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.

The guilt of the sum is greater than that of all of its parts?

Once again this week the tragic case of Baby P(eter) is on the news screens of the UK and once again the Press screams about individual’s incompetence as the failing(s) but it may miss the collective target in terms of overall responsibility.

Imagine if you can a situation in the UK where a group of GPs work closely with a group of health visitors in a practice setting. Over the years they develop a rapport where each knows the strengths and weaknesses of each other and also they know their patients.

Their social intercourse on a daily basis means that little snippets of information are passed between them. For example there might be a family of concern about whom a conversation similar to this might take place en passant:

"Hello Northern Doc, you mentioned the other day that child X had condition Y."

"Yes I did. What of it?"

"Well did you know that their Mum was assaulted last week?"

"No, I did not. Who by? "

"Her new partner."

"Who’s that?"

"Dicky W*nker. "

"Really? Didn’t he do time a few years back for indecent exposure to minors in the local park?"

"I didn’t know that Northern Doc but I am now on the case. . . "

A simple sharing of information like that combined with follow up by those concerned might just lead to the exposure of a Schedule 1 sex offender who had been beneath the radar for years.

Now the Party does not do information sharing between professionals although it wants you to share all of your information between Party members via the Summary Care Record. Information is often the key to protecting children but information in isolation is often useless.

Protecting children, and the elderly, is like a jigsaw puzzle. If you hold a small piece of the jigsaw in isolation you do not see the whole picture. The ability to share the pieces may give you an increased chance of seeing the whole picture.

Which is why the Party took away our health visitors and reorganised the way in which we now work. What used to take one conversation like the one above now takes several phone calls and days of waiting just to identify the responsible individual. Having identified them you then have to find them to actually talk to them and share the information.

The current state of NHS health visiting means that trying to complete the jigsaw as a GP is hampered by the NHS adopting so called “silo working”.

The sum, here the protection of the individual, is greater than all of its parts, for all of the parts are usually there. They, as usual, are not shared. So the sum fails but the individuals are blamed. They are blamed for the failings of those who instituted the sum.

The sum was devised by our politicians and all their little local commissars. It was they who ultimately employed all those who failed and it is they who also dictated their terms of engagement.

Praise be to the Party for they are once again all wise (after the event). The problem with the Party is that when the system fails all fail for they cannot without the system.

The depressing thing is that it is said it will happen again. Unfortunately it will and all of the NHS reforms of the last 13 years have made it easier than ever to happen for they have destroyed the information sharing that is vital if these tragedies are to stand a chance of being avoided.

Child Protection, away days and Lord Laming’s report and is VIC there?

Is VIC there?


This week we had a scheduled meeting with the finally identified (after many, many months of searching), fully paid up but, totally unaccountable but important Party idiot and elite member of the local Thickerazzi, who had rearranged health visiting in Northernshire using what we shall term the highly successful “Doncaster” model - their words not ours. It is like Haringey child protection only better as it is “world-class” again their words in quotes not ours.

The, totally unaccountable but important Party idiot and elite member of the local Thickerazzi, was unable to attend this meeting. They had to “rush” away to another “important” meeting no doubt in one of the larger shire towns here in Northernshire.

Remember no one ever “goes” to hospital (with their life threatening bunions) they are always “rushed” there.

Likewise with local Politburo commissars where all Party approved meetings are always “very important” as is their avoidance of meetings arranged a long time in advance (because of the importance of Very Important Commissars VICs). It is also essential for their avoidance of responsibility for inaction.

No meeting = no problem identified by the local Party Politburo to paraphrase the originator of current Politburo thinking and (in)action in the UK a certain Joseph Stalin.

Cancellation, at short notice, adds to this avoidance of responsibility and devolves the accountability to their juniors or to those asking for the meeting.

“It can’t have been that important, comrade, or we would have been there . . .”

Nice work if you can get it, comrade VIC, all expenses paid and work avoidance too.

We landed up having a meeting with a junior, but elite member in training of the local Thickerazzi, who was there to “support” (= do nothing) the workers in another profession who care on the front line for patients whose service had been rearranged on similar lines to the “Doncaster/Haringey” model which was failing spectacularly to deliver the previous levels of service that had actually worked.

This NHS “success” had been arranged by the totally unaccountable but important Party idiot and elite member of the local Thickerazzi who just happened to be absent.

Remember “reform” of the health service is the process where if something works it has to be replaced by something that does not and creates in doing so more managers to ensure that less is achieved.

Support is an interesting word in NHS management as it usually means do nothing and if something brown hits the fan then senior NHS managers usually are conspicuous by their absence and get promoted. The grunts on the ground usually get shafted.

The comrade workers being “supported” were duly lined up, in uniform and on parade, as heroes in the Great Patriotic War always are, to show that the local Politburo were (again) in the top twenty of world rankings (we think there may be a silent w or Rossey r missing here) for “world class commissioning”.

The issues that we had wished to discuss with the totally unaccountable but important Party idiot and elite member of the local Thickerazzi are already those that His Lordship Lord Laming has highlighted as child protection failings but the VIC responsible was not there.

They had more important things to do than talk with frontline healthcare professionals called GPs. Our concern was not to miss the next Baby P(eter).

But this was not discussed due to the absence of the totally unaccountable but important Party idiot and elite member of the local Thickerazzi who had created all of the problems.

We know not what they were concerned about but their meeting must have been very, very important?

Praise be to the Party and its numerous and totally unaccountable but important Party idiots and elite members of the local Thickerazzi. These are the people that institute the policies that fail patients so badly.

When concerns are raised and they are finally identified what do they do?

Nothing.

They run away and hide in another meeting. And eventually get promoted. They are important as they do nothing for anyone least of all our children.

A Recent Symposium

ND and fellow Resistance Fighters were recently at a true symposium (the Greek meaning of the word) at the Café Michelle. As they indulged in a bit of symposing inevitably the conversation turned to the increasing top down dumping of useless work on doctors by non medically qualified managers. As by now a lot of symposium “work” had been done there was a lot of irreverent humour floating about.

During this period someone jokingly said:

“I think therefore I am. You think therefore you aren’t!”

This was met by one of those stone cold silences that stop laughter dead when all realize that something profound has been said.

Someone had encapsulated the current state of the relationship between NHS managers and medical staff in Northernshire. It is called “clinical engagement”.

Praise be to the symposium for sometimes in vino veritas.

Postscript: a few days after that remark was made a story broke regarding child protection issues in a town in the south of Northernshire. The issue that gave rise to the above comment was proposed changes to local child protection procedures and the model proposed by the local Politburo commissars was that used in the same town in the news story.

Praise be to the Party and its local Politburo commissar managers for they always know better especially regarding child protection.