In Stitches by Dr Nick Edwards
My name is Dr Nick Edwards and I've worked in the NHS since 2002. In 2007 I embarked on writing a book about life as an A&E doctor, to try and show what it's really like. As I wrote, my mind became more focused on how things could be improved. Here's a short extract from the book:
"It's not just me who gets annoyed with how accounting rules forget about patients. I went to a conference last week and heard a story about a patient from a fellow A&E doctor. He was 45 and fed up (the patient not the doctor - she was 33 and fed up) and came in because he didn't know what else to do. He had a tingling in his thumb, index and middle finger - carpel tunnel syndrome. The irritation was so bad that he was having trouble sleeping. He had had it seen by his GP and had been referred to the local surgeon, who, with a couple of minor cuts to the structures in his wrist, could resolve the problem. However, he hadn't had the operation. The surgeon had available time, there were some brand spanking new theatres to do the operation in and the day ward had a lot of free space because the local private treatment centre had nicked most of their patients. The actual additional costs for the NHS (sutures, scalpels, bandages, etc.) would have been very minimal - the fixed costs (surgeon, nurses and theatre) had already been met.
The problem was that new budget rules mean the PCT pays for each individual operation and the local trust was much overspent. He had had his referral delayed until after April, as it would then be in the new financial year. As he had waited less than 18 weeks, the PCT would still meet its targets. the manager was happy as the cost was delayed for the local PCT until after April, and the government could say that it had fulfilled its targets.
The people who weren't happy were the surgeon and theatre staff, who were bored with twiddling their thumbs, and the A&E doctor who had to give out strong pain killers at 2am for a problem that could have been sorted out weeks ago. And, let's not forget, most importantly, the patient. I don't profess to understand the details of accounting and I have limited financial management skills (hence my excessive credit card bills) but surely this is madness. When NHS finances and organisations are not cooperative, but competitive, then middle managers cannot see the wood for the trees."
The book is written in a humorous and tongue-in-cheek style at times - with lots of human interest stories - but the most important issue I was trying to reveal was how management and politics pervade down to frontline work. In this way I hope to increase the interest in the everyday politics of the NHS and is part of the reason I am working with the NHS Support Federation.
Issues of concern include: the wasteful use of PFI and how the fragmentation of the NHS interferes with every day practice; staff stress and patient numbers; the rise of alcohol and drug-related problems coming to A&E; the political interference of targets; and hospital closures and why they may not be in the best interest of patients.
But I have also offered some solutions, which I hope policy-makers listen to. Although the book has not been written in collaboration with the NHS Support Federation, the ideas stem from a similar line. The book hopefully puts the politics into the personal, raises real issues and will encourage others to talk about the NHS. I hope you enjoy reading it.
You can order a copy at a discount on the cover price, with profits going towards NHS Support Federation campaigns, by emailing olivia@nhscampaign.org. To browse inside, click on the cover image on the right.
