Wednesday, 13 January 2016

NHS Treatment Delayed is NHS Treatment Denied

So the Junior Doctors have had their 'strike' with a threat of more to come. Not all doctors were on strike as emergency cover was maintained. In other words the Junior doctors, under the direction of the BMA, decided that to press their argument home they were to impose on the patient weekend conditions on a weekday. Throughout the day there have been conflicting versions from striking doctors as to why they are on strike. One version complains that they will 'effectively get a pay cut' with the new contract, another complains that they will no longer get higher pay for unsociable hours. Most follow what is the quasi-official line of the BMA that this is all about patient safety. This is where the argument completely unravels. Study after study shows that discharge rates at weekends reduces massively (my personal favourite study is from the 2002 paper from the Emergency Medical Journal emj.bmj.com/content/20/2/149). Reducing delayed discharges is not only crucial to the welfare of the individual patient but also to the patients waiting for admission and patients waiting to be seen in A&E only to be delayed by, you've guessed it, a delayed discharge elsewhere in the hospital. It is no coincidence that A&E sees its highest backlogs on Mondays when doctors resume non-emergency work and go about releasing patients who could otherwise have been set free to go home 24, 48 or sometimes 72 hours earlier. While the frantic bed unblocking goes on there are patients being denied the care and treatment they need. In my own personal experience I have been told to come to hospital on a Sunday to collect a patient who was discharged only to wait for over 4 hours while nurses frantically searched for a doctor to sign a prescription. A consultant was found who was worked off his feet. If junior doctors were on shift his job would have been less exhausting, my friend would have been discharged a great deal earlier and the bed would have been free, for example, to an A&E patient. Ironically it is in A&E where a junior doctor may well be working at the weekend and frustrated with weekend bed blocking due to lack of junior doctors on the wards. This account is repeated in the BMA's own publication "Hospital Discharge: The Patient, Carer and Doctor perspective" where patient "Julie" spoke of hours of delay due to not being able to find anyone to sign the paperwork. In this same publication a former chair of the BMA Junior Doctors Committee says of delayed discharges "When done poorly patient care can suffer, with distressing consequences for the patient and their family. Jeremy Hunt has called on Junior doctors to follow nurses, technicians, caterers, engineers and all the other people that make the NHS tick to work a regular weekend shift to nail the problem of delayed discharges. They've been persuaded by the BMA not to answer that call and go for the emotive argument of patient safety. The actions of the highly qualified, dedicated but poorly led junior doctors have not only continued to leave patients at greater risk at weekends but have decided to exacerbate this by recreating these conditions as a form of industrial action.

Failure to make adequate and timely arrangements to discharge patients has been a blight on the NHS for too long. It creates bottle-necks that often disrupt entire hospitals and adds to the stress suffered by patients, who find themselves stuck in hospital. If patients are not discharged, new patients, who require medical attention, cannot be admitted. Delayed discharge will only be eliminated for good when the NHS is adequately resourced and capacity meets demand.

I have to be honest, that last paragraph is not from my own hand so I must give it the necessary credit. My thanks to the BMA.