Quality or Quantity

On 21^st July 2015, Gill Pharaoh died, aged 75. She was a retired Palliative Care Nurse who had written books about caring for people at home, chronic illness management and palliative care. All this has been over shadowed by the nature of her death.

Gill Pharaoh died in an assisted dying clinic, in Switzerland.

Ms Pharaoh didn't have cancer or any other terminal condition, but she was old age. At 75 she was experiencing the effects of old age on her body and her life and she didn't want the loss of ability, control and dignity that she saw ahead of her.

But this wasn't a woman acting on vanity, this was a woman who knew the realities of old age, she was a retired Palliative Care Nurse and had written books about chronic illness and dying at home, and decided she wanted to choose the time and way she died. Her death should be the wake-up call that we, as a society, are desperately overdue a sensible and adult debate on euthanasia and assisted dying.

A debate that looks at people's wishes and concerns. More and more we are finding ways to treat and manage different health conditions, and people are living longer; but not always living well. We can keep people alive longer, it is now common to see elderly people living with two or more chronic health conditions (Something that was rare even thirty years ago), but is it always right to keep people alive when we also rob them of their dignity and quality of life?

We need to debate, level-headily and calmly, the way people who wish to have control of over their lives and to choose how their lives end, comfortably and with dignity. We also need to debate the safeguards needed in assisted dying. Safeguards to prevent people being pressured or bullied into assisted dying.

A debate that listens to people's wishes and the views of people living with long term conditions and life-limiting conditions, we need to listen to the people involved first.

This debate, I fear, we'll never have, because at the first mention of euthanasia we are swamped with hysteria from our media and religious leaders. We are bombarded with talk of “Doctor Death” and old people being forced into death camps, and this is all we seem to hear. The one word that dominated the reporting of Gill Pharaoh was “healthy”, there was so little reporting of her reasons and rational. How can we have an adult debate in this climate?

Every fortnight a Britain travels from the UK to Switzerland to use one of their assisted dying clinics; of all the foreigners using these clinics Britain's make-up a fifth of them (1). These are the people who can afford and are able to travel to Switzerland.

We are long overdue a calm and adult debate about assisted dying, but in our climate will we ever get that or will we just be drowned out by the hysterical shouting, again.

Fourteen years ago my mother died from cancer. At the end of her life she stopped eating and drinking, by her own choice, because she'd grown too tired of her illness to carry on.

Drew Payne

Why I am Supporting the Doctor's Strike, And It wasn't a Hard Decision

Tuesday 12^th January, tomorrow, doctors will strike and I’ll be supporting them. This isn’t us v them, this is a direct attack on my colleges, the doctors I work with.

Jeremy Hunt wants doctors to accept new contacts but these contacts are far from fair. They will radically re-write their conditions of work.

This is why I am supporting the doctors:

1 Junior Doctors are any doctor who is not a Consultant or GP. This isn't just junior House Officers but the vast majority of doctors in the NHS.

2 Under the new contact the number of hours a doctor has to work each week before they can claim overtime raises from 60 to 87 hours. Doctors could be forced to work 87 hours a week (Most of us work 38 to 40 hours a week). How can anyone be expected to work 87 hours a week as their basic hours. Do you want to be seen by a doctor who has already worked 80+ hours that week?

3 This new contract will cut doctors' pay in real terms. They are being offered an 11% pay rise but their unsocial hours payments will be cut by 25%. The new contact will say that working until 10 o'clock at night, night shifts will not begin until 1 o’clock in the morning and until 7 o'clock at night on Saturday will become part of the "normal" working work. Unsocial hours payments are rewards for working outside of normal working hours, a reward for the dedication for doing so, a reward for the loss of social and family time doing so. This new contract says that dedication is worth nothing.

4 The penalties on Trusts for making doctors work more than their contacted hours will be virtually removed. If a Trusts does make doctors work dangerously long hours they will still be fined but they will pay themselves the fines. This is no fine or penalty at all, and says to Trust managements that the government is not interested if they over work their doctors. Of the increase to contact’s basic hours and the near abolishment of unsocial hours makes it far easier to force doctors to work dangerously long hours without encoring even meaningless penalties.

5 Jeremy Hunt claims that this new contact must be brought in to move the NHS to a seven day a week service. But this is a lie! The vast majority of the NHS is a seven day a week service. As a nurse I know this is true. #ImInWorkJeremy proved the lies of Jeremy Hunt's claims.

This is an attempt by Jeremy Hunt to “break” the power/influence of the doctors, but in reality all it will do is give us even more stressed and over-worked doctors. How will that benefit patient care? It won’t, but Jeremy Hunt has repeatedly shown that patient care is not a high priority for him.

If we turn our backs on the doctors who will Jeremy Hunt come after next? As a nurse my pay has already been capped at 1% for the foreseeable future (and with inflation at over 2% this means a cut in real terms), student nurses will lose their bursaries next year and will be faced will the burden of student loans just to train as a nurse, and nurse's unsocial hours payments are already under threat. If we tolerate this who will Jeremy Hunt come after next? Everyone in the NHS has to be united.

A big deal, in the media, is being made about this strike affecting patient care, but it will not damage patient care the way Jeremy Hunt's repeatedly attacks on the NHS and the government's cuts to NHS resources have already done.

I do not want Jeremy Hunts' NHS, it will not care about patient care and quality of care, it will not care about its staff and the quality of care they are delivering (The NHS's staff are its greatest resource), it will just care about how much money it can "save" and how many NHS services can be farmed out to private companies (And they have failed again and again when they take over NHS contacts).

As doctors strike we all need to support them, and not give into tabloid lies. This isn’t just a strike over a pay, but this is a direct attack on doctors and therefore a direct attack on patient care.

Drew Payne

“My Own Four Walls”

At the beginning of November I fell down a flight of stone steps at work, as I was leaving a patient's home and rushing on to the next one. As I fell my left foot was twisted back under me and I landed full on it, my full weight landing on my ankle and smashing it into a stone step. In that moment I fractured and dislocated my ankle in three lands.

Apart from a lot of pain, I had to have my ankle operated on to repair the fracture, it was too mangled to heal on its own, which has left me was a lot of metalwork holding my bones back in the right place. The worst part is that I had to have my leg and ankle in cast and be non-weight bearing for eight weeks (This is now week seven).

Once home I could hobble around on crutches but I couldn't leave the house. I am not very stable on the crutches, I can only walk on flat surfaces (The pavements here are far too uneven to safely hobble along on my crutches), and I can only walk for short distances because hopping along on these crutches is so damn tiring. Ten metres and then I need a rest. For the last seven weeks I have been house bound.

Being house bound has not been fun; it has been very frustrating and isolating. I am here, in this house, twenty-four/seven. My world has reduced down the sofa in the sitting room, and occasionally the toilet when I hobble out to it. My human company has been Martin, my partner, and the television. Martin works long days and is tired when he gets home, then he gets quizzed by me about what has happened during his day. Just hearing about the world out there makes me feel I am still part of it. I watch a lot of television, far more than I ever used to. The television doesn't just pass the time, though it does and that can help, but it tells me what is happening out there, it is another thread I can keep in touch with the world by.

But I never realised how isolating staying at home all the time is. I've had days off work, even weeks off work, but I have never been so long without the usual variety of people in my life. When friends telephone me I cling onto those telephone calls for as long as I can. I want to hear about their lives, what is happening with them. My news is so limited, how many different ways can tell someone that daytime television is so crap, but they have stories to tell and they have lives they can share with me and I want to hear everything.

I can spend hours on social media, surfing through Facebook and Twitter and Tumblr, because they are filled with other people's lives. Stories of what they have been doing, what they plan to do or sharing stories from yet other people's lives. I can read those stories, past comments and for a brief moment share in those people's lives.

I don't want anyone to think that this is a pity blog. In just under a week the cast on my leg finally comes off and I start being much more mobile. With mobility will come back independence and contact with the outside world. I will be able to leave our home and will eventually be able to return to work and my old life. Not everyone who is house bound has the same release from it.

I work as a District Nurse and my job is to provide nursing care for people who are house bound. For so many of my patients the only people they see, from day to day, are us District Nurses and their carers. They can be so lonely and crave contact. I will only have a limited amount of time to provide their nursing care (Give them their insulin or other daily injection, help them to take their medication, change the dressing to their wound, etc...) and they emotionally cling onto me, making conversation, asking me question upon question. I'm never cold or brisk with my patients, if anything I talk too much with them, nursing someone you become involved with their lives, especially with the patients we care for on long term. I was always aware of how isolating being house bound is, I have seen it so many times in the patients I have nursed.

Being house bound myself, even only for seven weeks, has forcefully reminded me how isolating and frustrating it is. We as humans are social creatures and most of us need the company of other humans, so why do we allow people to become so socially isolated just because they are elderly or their health is failing. In the last five years, under Tory austerity, council budgets have been slashed, we've seen many day centres and luncheon clubs for elderly people closed. Others have had their resources cut and so have had to cut the number of days people can use them, isolating more people in their homes.

We now have developed an attitude that people should stay in their own homes above all else, and that entering a care home is somehow a failure to be avoided. I have nursed so many people in their own homes who are almost prisoners of their homes, who would be far happier in a care home. In a care home there would be company for them, other residents to talk and socialise with. Staff would be available to meet their needs at their pace, not be rushed into the time bands allowed to District Nurses and carers. Instead they are confined to their own homes, grabbing what company they can from the limited time professionals visit them.

But are there enough care homes out there to meet people's needs even if we changed our attitudes? Care homes are full, good care homes have long waiting lists for them. We are not building enough good new care homes because the private companies who run them can barely make viable profits from the ones them currently run, there are very few incentives for them to open new ones. Also, care homes are not valued as places to work in. In nursing, working in a care home is still seen as professional failure, “Oh, you only work in a nursing home.”

In a week my cast will come off and I will finally be able to leave my home under my own steam. When I finally return to work, though, I will go back to caring for patients who are house bound without any end in sight. When did care of our elderly population become such a low priority?

Drew Payne

A Worrying Change

At the beginning of November 2015, two people were convicted of manslaughter. They were Isabel Amaro and Hadiza Bawa-Garba, and they were convicted of the manslaughter of Jack Adcock. But Isabel Amaro is a nurse and Hadiza Bawa-Garba is a doctor, and Jack Adcock was a six year old boy in their care.

Jack was admitted to Leicester Royal Infirmary, on Friday the 18 February 2011, with diarrhoea and vomiting, and breathing difficulties. Jack had Down’s Syndrome. He died eleven hours later after a cardiac arrest, due to Sepsis, secondary to pneumonia. This was a very ill child.

Both Isabel Amaro and Hadiza Bawa-Garba missed his deteriorating condition. He had abnormal blood results, high levels of urea and creatinine in his blood, and he was showing signs of septic shock. When he had a cardiac arrest his lips had turned blue. Dr Bawa-Garba had not contacted her consultant about his condition and when he arrested she stopped the crash team, mistaking Jack for another patient who was not for resuscitation.

This was serious misconduct and negligence by both these women, but was it manslaughter? Did these two women deliberately neglect Jack’s care to the extent that he died? There is no evidence of this.

We don’t know the full details of what happened when Jack Adcock died. How busy was the ward? (In her evidence Dr Bawa-Garba said that she’d not had time for a break) How many other patients where Isabel Amaro and Hadiza Bawa-Garba also looking after? How many of them were also very ill? How many other staff were on duty that day? Was the ward short staffed? (Isabel Amaro was an agency nurse so the ward was down at least one member of permanent staff)

Many of us nurses have been on duty when it has been busy and our unity or team has been short staffed. For many NHS nurses this is now a common working condition. This is the time when things can go wrong, drugs errors can occur, lapses in care can happen. Staff are pressured, stressed and short of time, with more and more demands being made on them. They are only human. As resources are squeezed and pressures increase more and more nurses and doctors will be working under these conditions. This is now the reality in Jeremy Hunt's NHS.

Negligence and misconduct should never be tolerated but is a manslaughter charge the right response? But our courts do not deal in the complicated factors that busy and under staffed units are being put through, and are they always the right place to deal with lapses in healthcare practice? They deal in the rights and wrongs of one person's actions, they rarely deal with complicated institutional failings (Because what else are the stresses being put on NHS staff today?)

When working on a busy and short staffed hospital ward do nurses now have to take care so that we don’t end up charged with manslaughter?

Drew Payne

My Political Wish for Friday, the Repeal of the Health and Social Care Act 2012

The Health and Social Care Act has failed and needs to be replaced. Unfortunately it has failed on so many levels that to effectively modify it would mean ripping it apart and starting again.

Its focus was all local with no strategic control; we saw the effects of this with last year’s winter crisis in A&E Departments (Which actually was a failure in healthcare across the broad and especially in social care). The “Better Care Fund” has taken millions out of Primary Care funding to pay for short falls in Social Care funding. Private companies have not produced any benefits when they have taken over running NHS services. Hinchingbrooke wasn’t the only time a private company “handed back” an NHS contract. Also, the Kings Fund has stated that private healthcare companies are more expensive to run; NHS spends 5-6% on administration where private companies spend 15-30%.

As a Community Nurse, I have not seen any of the promised benefits of the Health and Social Care Act, though our workload has increased as the number of patients we care for has increased (This has been seen right across the NHS).

Whatever replaces it needs to both meet the needs of local communities but also needs to have a strategic control; otherwise we will repeat what happened last winter. It also needs to bring Social Care back under the control of the NHS, because at the moment there are too many agencies involved in it and too many gaps between them.

Whatever replaces it needs to be well funded, not cooking the books with “efficiency savings” budgeted in. Healthcare costs are rising faster than inflation (Look at the price of medications) and the number of patients needing treatment is also raising. A measly 1% increase is actually cutting healthcare funding in real terms (The coalition government has imposed 4% cuts to NHS funding year-on-year, even with promises to “Ring fence front-line services”).

Whatever replaces it needs to be legally sound. Over the years both the Conservatives and Labour have opened up the NHS to private tenders and contracts, this has brought the NHS under UK and EU competition laws. Repealing Health and Social Care Act maybe a legal nightmare and companies already with NHS contracts may demand millions in compensation.

Also, healthcare professionals, healthcare managers and patients need to be consulted about what replaces the Health and Social Care Act, it should not just be the idea of economists and politicians (as has happened all too often in the past). the Health and Social Care Act came as a shock to NHS staff and patients alike, it’s replacement should not.

Andy Burnham is talking a lot about “integration” in healthcare, but who is he listening to?

(This blog was originally written as part of the Nursing Standard’s Readers Panel, and appeared in an edited version in that section)

Drew

Vote, Vote, Vote, Maybe? (Part 6)

Further on yesterday's blog.

Yesterday afternoon I got an email reply from the Liberal Democrat candidate, Paul Reynolds. This morning, in the post, I received a letter from the Labour Candidate, Lyn Brown.

I suppose I should be happy now, four out of the five main candidates have finally replied to my email, but it all feels very hollow. How many of those replies would I have got if I hadn't badgered them through social media?

Yes, they are busy campaigning (So they say though I have seen very little of it in my area) but they are not doing it alone. They have assistants, other people involved in their campaigns, volunteers and an organised political part behind them. I emailed them with plenty of time, I spent my email out on the 5^th April, and it was only when I started blogging about it, and sending links to those blogs directly to the candidates that I started to get replies from them, before that I hadn't even got an acknowledgement of my email.

As I posted yesterday, campaigning in my area has been pitiful, a handful of fliers pushed through our front door and that's all. I would love the chance to quiz these candidates face-to-face but I haven't see any local events or campaigning.

Is politics losing touch with the voters, is it being run just for the benefit of politicians or am I just getting too cynical?

Drew

Vote, Vote, Vote, Maybe? (Part 5)

Events more on. The election is now only six days away and I move forward but only by half a step.

Lyn Brown (Labour Candidate) has confirmed that she will answer my questions but only by letter, because I’m one of her constituents (Which was only told to me yesterday). How long this letter will take to arrive I don’t know. I certainly don’t know if it will arrive before the election, and if it doesn’t then what is the point?

The silence from the Liberal Democrat candidate, Paul Reynolds, and the UKIP one, Jamie McKenzie, is almost deafening. I have emailed them again, asking for them to reply to me, but it is now twenty-six days since my first email and I don’t hold out much hope of a reply.

I have just done another internet search on Andy Uzoka (Christian Peoples Alliance) and Cydatty Bogie (Communities United Party) and I can still find no contact details for either of them. Are they even standing? And if so are they even serious candidates? It doesn’t feel like that the way the way they seem to be making themselves deliberately un-contactable.

I know I am sounding more and more cynical but that is the way I am feeling. When I started this I wanted to know my local candidates’ views and knowledge of the NHS and its issues. Now this has become a frustrating battle to get these people to just engage with me. They want to be my local MP, with all the influence, privilege and high salary (Especially compared to the average wages of someone living in West Ham) that comes with it, yet they can barely be bothered to acknowledge me, let alone answer my questions. Why do they think I’ll vote for them?

If this is the standard of people standing at this election then no wonder that people are so disillusioned with politics.

Drew.