NURSES.

The quality of care offered by the NHS has been placed under a magnifying glass over the past few months. Constantly being in the news it led me to question, why? One of the most let's say 'obvious' answers is of course under staffing. This was most definitely found to be the case with the Mid-staff's scandal where the Francis report had stated that "A chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care,". A lack of nursing staff = more demands on existing nurses = more stress and pressure = more adverse affects on individual attitudes = bad quality of care. This is what was found from the stories stemming from the Liverpool Care Pathway - where patients were often denied food and water due to a number of staff not being correctly educated on the LCP.

It has been predicted that there will be a serious shortage of nurses and midwives by 2016 and this will lead to obvious problems with care offered by the NHS, something the NHS will undoubtedly have to face. One of the biggest reasons for the shortage is thought to be the loss of our UK nurses to other countries. For instance, the US offers a starting salary of around £40,000 compared to the (around) £21,000 offered by the UK, not forgetting the year of experience they are required to also have. This has led the NHS to bring nurses and midwives from abroad, leaving them with almost the same problem.

For me, I have seen first hand the role of a nurse from my voluntary work and my view has developed as I've learned more about their duties. The role of a nurse is so broad and diverse as they need to be able to administer medication, offer emotional support and guidance, educate the family and the patient on the illness as well as making sure all the needs of the patient are met. Nurses truly are the definition of 'front line staff'. Where doctors have the responsibility of seeing through the patient from the diagnosis to the treatment and making decisions on the treatment provided it is the nurses that gets to care for the patients on a more individual level.

It's disheartening to see what has happened to the profession over the years and the issue is of high importance to be addressed. Hopefully, when this happens we'll start to see an improvement on the quality of care offered. :)

READ this if you'd like to know more. Let me know what you think.
http://www.theguardian.com/healthcare-network/2013/aug/20/need-graduate-nurses-nhs

How real is real?

24 hours in A&E, ER, One born every minute, Keeping Britain Alive, House MD, Greys Anatomy, Junior Doctors and the list goes ON.

Reality TV or drama, are they altering our view on the healthcare system (in the UK and/or America).

I was asked my view by a family friend on the lifestyles of doctors the other day. I replied by explaining the pros (rewarding, mentally stimulating, FUN) and cons (stressful, LONG hours) and how I thought that it was mainly a give and take relationship. The more you put in, the more you get out.

They replied by asking me: 'Did you watch Junior Doctors?'
Ahh the beauty of reality TV. I had watched the show and did enjoy it. It showed lives of junior doctors and all the ups and downs they had encountered during their placements. We both discussed the show in terms of how real it was and how much of it was just used for entertainment and spoke about how sometimes we'd almost have to remind ourselves to separate the 'real' from the real life. From this conversation it really became plain to both of us how much these type of shows could influence people's perceptions of the NHS.

We then moved on to the topic of shows such as Grey's Anatomy and House (my personal favourites). The medicine is a lot more realistic than shows such as Holby city, however the diagnostic procedures we come across in House, and the constant attraction Seattle grace hospital has to crazy catastrophes was definitely not so realistic.

The glamorous portrayals of their lifestyles definitely seems attractive however unlike the 'reality TV shows' we most definitely didn't feel the need to remind ourselves that this was just entertainment. 

So, what do you think?
How real is real?

A&E Bailout?

A&E. The headline for the majority of the health news that has been circulating the BBC for quite some time now. Accident and Emergency departments are open 24/7, 7 days a week, 365 days a year, and specialise in just that - accidents and emergencies. However, as we've all been hearing for months now, this is simply just not the case and this is leading to A&E departments being almost on the bring of collapse.

Why are they struggling so much you ask? Well it all comes down to three main reasons:

1: Lack of out of hours services 
Back in 2004, Tony Blair's Government made a deal with GPs to reduce their working hours and allow them to no longer be on call for weekends and evenings all in exchange for £6000 of their salary. This has been described as the root to the cause of A&E disintegrating by Health Secretary Jeremy Hunt. He believes that the current GP contract is 'fundamentally flawed' as responsibility of out of hours services has been removed from the hands of GPs. Many GPs are outraged and annoyed at the constant blame they receive as many of them currently feel 'overworked' and feel that a lot of unnecessary pressure is being placed on them. They also agree that their is a flaw in NHS 111. This is a helpline you can call when your family doctor is not available and so advice is given to you on what you should do next. GPs believe that the system is flawed, as the resulting next step is often advice to visit A&E.

2: The Ageing population
People are living longer. A great statement yes? Well, it does come with its own problems. People are living longer but they as they grow older they are more vulnerable to disease, and more severe diseases at that. It is presently thought the the elderly with complex conditions are now the greatest challenge. Many of them are said to arrive by ambulance and often have to have an extended stay. Which poses another problem - space and beds. David Cameron is proposing that what we should do is concentrate on building the relationship between A&E departments, GP practices and social care departments so that the elderly may receive more help from their local communities.

3. Staff Shortages
With the increase in demands by patients it is clear that staff shortages are a definite problem in need of desperate attention. This is all results in critical cases being handed over to junior doctors who may not be competent enough to deal with the patients thus endangering their safety. This battle between increase in demand, and decrease in supply seems as a fundamental issue at the root of the cause.

The solution to fixing the problem that is A&E waiting services is proving hard to find. However, a 'bailout' as been announced for specific struggling A&E units. This is just a short term solution to a long time problem of course, and many are aware of this.

What are your views on this? Comment/e-mail me, I'd love to know.

Food for thought:
http://www.bbc.co.uk/news/health-23612539#?utm_source=twitterfeed&utm_medium=twitter
http://www.telegraph.co.uk/health/healthnews/10192661/Crisis-in-AandE-as-hospitals-grapple-with-staff-shortages.html
http://fullfact.org/articles/factsheet_crisis_accident_emergency_care-29078

Homoeopathy - out with the old and in with the 'what now'?

It believed that 2013 will be the year to see the end of homoeopathy services provided by the NHS. £4 million go into the spending of this industry and many are concerned that this money is simply being wasted on 'placebos' that have not been 'scientifically proven to work'.

Homoeopathy is another name for complementary and alternative medicines. It is an option available to the patient if they choose, to go alongside or instead of the conventional western medicines available to them. The treatments provided under this branch of medicine follow the general principle that if a treatment or substance can cause a symptom then it can also remove that symptom - when it is present in a diluted form. Some common treatments include the likes of acupuncture and herbal remedies.

Funnily enough, this is not the first time I've come across alternative medicine. For my EPQ (Extended Project Qualification) I investigated the science behind fasting and the truth behind the rumours that it lowered high blood pressure. I came to like the idea of using fasting as opposed to conventional medications as it provided a route free of side effects as well as (when done right) providing effective results. However, this alternative method does not follow the general principles mentioned above and so I'm not entirely convinced it comes under the heading of 'homoeopathy'.

Reviews on homoeopathy are mixed. For instance, earlier this year a report from the Commons Science and Technology Committee concluded that the service was no more than a placebo and recommended to the government that all funding from the NHS should stop.

Obviously, this is an extremely controversial topic so I'm not going to dwell on the opinions on others as realistically the phasing out of such services really comes down to the decisions of GPS.

Currently, homoeopathy is only available in certain areas of the NHS. 3 NHS Hospitals that are known to specialise in these services include the Royal London, Glasgow and Bristol hospitals. However, it is believed that the future of Bristol Homoeopathy looks negative as it's popularity has declined over the year.

GPs are also able to practice homoeopathy and are able to also refer patients to homoeopaths. However, it is believed that the majority of GPs are against the service. As GPs are now responsible for most of the health service budget, due to the new CCGs put in place (Clinical Commissioning Groups), it is now largely in their hands to decide if the treatment should be 'funded' or 'rationed'.

What do you think? Are with or against GPs? Let me know - comment below or e-mail me.

Homoeopathy 101:
http://blogs.telegraph.co.uk/culture/tomchivers/100044581/homeopathy-dropped-by-the-nhs-and-about-time/
http://www.telegraph.co.uk/news/9962151/Doctors-want-homeopathy-on-the-NHS-to-end.html
http://www.quackometer.net/blog/2012/12/2013-will-see-the-end-of-nhs-homeopathy-hospitals-in-england.html

Let's talk.

I've been actively volunteering with different organisations since this time last year. It started of light and took me a while to adapt to the volunteering way of life as I found it was much different to anything I had really been exposed to before. Before I knew it I was involved in a couple of different organisations and I had become a regular volunteer - involving myself as much as I could when I was't completely under the stresses of those that come with A-levels. I really began to love volunteering and I would really urge any of you out there to try it, what have you got to lose right?

So, my first 'official' shift started at the hospice yesterday. After having completed 3 shifts under the supervision of a fellow volunteer I took hold of the reigns finally and went solo. I've got to admit I was a bit nervous at first but as soon as I started I instantly felt comfortable - which I think is partly due to the friendly staff and volunteers at the hospice. 

I went about the routine as I had done previously and followed the time schedule as best as I could. Checking in with the patients and their visitors is most definitely my favourite part and gives me a chance to see how they're all doing (not just an excuse for talking). 

Yesterday was different though. I had always had little chats here and there with the patients but most of them hadn't really been up for conversation per say, which was completely understandable considering the conditions they were in. I respected their privacy and understood if they didn't want to be disturbed, after all I was just there to help. However, this time was different. Whilst on my ward round I somehow managed to strike up a conversation with one of the patients. We talked for a good 25 minutes about her life, my life, our experiences, everything! I explained to her that I wanted to do medicine and she replied by saying that she was glad someone of my generation was being ambitious. I was humbled. She outlined that she personally thought a doctor should be 'empathetic without being emotionally involved' - something I'm sure I'll keep in mind throughout my (hopefully) future medical career. I completely understood where she was coming from as being emotionally involved in a case would surely be detrimental to the judgement of the doctor which may lead to the wrong decisions being made. 

I listened to her stories about her travels, and it was clear that she had really enjoyed her life. She'd done it all, fearless of where she would end up. She was also persistent to continue with her brave attitude as she told me how she had come to terms with her condition but her family hadn't. The conversation definitely cleared up any of my ignorances before as I become more aware and more conscious that these were people who had all lived lives so unique and so different and that they should be treated with that in mind. They should not just be seen as symptoms of a disease to be controlled. No, they should be seen as individuals. People who unfortunately have become a victim to bad health and are now in need of our help, and it's our duty to aid them with anything they may need, whether it be spiritual, psychological, or physical. 

This moving conversation is something I'm sure I will remember in the future and is something that truly certified not only my love for the patient interaction involved in medicine but it certified my love for volunteering. I'd always heard about these stories from other people who made it seem like the norm. I'm glad to learn it's not the norm because when these conversations do happen once a while and out-of-the-blue it makes them all the more special.

I really do wish her and her family all the best. Her fearless attitude will always be inspirational to me. 

Thank you for reading. 

The Liverpool Care Pathway, what's happening?

LCP.
I came to terms with this procedure not so along ago. I was on a shift at a local hospice where I volunteer at and during the handover with nurses I was told that a patient, let's call them 'X', was put on 'LCP'. Now, I'm going to admit that I had never heard of this 'LCP' before this time and I was instantly curious to find out what it actually entailed. So I asked. The reply was: 'LCP is for end of life care, when the patient is nearing the last few hours or days of their life'. The answer wasn't very detailed so I decided to look into it more myself.

Now, LCP was proposed by the Royal Liverpool Hospital and the Marie Curie hospice during the late 1990's. Let's get this straight, LCP is not a treatment but is merely a sort of process in which specific care is brought to the patients when their time of death approaches. The proposed idea was to enable the patient to have all their needs, be it spiritual, psychological and physical met by the senior doctor in charge of their care.

Problems started to arise when it became difficult to tell when a patient was nearing the end of their life. How could doctors tell? It was simply a guessing game.

I liked the idea of the LCP. I liked the idea of it being used as a 'framework' for good practice. I liked the idea that health care professionals would talk through plans with the patient and their families carefully and ensure that their needs would be met. I liked the idea that good communication between the health care team and the patient & their family would be a vital and key part of the proposed idea. Most of all, I liked the idea that the LCP was reserved as a last resort, a resort to which should be looked at when the entire team had reached a consensus that the patient was nearing death.

However (yes there is always an 'however') what I didn't like at all was the fact that these principles and guidelines set by the LCP were not being met. From the stories plastered all over the news lately I've grown to question weather the LCP is the way forward. They've been disturbing stories from patients families who have said that nurses would often deny the patient a drink and so patients would often go days without having their thirst quenched. This is simply inhumane and unlawful.

It's a shame that the LCP and their guidelines haven't been met by everyone as I think if it was applied properly it would be a very successful way to care for end of life.

From the concerns that have been raised by numerous different patients the health minister, Norman Lamb, has announced that the LCP will be phased out over the next 6-12 months. Instead, a individual and tailored end of life approach set by a senior doctor will be introduced, carried out and reviewed through its implementation.

It's a real shame that the previous guidelines were not met.

Let me know what you think. Comment, e-mail go for it.

Some more info for you below:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212706/100715_letter_to_trusts.pdf
 http://www.mariecurie.org.uk/Documents/HEALTHCARE-PROFESSIONALS/Innovation/Liverpool-Care-Pathway_FAQ-23-August-2012.pdf
http://www.bbc.co.uk/news/health-23315865
http://www.dailymail.co.uk/news/article-2364029/How-Liverpool-Care-Pathway-used-excuse-appalling-care.html
http://www.bbc.co.uk/news/health-23301360