Darkness on the edge of town

Just as a follow up.

The following organisations provide audit and confidential enquiry and publish data and guidelines on what it is that people in hospitals seem to get up to. This is what I would call a good thing.

NCEPOD – national confidential enquiry into patient outcome and death

CEMACH – confidential enquiry into maternal and child health

SASM – scottish audit of surgical mortality

NICE – national institute of clinical excellence

SIGN – scottish intercollegiate guidelines network

NPSA – national patient safety agency

Healthcare commission – as of today now the care quality commission

The department of health – i spent this evening looking through the published figures on 4 hour targets for emergency departments

What do all of these organisations (apart from the CEMACH one) have in common?

None of them include Northern Ireland.

We appear to be in our little world over here. Away from the prying eyes of audits and people saying we really shouldn’t be killing people quite as often as we do.

I can’t find any data online about the 4 hour targets for Northern Ireland. Though i’m aware we’re doing quite well and the hospitals in Belfast aren’t doing quite so well.

The four hour targets are a lose-lose situation. If you meet them management will say well done have a cookie and you obviously have enough staff so you don’t need any more.

If you don’t meet them you get a slap on the wrists and told to work harder.


So if we’re killing you in our hospitals then you can at least rest assured that no one is watching.


5 Responses to “Darkness on the edge of town”

  1. 1 FF April 2, 2009 at 8:07 pm

    Maybe you should go spend some time with management? They/we aren’t the wrist slappers- (they)we are the people who get our wrists slapped on behalf of the organisation and defend it with our lives/careers. Personally, I’ve never understood the 4 hour target- I think it only means medical outliers who take precious beds which cancer and elective and all sorts of other patients need. I think that Minor Injuries Units/Multidisciplinary Out of Hours Assessment units would be much better, with step up/step down beds as required. But that’s just my tuppence worth. However, the other access targets are a necessary means of accountability which Trusts need in the context of an attempt to provide free healthcare at the point of need. The issue for NI has been that the implementation of these targets has been at the same time as RPA, and now the comprehensive spending review which means no new recurrent money to try and maintain these standards. Which is a difficult and stressful situation to be in. And it’s also pertinent to note that we haven’t the infrastructure in information yet to submit to national audits, given the recent introduction of access targets here. But some of us are working on that, this very day, in fact.

    Managers aren’t the ones to blame… most of us happen to care just as passionately, but choose to use our skills for systemic change rather than immediate, individual care. Rant over 🙂

  2. 2 Nelly And I April 2, 2009 at 8:39 pm

    let me remove the word “management” from the above and replace it with “government” or “simple fact that healthcare is too pricy for society to pay for”

    i have come to the conclusion that as much as i’d like to, i can’t really blame it on management. there is simply not enough money in the pot and it is their job to make the best use of it.

    management will give us (or my bosses) a pat on the back, because someone above them will no doubt give them a pat on the back too if we can all just make do with the money we’ve got.

    i just live in a naive little world where we actually have enough money and resources to deliver the service we should be delivering.

    the very fact that difficult decisions have to be taken about resources (and i have no desire to make them – i’m happy with life/death treatment issues – i just couldn’t run a lemonade stall never mind a hospital) kind of bursts my naive little bubble.

    i think (like everyone we just like someone to blame it all on. even though there probably isn’t. it seems to me that everyone is pissed off about the system we work in – management included.

    your rants will always be welcome!

    incidentally the blog was more about us medics not keeping our house in order than about managers – audit on our outcomes is our responsibility and we abdicate that on occasion.

  3. 3 Nelly And I April 2, 2009 at 8:53 pm

    and i know management gets a bad name with the public (unfairly) and everyone thinks doctors and nurses are wonderful (unquestioningly) and can do no wrong, but it could be worse, think of the poor social workers – everyone in the public eye seems to really hate them.

  4. 4 FF April 4, 2009 at 6:57 pm

    Let’s call it quits then… with one pointer with regard to the ‘pats on the back’ – just remember that clinical Directors and Associate Medical Directors are also managERS… management is a concept that doesn’t really exist… 🙂

  5. 5 Nelly And I April 5, 2009 at 1:26 am

    lots of fair points well made. There was me thinking i could have an ill considered rant into cyberspace and now i’ll have to stop and actually think the things out first, darn it…


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