Raconteur is now a medical consultant in a DGH

Post research and now a medical consultant in a DGH. Said DGH is, in common with many others, being actively inspected by CQC. I could fill pages on why CQC has been more active post-Berwick report and the how the hospital's finances has been destroyed by tariffs for common procedures coming down year after year due to the so called efficiency savings. I could also write on how the hospital is not paid properly for increasing A&E admissions. For those who don't know, the hospital is not paid if it admits more patients as compared to previous years and it is not paid if the patient stays in more that 'x' no. of days. When medical admissions are rising year by year and revenues are falling due to efficiency savings, the hospital is also expected to hire more staff to make things safer. Post CQC visit in couple of years ago, the trust hired 200+ extra nurses and some more doctors. Currently the trust is in severe deficit, in common with most of the acute medical trusts. Meanwhile, emergency admissions rose to unprecedented levels this winter, eased off a bit in May-June and is now climbing back to winter levels again. No summer respite this year. Combined with increased frequency of CQC visits, monitor and NHS England visits - it is caught in a bind. I don't see any good solutions - the Lansley act has destroyed many institutions and fragmented care. I work for the hospital, but couple of other organisations who have won bids to operate certain 'services' then pay the hospital for me to operate clinics on their behalf. I get one salary from the hospital, but work for 3 different organisations who each have their own IT systems which don't talk to each other. Bureaucracy tripled and IT systems proliferate and patients get fragmented care and my stress levels hit the roof trying to get patients a similar level of joined up care between 3 different organisations. The purpose of the act was to increase efficiency and drive down the costs by making each service go to the cheapest provider. If you have different organisations involved - primary care organisation, hospital and then external organisations which are not NHS but private or 'community' enterprises running cardiology, diabetes, ultrasound, physiotherapy, COPD, podiatry, occupational therapy etc, then joined up care is well nigh impossible due to the multiplicity of providers each running its own medical records, its own IT systems, governance systems etc. Work is duplicated and efficiency is reduced and costs increase. How did the authors of the Lansley act think this would pan out? They had to know that this kind of fragmentation would result in increased costs, bureaucracy and be detrimental to patient care. Enough people told them that at the time and they chose to ignore it. Now we have to bear the brunt of it and patient outcomes are not worse only because we work harder to prevent chaos between organisations. Rant over

Bed cuts in NHS

Just read the news today that NHS has shed more than 30,000 beds over the last 10 years. As a junior doctor working in a busy DGH (District General Hospital to the uninitiated - ie. a secondary care hospital with some amount of tertiary care facilities), I guess I am in the front line of this unfolding disaster.
Our own hospital is buiding a new hospital which will result in loss of 300 beds when we move from the old buiding to the new one
To practise this bed cut, management has decided to close two care of the elderly wards resulting in loss of 60 beds in medicine.
Given that the hospital is already running at >95% bed occupancy, the logic behind this move is impenetrable. With average age of the punters coming in being around 75, closing care of elderly and rehab wards obviously makes sense!
Another reason being touted around is, with summer around the corner admissions will fall and hence if the closure doesn't lead to disaster, it can be hailed as a success and will justify further bed cuts when the new hospital comes up.
During winter we were opening temporary wards to cope with sheer number of sick people. Red alerts for bed status were the norm every weekend. With winter over we are barely coping with huge pressures to discharge early. Just how the hospital is going to cope in next winter is going to be interesting for me, as I will be moving to another hospital by then, but as you can imagine, hugely stressful for the staff here.
What all this does to spread of hospital bugs and patient care is a rant for another day.