10 resolutions the NHS should make Now.

1. Streamline equipment. Ten surgeons in a department should not mean ten varieties of hip prostheses are stocked. A choice of two alternatives of expensive clinical equipment is sufficient and guards against supply problems with either one. 
2. Remember, just because an operation can be done, doesn’t mean it should be. Obese diabetics aged 80 confined to wheel chairs due to breathing difficulties are not ‘entitled’ to knee replacements. Same applies to plastic surgery for ‘psychological distress’ caused by body parts being too large or too small. 
3. Standardise non clinical supplies across entire  Trusts, Local Authorities and Health Boards. In fact, even buying the same paper and envelopes throughout all departments in the same hospital would be a good place to start for economies of scale.
4. Remember that cost and value are very different entities whose relationship may not always be obvious, immediate or temporally related. Supporting Professional Activities (SPAs) are seen as a waste of money due to failure to recognise time for teaching, research and quality improvement projects means trainees score the hospital highly on GMC surveys. Universities listen to this and send more medical students to ‘good’ hospitals where high quality teaching is valued. These students bring money.  
5. Re-introduce prescription charges in Scotland, Northern Ireland and Wales where prescription medication has been free since 2011, 2010 and 2007 respectively.  Here in England, actual payment is made for only 10% of prescriptions. The other 90% consists of medicines for children and those entitled to free prescriptions. While ‘free for all’ is politically popular, there should remain a means tested rate of payment for those of us in the top 10% who can afford to pay. We should use, but not abuse the system.
6. Stop wondering why operating theatres are so ‘inefficient’. They are not. Instead acknowledge that adopting the latest in safety and best practice, (performing huddles, repeatedly checking name bands, having surgical pauses and post procedural debriefs) takes time. I’m not against these; check listing improves patient safety and helps prevent human error, but it takes time. And time has both financial and opportunity costs. This is not inefficiency but reality. 
7. Medium term employment contracts. It is very difficult to get fired from the NHS. You can be sick as often as you like and receive various levels of warning, reprimand, additional support and phased returns. Employment contracts reviewed every five years would allow the chronically sick and dis-interested slackers to be relieved from continually hampering the organisation. We all know who they are yet their managers seem powerless to fire them.
8. Redress the balance of non-clinical to clinical staff. An organisation whose sole purpose is to treat the sick should have more than 50% of its employees engaged in doing so. The contracts mentioned above could be useful here.
9. Decisions around healthcare provision must be based on clinical need and not on arbitrary vote winning declarations of speedy delivery. Cut your coat according to your cloth and stop wasting money chasing meaningless targets.
10. Start to value and incentivise staff to work smarter. Acknowledge and praise challenging work and excellent outcomes and your investigation of complaints and poor outcomes will be better tolerated.  Borrow from business with ‘Employee of the month’ rewarded with a parking spot or an early finish one Friday. Finished all your work half an hour early because the team worked fast and efficiently? Go home half an hour early instead of being redeployed to a late running team to help mop the floor. This will help reverse the drain of goodwill. There is no incentive to work harder if the reward is to be given more work. 

Midwives are driving me MAD...

If the requests were not in fact true, they would be hilarious. Back in real life, the rude demand of 'EPIDURAL ROOM 2!' being bellowed down the phone the second I get my toothbrush out, (which is only about three seconds after I have left the labour ward) is barely civil, never mind professional.

The phone is hung up before I can say 'Do you know anything about the lady?' (it's always nice to have some idea of the carnage you are about the walk into), but no, they've gone. Sometimes, if I'm feeling petulant I do not respond to their summons. When they page me again and again and again, innocently  I say we must have got cut off because I was asking them some details about the patient before meeting her- heaven forbid.

Now I know why it's called labour yard (and its nothing to do with the patients!

Anyway, I could go on and on as I'm sure many of us could.
If you want to share your mad midwife story please do in the comments box below.

Let us begin

It has been a long time coming but today I have finally managed to start my blog. My aim is to inform, clarify, explain all that happens after you have counted down from 10 and lose consciousness.
I will bring you highlights of my life as a doctor trained and working in the NHS and a variety of true tales, some happy, some not so.

I'd love to hear from anyone about their personal experience of anaesthesia whether good or bad. You can e-mail me on drelliemay@gail.com