Monday, 20 February 2012

Instinct and the mess that is child neglection in the current NHS.

It takes between 5-6 years to qualify as a doctor in the UK and about 10 –11 years at present to qualify as a GP. A lot of that time is spent learning certain core facts needed to do the job like anatomy and how drugs work. You need to be able to recognize and treat illness and this can be learnt partly from books but mostly from patients, experience and ones seniors.

One thing that is less easily learnt is what we will call instinct. This is when someone walks into your consulting room and their movements, language and behaviour suggest something is not quite right. That same person could see 2 GPs and one miss their instinct while the other hones in on it. We would hope both doctors would spot something obvious like a broken wrist but realize that not all doctors do instinct.

Such an event happened in the recent past when one of the team saw a family whose first language was not English and what English they had was mumbled, incoherent and mostly incomprehensible. The same GP from the moment the patients walked into the room noticed that something was not right. The ensuing consultation and observation reinforced their initial concerns.

A good officer should provide their commander with options but the Department of Health and politicians are not good officers. Their collective policies especially with regard to child protection via TCS (Transforming Community Services) have made information gathering for GPs a nightmare. For it was barn door obvious that this was an accident waiting to happen.

The local Soviet option is that we should to refer social services. A good option that if you can find a social worker and then one who will actually take any responsibility. Instead the local Soviet now wants an assessment document called a CAF (Common Assessment Framework) completing. They did at one time want GPs to do this before referring anyone to social services until they couldn’t find an open GP practice due to GPs spending all their time doing CAFs.

This is a mind numbing exercise that serves no useful purpose other than deforestation you can read one here and remember this will take longer to fill in than it took to identify the problem in the first place. And this is before they can do anything useful.

No all 4 family members have multiple shrapnel wounds, they are from overseas one has a sucking chest wound, the kids all under 5 have gonorrhoea no doubt caught from the toilet seats and one of them has a crow bar through their head and you want us to fill in an assessment tool? They are at risk and need help not paperwork.

In the good old days any queries would have been directed towards our practice based health visitors who were nurses, not social workers trained to fill in forms to prove how little they do and then withhold all that information from doctors. Our once practice attached health visitors were full trained child protection attack rottweilers who would get their teeth into such a situation and get it sorted. A simple word with them would be all that was required to set loose the pack.

Now we write our concerns in a book. No face to face communication, no questioning of facts or sharing of information just a book and you know something is done because a line is put through your information and you hear nothing.

The Party has cut off our arms and legs in terms of gathering intel as they are now gone via the pseudo privitization that is TCS – thanks Tony and Gordon you clearly cared more about the protection of the child abusers and the private sector than you did for abused children.

So the only option is now to fill in a piece of child protection paper and send it off into the ether in the hope that nothing will happen. It usually does.

You can write to NHS managers about your concerns but in the same way that those that thick in a Northernshire comprehensive ignored their teacher and so became a NHS manager they now ignore letters and never reply probably because they can’t read the big words in such letters like child.

So despite all the additional training and support provided by appraisal, revalidation and CPD a grunt in the field did the only thing they could to try and get more information. They spoke to the only professional who is not hidden behind a wall of paperwork and who is easily identifiable as having responsibility for the family and may actually know them.

They rang a fellow doctor. What they found confirmed their grunt gut instinct. Putting all the gory details into the patients’ records took half an hour and we still haven’t heard from those whose the Party reforms meant we should have. We probably won’t given past experience. We can only do our bit but in isolation that is not very much.

No doubt privitization will make this pathetically dangerous state of affairs even better? Will Clinical Commissioning Groups be able to undo the “progress” in child protection privitization made by TCS?

Praise be to the Party and all its dicks for sticking them up child protection via TCS.

No doubt when the accident happens the “drivers” of such reform will get off Scot free for having done everything to impede progress. It will of course be the passengers’ fault for not doing the paperwork.

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