurse sits at a phone, a highly skilled “care navigator” no doubt wearing a badge as per the Service, for demented patients who are meant to ring them to get help from the “care navigator”. How much of the conversation do you think the dement will remember?

Anybody brighter than your average NHS manager, or a work avoiding nurse doing “care navigation”, able to see a slight problem with this idea?

Like who tells the demented patient about this service? Perhaps a “care navigator facilitator" when it does not work? Another nurse off the front line? Cue another level of “service” provision?

We have already seen this with Community Matrons who have failed spectacularly at reducing hospital admissions that they now have created a Community Matron “support worker” formerly called a district nurse to help them look after their six patients.

More and more chiefs, less and less Indians but at more and more cost to deliver less.

Given the current state of public funds and the inevitable needs for cuts a few of us at ND Central can see one place where the axe should fall with no harm to patient care.

Useless job number 2: "the discharge co-ordinator".

When we were grunts if a patient was fit for discharge this was arranged by the ward staff. Usually staff nurses, sometimes with ward clerks involved, under the supervision of a ward sister who would between them arrange all the bits and pieces needed to allow a patient to go home.

This was in the days when wards had real nurses in adequate numbers and with enough beds to treat patients. MRSA was there then but easily manageable as there were enough isolation facilities, nurses and beds to contain it.
These days are long since gone as despite an increase in ill patients and a population increase of 10 million the number of hospital beds per head of population has decreased. No rocket science here comrades less fuel in a rocket leads via “efficiency savings” to get more bangs for your buck. Or was that deaths for your dollar?

So what used to be a simple procedure called a discharge is now made more complicated as someone now has a job to be a “discharge co-ordinator”.

Rocket scientist or an auxiliary nurse promoted? Have a guess.

Such is the success of these highly paid professionals that if you have ever been on an NHS ward as a patient (and two of us have been in the recent past) and been discharged at 08.00hrs by a consultant can you guess when you actually are allowed to leave a ward?

Try 15.00hrs.


Because the pharmacist who dispenses your discharge drugs was on a ward round.

A pharmacist on a ward round? Bit like a chocolate frying pan but they are important para medics and no doubt the "discharge co-ordinator" had vectored in this 7 hour wait into their incredibly complex NHS navigational equations to improve patient care on the frontline.

Sit on your (ar*e) when well doing nothing waiting for almost a whole working day for an incredibly important pharmacist to dispense drugs that they could do in 15 minutes or less. But the ward round was important so up yours you are only a patient. A 7 hour wait is perfectly acceptable and it is being “co-ordinated” as well.

Gone are the days when Sister would have noticed that a patient discharged by a consultant at 08.00hrs was still on a ward at 10.00hrs and dispatched an auxiliary nurse to get the TTOs (abbreviation for take home drugs) and got them within the hour.

Praise be to the Party for creating “care navigators” and “discharge co-ordinators”. What will be next illness “observers” or nurse “co-pilots”?

Whatever happened to trained nurses in adequate numbers to do the job? We know they are replaced by managers and call centres. Progress.

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