Saturday, July 18, 2015

Its all a bit odd

Florida. A wet, muggy afternoon. Am on holidays in Disneyland...sitting by the pool as I write this. Don't worry, I am relaxed..enjoying my time off..but while the rest of the family takes an afternoon nap after yet another scorching day at the Park, this seemed like a perfect moment to pen some thoughts.

It's been amusing to see the #IaminJeremy take wings on social media...and it's always the humorous ones which make you chuckle the most..and enough already has been said about whether Consultants work 7 days or not, so won't waste my breath on it.The hard fact is that Consultants, in the main, do emergency weekend work, the contract doesn't allow you to duck out of it. Non emergency however isn't. The debate of course is what constitutes what and whether Consultants should have the right to do so or not.

As a clinician, and as a manager, this has left me scratching my head a bit. Beyond the humour and the daily mail headlines, it's all a bit weird. As a manager, take this catch 22. Hospitals are jammed to the gills, social services are bust, departments are judged based on how many discharges have happened per understandably with all hands on deck, elective procedures get cancelled. The waiting lists bulge and to ease that target, with Consultants  having power to opt out, the only way to bring back parity, waiting list initiatives come into play- and whether we like it or not, it's a headache for many in management, not to mention the financial consequence. So if only, that leverage could be broken, then it's another way forward or simply put, another part of the system creaking..another finger in the dam.

Let's take it as a clinician..let me give you an example of my specialty. Foot clinic...a requirement via NICE is any new diabetes foot ulcers should be referred within 24 hours. Most hospitals don't have even a 5 day service, let alone a 7 day service. Now if someone asks me should I do a Saturday foot clinic..the answer is "Yes..with a but". The 2 buts, at least in my case, what else do you want me to stop doing? I work on a 1:7 weekend helping to evidence patients on wards as well as ensure a 7 day urgent diabetes service is in place. Do I drop that...or would there be investment? Even if we get past that hassle, to run a foot clinic, there needs to be a podiatrist, not to mention urgent access to vascular, orthopaedics, radiology...ergo everything running like a Tuesday. Do-able? If you say yes, come to the table, I say.

What baffles me however is the stance. Politicians are rarely someone who take steps without advice and the key of negotiations are always simple...keep something up your sleeves to make sure the other party never walks away. The tone of war/battle makes it all sound very heroic but at the end of the day, the people you need are the ones you are trying to alienate. Healthcare is an oddity in the sense that without the personnel engaged, you simply can't deliver. To say in 1 hand, the days of the god-like Consultant is over and then also say that it's due to absence of a Consultant,mortality can go up is all a bit odd.

A bit of honesty from both parties..yes, the BMA would be welcome too.Or let me rephrase..perhaps a bit of better clarity. From the politicians point of view, it would, perhaps sound, much better if there was acceptance the majority of Consultants do work emergency services BUT there is now a need to discuss elective work on its all now tied in with how the non elective side works. From the BMA side, perhaps a bit more honesty too...who are you standing up for? All the Consultants or is this just about the new ones? Or is this again about sacrificing the incoming ones to keep individual bits ok? It honestly gets a bit Pythonseque when you see a Professor lecture about 7 day working, when as a junior, you have seen them appear 1-2 times a week on the wards, leaving everything else for the juniors...

So perhaps, just perhaps, all the posturing needs to ease off. It's pretty pointless to be honest- as without the finances this won't stack up. As someone who enjoys negotiations, I also understand classic negotiation posturing on both sides and the end point, as we all know, will be somewhere in the middle. To politicians, let us do our jobs..we aren't too bad at most statistics will say. Yes, there are things to improve..and to be honest, if we didn't we would be living in utopia. To the BMA, for sake of us all, negotiate and negotiate with some chutzpah and panache, not like petulant kids. ..and whatever you do don't sacrifice the incoming ones at the altar of bargaining.

Best of luck and have fun...for me? It's time for me to meet Buzz Lightyear. To infinity..and beyond! 

1 comment:

  1. Enjoy Florida ! Bring back some reflections from Disneyland. Perhaps the NHS could learn a thing or two from them!