We old doctors have watched the decline over the years with a
terrible feeling of hopelessness.
My old cleaning lady told me once that
her father was a scaffy.
A scaffy is the old Scottish word for a street
cleaner. Her father's job was to clean Ann Street - that was his street. Each
scaffy had his own street and they all took immense proprietorial pride in
their street, each one vying to be the best.
Today our city's streets are cleaned by some big company,
employing people who give the impression of not giving a damn.
I believe
the same principle applies in hospitals.
When I started my career as a doctor, I applied to work for a
particular consultant. It was his decision whether to employ me or not. His team
consisted of a houseman (me) and a registrar and himself. In this first job - surgery
- there were 2 surgical teams, each having a huge old fashioned nightingale
ward.
Like the scaffy, the patients in my ward where mine. It was my job
to look after them. I lived in the hospital, but was allowed out every other
night and every other weekend. When I was not there, the houseman from the other
surgical team covered my patients. I did the same for her when she
went out. So we both got to know each other’s patients.
The nurses on my ward were wonderful. If I remember right, there
were 3 sisters and several staff nurses, who rotated every 8 hours. Again -
that ward was their ward and they took a pride in it being
to the highest standard possible.
The ward also had its own cleaner who came in everyday and took
a similar pride in her ward
The hospital had a
matron who regularly inspected each ward.
All this has been lost. Consultants are
no longer allowed to choose who work for them. They do not have a particular
ward and a team. Junior doctors now all follow a complicated training
rotation, which moves them here there and everywhere, never being allowed
to experience the responsibility of having their
own patients
Their hours are now governed by the EU which protects them from
the crippling regimes that we endured but does not allow enough hours to give
proper cover or to learn enough to practice.
Nurses also seem to be moved from ward to ward, so that no one
sister, is on one ward, long enough to get a sense of responsibility for it. I
do think that the biggest problem with nursing is under staffing. Most nurses
want to do a good job but find it impossible because they are too busy.
Because nurses are now frequently going off sick, the NHS constantly
has to employ agency nurse at vast expense. Agency nurses should
be just stop gaps, for emergencies, but it seems that often there are more of
them, than the regular nursing staff. With all the best will in the world an
agency nurse will not be as appropriate.
Everything
everywhere is getting too big and too impersonal - is this globalisation?
I don't like it
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