Night on-calls

Interesting week of night on-call. Was busy the first two days and then it was better. One very sick patient went to ITU. The other sick ones we managed to keep alive.
The one that went to ITU had sepsis with low blood pressure and acute renal failure. Put in a central line and poured fluid down her. But persistent low blood pressure and kidneys failed to recover enough. So off she went to ITU. The other really sick patient had similar features with added history of heart failure, which combined with acute kidney failure meant a slightly more cautious approach. Surprisingly enough second chap recovered better that the first one who had a better state of health prior to getting sick. Vagaries of human body I guess.
Often it is for the one to one nursing care and monitoring that we transfer to the ITU. In a general ward especially at night there are two trained nurses for upto 30 patients and 3 doctors to cover 300+ patients and all the new admissions. So if you have a really sick patient you are so relieved when ITU takes him off your hands, otherwise you will soon have 5-10 new patients to clerk in and decide a management plan on and all the sick ones in the wards. Solution increase the number of bodies on the ground.
That can't be done because of the European working time directive, I mean it can be done but the hospitals will have to hire more juniors which they can't because most hospitals are in financial trouble.
You hear about the NHS surplus this year. This is with the primary care trusts(PCT) and not the secondary and tertiary care hospitals most of which are just viable or are in debt. There is no way to redistribute this. All because of the internal market set up by Tories and strengthened by Labour. This means the PCTS get all the money and then commission the hospitals to take care of the patients. The hospitals then bill the PCT. There are so many restrictions on the hospitals claiming the money back from the PCTs so practically most hospitals do twice or thrice the amount paid by the PCTs. However the hospitals can't not treat the patients, which means it ends up footing the bill. PCTs end up in surplus and hospitals in debt.
I think I've ranted enough today