People who abuse or threaten nurses and doctors in England will face fines of up to £1,000.

I just hope that it extends to everyone in the NHS.

Like ambulance workers.

More on a case of ‘abuse’ towards my crewmate and I tomorrow…

My brother let me know about this story and when I got home Mariamne had emailed me the link (as well as telling me about some awful nursing homes in America).

 Manchester United and Liverpool have issued a joint statement condemning the fans who attacked the ambulance taking Alan Smith to hospital at the weekend. Smith, 25, suffered a broken leg and a dislocated ankle during United's 1-0 FA Cup defeat at Anfield.

Reports in several newspapers on Thursday claimed the ambulance was surrounded by people who threw stones and bottles at it and even tried to rock it from side to side. The two paramedics - both Liverpool fans - were described as being "horrified" by the hostility shown once the culprits realised the occupants of the ambulance were Alan Smith and Manchester United's club doctor Mike Stone.

You can read more about it at the Guardian.

It really beggars all description, attacking an ambulance is just evil – even warring nations tend to not attack Red Cross ambulances, yet these ‘fans’ wanted to do serious harm to the people inside.  I’m just hoping that there is plenty of CCTV footage for the police to look at.

When I saw the picture of the footballer’s injury I instantly recognised it as a fractured dislocation, which is a very nasty injury.  He should be very grateful to the doctor that he was unaware of what was happening to him (I suspect that the doctor gave him some Ketamine).

Just a nasty business all round.

Further to my last post I was sent this link by Lianne (Thanks Lianne)

This article reports on a story in the BMJ, saying that the elderly in NHS nursing homes should not receive CPR.

Writing in the British Medical Journal (BMJ), Simon Conroy, a clinical lecturer in geriatrics, called for a review.
He said: "Given the likely low chance of success, it may be that the institution should not offer resuscitation at all.
"Resources saved by not spending time in training and the subsequent discussions could be better used in improving the quality of care.

(The full article is behind a paywall here)

Please note, I haven't read the full article - I may try to sneak down to Newham Hospital library to have a peek at it.

But I can see a couple of problems with the thinking from just the Daily Mail piece.

First - All NHS nurses are trained in CPR as part of their basic training. It doesn't cost much to keep those skills updated. As I wrote in the previous post, the London Ambulance Service will come out for free and teach you how to perform effective CPR.

70% of cardiac arrests happen outside hospitals, and before the introduction of defibrillators in public places the survival chance was 1%, after the defibs were in place the chance of survival was 3%.

Given the cost of Defibs, was this a worthwhile spending of money? Does the doctor who wrote the article think that putting Defibs in Tesco while removing them from nursing homes is a good idea?

Secondly - Why should we put any money into a treatment that only has a 3-6%(depending on source) success rate? If it is a waste of money to resuscitate the elderly because it has such a low chance of success, then that would apply to any out of hospital arrest.

I'm sorry, but it smacks too much of "let the old ones die" to me - and that is just distasteful. If we start heading down that route, then we may as well stop treating the unemployed or chronically ill because they don't contribute anything to the economy.

My personal view is that CPR is inappropriate in a large number of nursing home cases - but that it should be an individual choice not to be resuscitated and not the default option.

I would have like to have written more, but I'm at work and time/computing resources are limited.

UPDATE: A couple of people have sent me a copy of the article - I'll not mention any names in case it gets them in trouble - but thanks to those who helped. Once I've read it I may post about this subject again.

Some patients with chronic lung disease need oxygen, and rather than keep them in hospital, these patients often have cylinders of oxygen delivered to them at their home.

Until recently it was the pharmacist who supplied these cylinders, but the government in it’s infinite wisdom has decided to privatise the supply of oxygen.  This means more paperwork, which NHS Blog Doc has already covered.

And now a patient has died, possibly due to a delay getting her oxygen delivered.  It drives me crazy that I spend my time in my ambulance going to 23 year old men with coughs, yet apparently no ambulance was called for this woman.

It all comes down to the government wishing to run the health service like a business.

I know that some people believe that the free market will constantly provide superior service to anything run by the government.  Unfortunately healthcare isn’t a ‘market’ and this market view of the NHS  leads towards some very silly initiatives.  It’s why ‘failing’ hospitals get less money than ‘successful’ hospitals, who would want to throw money into a failing business?

Why are hospitals so dirty?  Because of the free market contracting of cleaners to the cheapest supplier – regardless of the quality of the cleaning.

It’s also why, despite increasing numbers of patients, increasing calls, very few new staff and all the other reasons why we may not meet our government ORCON target this year, we’ll get less money to be spent on improving our service.

But what do I know – I’m a van driver not an economist.

This week the round up of medical blog posts “Grand Rounds” is up at Science and Politics.

As Neil Gaiman just wrote…

Writing away on about three different deadlines right now, so the blogging is probably going to suffer for a week or so. (Traditionally I either follow a post like that by disappearing completely or by posting twice as much.)

I never thought I’d share anything with him, but the first draft of ‘da book’ needs to be in by the end of the month, so blogging may be a bit light for the next two weeks or so.  I’ve got some stuff to write about last nights ORG meeting, some in private emails, some of which may end up in this blog.  There also may be some scribbling over a little project I’m doing – this may however remain private.

If I get something really interesting in the next two night-shifts I’ll let you know, but I may be a little to busy to turn belly-aches into interesting posts.

The Amazon adbox (the only ad I’ll ever have) has been turned into a “what I’m reading now” box.  Do with it as thou wilt.

The regular round up of medical blogs, ‘Grand Rounds’ are up at Barbados Butterfly.

DISCLAIMER: I am not an economist, and while I talk about union matters I’m not a member of any union.  Everything that I post here is true to the best of my knowledge at this moment.

When the unions asked the ambulance crews if we wanted to sign up to AfC “Agenda for Change”, we didn’t know the terms and conditions, nor what we would be paid.  The unions (at least Unison) suggested that we sign up to the new deal sight unseen.

The official deadline for the implementation of AfC was October 2004 – but it has taken so long for our pay to be worked out, we have only just started receiving it.

Our basic pay has gone down.

In the old scheme I was paid approx £22,500, with a bonus of £2,000 due to the high cost of living in London.  I wasn’t paid more for working nights or weekends.

Now, under AfC, I am paid £19,248 as basic pay.  I have money added for living in London.  The difference is that you receive a bonus on your pay depending on how many “unsocial hours” (nights and weekends) you work.  Due to the shift pattern I am on, my bonus is 25%.  Some people who don’t work nightshifts will have 0% bonus.

I take home more pay than I did under the old scheme (although in the long run I think I am going to be worse off because of the way the AfC ‘bandings’ work)

This month we have had our pay adjusted as we should have been paid this new rate from the deadline of October 2004.

However our ‘basic pay’ has been overpaid due to the difference between what we were paid (£22,500), and what we ‘should’ have been paid (£19248)

So that has been deducted from this months paypacket (around £3020 removed from each of us, some people for arcane reasons too complicated to go into have been deducted around £2,200).  Also deducted has been the £1,000 we were ‘advance paid’ last year.

Due to our ‘bonus’ for working unsocial hours which we haven’t been paid – I have an extra £5,137 in this months paypacket – which for me, personally makes this a good month.

My additions equal £5,137

My deductions = £4,020

My bonus for this AfC is therefore £1,117 which is added to my normal pay.  I come out on top (just).

But…

If you don’t work any unsocial hours – then you would miss out on that extra £5,137 in your packet, yet will have been deducted the £3,020 because of the reduction in our basic pay.  So I’ve heard of people taking home in total less than £800 this month.  (I’ve heard rumours of someone’s paypacket being £68.)

Also we have paid tax on the £3,020 we were ‘overpaid’ – will we be getting a tax rebate?

While our pay is ‘protected’ from being lower than it was before AfC, this doesn’t seem to count for deductions due to overpayment – although some people more legally minded than me are saying that such a ‘clawback‘ of money is against the terms and conditions of AfC.  Additionally it is believed that any reclaiming of ‘overpayment’ should be discussed with the staff four months in advance, and not sprung on us when we opened this months paypacket – it should also have been arranged so that any repayment doesn’t cause ‘undue financial hardship’.

The general thought is that the LAS accounting/management team has made a huge screw-up both legally and morally, and we are hoping that there will be a big U-turn over this pay coming soon.  Some staff are seeking advice from employment lawyers, which will make the next few days ‘interesting’ so say the least.

Morale at the moment is about as low as it can go – and this will doubtless affect our ORCON times, as who wants to come in and work overtime when you feel as if the LAS has shafted you.

The unions are remaining silent at the moment, and current belief is that they have sold us road staff down the river.

Personally, I’m fuming over decisions that have scuppered so many people on the road.

Comments are, as always, welcome especially if you think I have worked things out incorrectly – but trust me, everyone in the LAS affected by this has been working things out to be the same.

 

See – I told you I could do this without swearing.  Although there is a lot of swearing in messrooms across the capital at the moment.  I’ll update you when I know more.  Also – if my basic pay has gone down, this will affect any application I make in the future for a mortgage/loan – and I couldn’t afford a mortgage on my old pay…

An EMT killed their workmate when they ‘playfully’ shocked them with a defib.

“Joshua Philip Martin was in his fourth day on the job as a rescue-squad worker in Russell County when, in a playful mood, he decided to reach into the front seat of the ambulance and zap one of his co-workers with the defibrillator paddles. The rookie's mistake was fatal.”

A horrific story, and really beyond comment.

Via Warren Ellis.