We all know that our NHS is underperforming, with record-breaking delays frequently announced regarding access to treatment.
We read the big headlines regarding understaffing and underfunding of necessary resources, like updated digital support, both of which require major investment. We know that when staffing and major resources are eventually rectified, the resulting improvements will become apparent and tangible over a period of time.
But, while the spotlight is highlighting these fundamental issues which cause so much harm to our NHS, who is addressing the multiple smaller problems which we face every day? Small, simple problems can usually get sorted out quickly and improvements happen quickly too. We all know the proverb regarding taking care of the pennies so that the pounds look after themselves.
The BMA has been waxing lyrical about the lack of grass roots reform in the NHS, whereby the daily challenges we face as care givers and as patients are flagged up and acted upon. When the little problems are ignored, they evolve into increasingly complex problems, which are not only more difficult to mitigate, but can hide the root cause of the original problem.
I recently had an interview with BBC Radio Wales, where the discussion focused on the surreal issue of the lack of pillows in the NHS. The radio presenter could not believe that operations were being cancelled on account of such a simple issue, but the sad reality is that when the little things are overlooked, the small problems snowball to eventually create big problems.
Taking the example of a pillow: in order to undergo a general anaesthetic, a patient must have several items in place, including an identification wrist band, a completed checklist, a hospital gown, compression stockings….and a pillow.
Without a pillow, the anaesthetic does not proceed until a member of staff returns with one from elsewhere and given that the theatre complex can be distant from the wards, there is an associated delay.
Unless the operating list can somehow claw back the lost time, the last patient booked on the same operating list is at risk of cancellation, since there is no staffing safety net in the system to allow a planned operating list to run beyond its allocated time.
This is how a simple pillow can cause a patient to remain in hospital all day and then go home without planned surgery. The butterfly effect doesn’t end there, though, because the hospital beds are at such a premium, there is a strong likelihood that somebody else had already been cancelled to allow that patient to occupy the surgical bed.
Or else, the patient arrived in the theatre suite directly from an ambulance, which was unable to decant that emergency patient to Accident and Emergency, so that patient potentially has other items missing from the mandatory theatre checklist too, causing delay in the CEPOD emergency theatre list.
Working phones are essential for communication, yet, they are in short supply in the workplace. Many hospitals are ‘dead zones’ for mobile phones too, along with inconsistent wifi which automatically ends after a set period of time in order to control the number of wifi users.
Empty soap dispensers, lack of bed sheets, no paper towels, broken hospital bed controls, the list goes on. This is hardly surprising, since our NHS, like any other organisation, will have constant glitches and requires constant maintenance to keep the machine in good working order. But this does not routinely happen, because nobody is routinely or promptly addressing these problems.
When we don’t have a voice, with problems not nipped in the bud, these problems are not fixed and we end up with ridiculous scenarios like the one involving insufficient pillow supplies.
System.NullReferenceException: Object reference not set to an instance of an object. at Umbraco.Cms.Core.Models.PublishedContent.PublishedContentType..ctor(IContentTypeComposition contentType, IPublishedContentTypeFactory factory) at Our.Umbraco.DocTypeGridEditor.Helpers.DocTypeGridEditorHelper.<>c__DisplayClass15_0.<GetContentTypesByAlias>b__0() at Umbraco.Extensions.AppCacheExtensions.<>c__DisplayClass5_0`1.<GetCacheItem>b__0() at Umbraco.Cms.Core.Cache.SafeLazy.<>c__DisplayClass1_0.<GetSafeLazy>b__0() --- End of stack trace from previous location --- at Umbraco.Cms.Core.Cache.ObjectCacheAppCache.Get(String key, Func`1 factory, Nullable`1 timeout, Boolean isSliding, String dependentFiles) at Umbraco.Cms.Core.Cache.ObjectCacheAppCache.Get(String key, Func`1 factory) at Umbraco.Cms.Core.Cache.DeepCloneAppCache.Get(String key, Func`1 factory) at Umbraco.Extensions.AppCacheExtensions.GetCacheItem[T](IAppCache provider, String cacheKey, Func`1 getCacheItem) at Our.Umbraco.DocTypeGridEditor.Helpers.DocTypeGridEditorHelper.GetContentTypesByAlias(String contentTypeAlias) at Our.Umbraco.DocTypeGridEditor.Helpers.DocTypeGridEditorHelper.ConvertValue(String id, String contentTypeAlias, String dataJson) at Our.Umbraco.DocTypeGridEditor.Helpers.DocTypeGridEditorHelper.RenderDocTypeGridEditorItem(IViewComponentHelper helper, IHtmlHelper htmlHelper, Object model) at AspNetCoreGeneratedDocument.App_Plugins_DocTypeGridEditor_Render_DocTypeGridEditor.ExecuteAsync() at Microsoft.AspNetCore.Mvc.Razor.RazorView.RenderPageCoreAsync(IRazorPage page, ViewContext context) at Microsoft.AspNetCore.Mvc.Razor.RazorView.RenderPageAsync(IRazorPage page, ViewContext context, Boolean invokeViewStarts) at Microsoft.AspNetCore.Mvc.Razor.RazorView.RenderAsync(ViewContext context) at Microsoft.AspNetCore.Mvc.ViewFeatures.HtmlHelper.RenderPartialCoreAsync(String partialViewName, Object model, ViewDataDictionary viewData, TextWriter writer) at Microsoft.AspNetCore.Mvc.ViewFeatures.HtmlHelper.PartialAsync(String partialViewName, Object model, ViewDataDictionary viewData) at AspNetCore.Views_Partials_grid_editors_base.ExecuteAsync() in C:\home\site\wwwroot\Views\Partials\grid\editors\base.cshtml:line 11
Help us to build a picture in Wales
The Pressure Portal is a way for BMA members to quickly log the problem and then get on with their jobs. The portal takes less than 30 seconds to complete and when the link is used routinely, the BMA can rapidly build a picture of which problems are more commonplace and which ones have the ability to snowball into major issues more rapidly.
As well as collecting information on how current pressures are affecting you, the Portal also encourages good practices to be quickly logged too. For example, one hospital issued water bottles to staff, resulting in staff drinking more water in work and feeling healthier and more productive as a result.
We don’t formally collect data regarding sickness leave relating to dehydration, like kidney stones and bladder infections, but it would be difficult to argue against having a well-hydrated workforce. Win-win for the hospital and staff alike.
I hope that you use the BMA’s pressure portal. Only with information from the front-line can we build a picture of what’s going on in the NHS to campaign for change. Let’s work on identifying and fixing the little stuff together before it becomes a bigger issue, whilst we continue to tackle the big stuff.
Iona Collins is chair of BMA Welsh council