An ambulance is called for someone who has fallen over and grazed their knees
We get inappropriate calls from the public who seem to be too scared to get people to stand up after falling over. For example, a person trips in the street and grazes their knees. A crowd gathers and persuades the person to stay on the floor until the ambulance comes. People look on in wonderment as the ambulance crew ask the person if they can stand. The person stands and is full of gratitude but 30 to 40 minutes is spent on the scene doing basic checks that we have to do before discharging patients and paperwork. The person could have got themselves up and gone to the chemist for wipes and a plaster.
Paramedic, ambulance service, Wales
Clunky IT systems detract from my work in A&E
Once I have assessed people in A&E, I have to write up the medical notes by hand or on a computer system. Because I work in the community and am based at a different NHS trust I then have to duplicate the assessment information to rewrite it on my own trust’s electronic system. I have no access to the local social care notes system which can cause a delay in finding out important collateral history. None of the different IT systems are linked. It can be very frustrating when making difficult decisions about people’s care and treatment.
Senior mental health practitioner, London
A patient arrived by ambulance complaining of a sore ankle. He then stormed out of hospital on said ankle
I recently had a patient arrive to my A&E, by ambulance, with the complaint that his ankle had been hurting for the last five months. When I explained that A&E is not the place for longstanding problems such as this because we specialise in emergencies, and that he’d have to see his GP to investigate, he was incredulous. After angrily berating me for not arranging him a same-day MRI scan, he stormed out of the A&E department walking on said ankle.The patient wasted both my and the ambulance service’s time which should have been spent looking after genuinely acutely unwell patients. It is so frustrating and demoralising to then be abused by patients like this on a daily basis. The public’s expectations and understanding of different healthcare services is central to this problem. People need to be properly informed of what is appropriate for A&E, when to go to the GP, when to use a pharmacy and when to self-care.
Doctor, emergency medicine (A&E), London
Sore throats do not constitute an emergency
I see many people with urgent sore throats.
GP, Dorset
I spend time fighting other parts of the NHS over who should pay for what
This is not a direct clinical issue, but applies to how the members of the information team (a staff group that often our colleagues and the public alike are not aware of), may be called on to support bureaucratic processes – instead of contributing towards improving the running of the organisation. One particular example is in the ongoing battle for charging, taking place between the trust and the commissioning support unit (CSU).
Each month, our team is sent spreadsheets listing thousands of instances of patient care that the CSU is challenging as being incorrect or inappropriate – so called SLA (service level agreement) challenges. If we don’t answer each individual example, the trust will potentially lose any payment for that activity.
I understand that this sort of process is a necessary check to promote value for money, and of course errors do get made that need correcting. Unfortunately, in the current climate, the attitude seems to have changed from this being a check and balance, to being a significant cost saving opportunity for the CSU. As such, they apply more staff resource to scrutinise and challenge trusts – using more inventive thinking to claw back money from providers. I have heard anecdotally that CSU analysts are incentivised based on how much they can claim back from trusts.
We, on the other hand, are not in a position to hire more staff to scrutinise and check and to answer to these sorts of overheads (in fact we tend to pay equivalent staff less) – instead redirecting resources that would otherwise be spent on trying to improve how we run the organisation.
Of course, we still continue to accept and treat patients as we always have. The actual cost of seeing the patient stays the same. The administrative burden, however, inflates the more we bicker about whether CSUs should or shouldn’t pay. The trust, of course, does not hold the purse strings and does not, therefore, have a position of power in these matters. While the CSU itself may profit, it certainly feels like the NHS is spending a lot of time withholding money from itself.
Information analyst
A colleague was woken up to prescribe a sleeping tablet for a patient. When he reached the ward, the patient was asleep
A colleague was once woken up in the middle of the night to attend to a private patient. The request was to change the aerial on the patient’s TV set.
Another colleague was woken up to prescribe a sleeping tablet for a patient. When he reached the ward the patient had fallen asleep but he prescribed the sleeping tablet anyway. The ward staff woke the patient to administer the tablet and then the patient could not get back to sleep again.
Doctor, anaesthetics, London
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Bad IT, grazed knees and bureaucracy: NHS staff share their frustrations
