Paul Thorpe

Paul Thorpe is a consultant spinal surgeon in Taunton

“Nurses are already as important as doctors”

By Paul Thorpe - 22nd November 2009 9:29 pm

So, all nurses are going to have a degree now. How depressing. The ability of the nursing hierarchy to destroy all that is good about their own profession in a vain attempt to be seen ‘as important as doctors’ and taken seriously politically never ceases to amaze me.

Most nurses are good at their job. I meet nurses who are great at their job every day, as I am lucky to work in a darn good hospital. Those nurses who went in to their job to nurse, I mean to actually look after patients - most of whom don’t have a degree - think it is a pointless and ridiculous idea.

Let’s stop trying to pretend that nurses are as clever as doctors. You have to get better GCSEs and A levels to get into medical school than you ever will to get into nursing school. Doctors will have a higher IQ than nurses. However, if that means that doctors are somehow more important than nurses, then you are - like the RCN - simply nursing the large chips balancing on both shoulders.

Nurses are already as important as doctors in getting the patient through their healthcare experience but their roles are different.

Patients and families don’t want nurses to have done research, or to be too specialised or clever to answer the call bell and make sure that they get their analgesia, or don’t get a pressure sore.

Other health professionals don’t want nurses to be too important to be able to tell them what is going on with a patient that day.

The nursing profession would do better to focus its attention on improving the remuneration and career progression for its members for actually being a nurse. It is terribly frustrating that the only way to currently achieve significant career progression in nursing is to stop doing it, pick up a clipboard and a Blackberry and become a manager. Some of them go on to become very effective managers; many are not, but who can blame then, when the bottom line tells them it’s the only way to climb the greasy pole and get a decent salary?

If we actually helped nurses progress up the bands for staying in their caring role, and didn’t try to populate wards with as many inexperienced band 5s as possible, then standards would rapidly improve with the number of experienced nurses actually on a ward rather than in the boardroom.

Secondly, the key point about being a professional is about being supported and encouraged by your professional structure to take professional responsibility for your decisions and actions. Doctors have this in spades - it is part of the core and fabric of how we work, and it why we will always have impression of ‘being more important’.

However, this is only in the same way as a fighter pilot is seen as ‘more important’ as an aircraft engineer. The job has a more sexy PR profile, but if the aircraft engineer can’t deliver their piece of the team role, the steely-eyed killer sits firmly on the ground polishing the Ray Bans. Nurses are often terrified to take professional decisions, as they often receive very little understanding and support from their professional hierarchy if something goes wrong.

Finally, the most annoying aspect of yet another ridiculous government attempt to solve all the problems of the health service is that it will be - like nearly all of their previous attempts - ineffective and also hugely wasteful. Nursing Standard has obtained the government’s own figures showing that current nursing degree courses are experiencing huge drop out rates. It’s up to 51% in some universities, and up to 78% on some specialist nursing courses.

There are, of course, complex reasons for why this is happening, but it is a criminal waste of money and of people’s enthusiasm to try to shoehorn them through an academic process which has not been designed to deliver appropriate education, and to which they are obviously not suited.

To any nurse who reads this, I hope you don’t feel this is in any way saying that doctors are ‘superior’. What I, and the patients, want, is for you to lobby and petition your political representatives to support and remunerate you for actually doing the things that first drew you into your very important job - nursing.

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I am trying to find time for normal life - it’s not easy

By Paul Thorpe - 14th October 2009 4:51 pm

You may have noticed my contribution to the world literature in medicine (for that read my Hospital Dr blog) has been a bit thin recently. Has he lost his angry edge, you might ask?

How could he let scandals such as the exposed useless performances of many ISTCs go without any comment? How can this failing rump of a government not be taken to task for their fiddling as their Roman Empire crumbles around them?

The honest answer is that I have experienced what happens to all of us in our consultant life at some time or another - a wave of clinical activity, on call pressure, demands for target delivery combined with keeping the admin going, the management areas focused and delivered, the teaching and presenting done.

This past three months have been some of the busiest I have ever experienced, even when I was regularly trudging between Bristol and London for BMA activities, while trying to hold down a full time job as an orthopaedic trainee, husband and father.

I coped with it, getting to the respite of an annual holiday with the missus minus ankle biters, thanks to the kindness and fortitude of the inlaws. An idyllic week on the beaches of the Caribbean always recharges the batteries and it could not come soon enough. Even my secretary commented that I seemed tired, stressed and was ‘acting a bit odd’ before I went.

As someone who lost a parent to severe depression in my formative years, that sort of thing scares me. I have always prided myself - as we often do - on my ability to absorb pressure and stress and just ‘keep going’. The final days before my holiday, I actually felt for the first time that I might find this difficult to cope with for a long sustained period.

So, while recuperating with the Antiguan fishes at 25 metres, I made a resolution - to reserve sometime for myself, my family and my non medical interests every day, even in some small way. To go out at lunchtime, take an hour to do some clothes shopping rather than give my wife my current (variable) waist measurement, simply be at school to meet the kids as they come out, then go back to work.

It worked. The first three weeks back from holiday felt better, even though the pressures are all there. I’ve got some nice new threads from Debenhams Sale. I’ve seen Up with my daughter and 5 other squeaky 8-year-olds. Our band even had a fun gig for a 30th birthday. But guess what? This week has slipped. They’ve pulled me back in. A few really difficult clinical cases, a busy on call or two, my annual appraisal, the spectre of 10 breaching patients for November, and the sudden announcement that we now have to shift to 10 week delivery (what planet do these people inhabit? Certainly not Planet Spinal Workload) have meant I’ve allowed the plan to slip.

So, next week, time to reaffirm, time to fight back for me, time to keep the lid on it and keep my sanity, so that my next booked holiday (with the kids in the Lakes this time) isn’t just a pressure valve that I am struggling to reach each time. My advice to all of you; never let them think that the targets, the pressures, the corporate NHS plc are more important than your necessary self-preservation. They won’t think about you until you are firmly in the occupational health sickness monitoring bin. Don’t let it happen.

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The NHS needs economy and business class

By Paul Thorpe - 24th August 2009 3:31 pm

So, the evil Tory party has been ‘exposed’ as not supporting the NHS.

Sixty per cent of Tory MPs have admitted in a survey that we should support giving tax relief to those who buy private health insurance, which has been extrapolated by those who commissioned the study as leaving their policy statement of supporting the NHS as being “in tatters”.

On the other hand, only 1% of New Labour MPs were allowed by Gordon and Peter to agree, the other 99% suggesting that it was fine to tax the rich to the hilt, so long as their own  healthcare insurance wasn’t affected. And a slightly fuzzy number of Lib Dems thought it might or might not be a good idea. Possibly.

Forget the argument in the US that the NHS is an evil government behemoth that has “death lists”, and must be resisted at all costs to allow the free market economy to flourish unchecked in healthcare. How have we let ourselves get to the polar situation that any support for the private sector is somehow an assault on the concept of universal healthcare, free at the point of access?

When you fly abroad, you can fly in economy. You, and your luggage, still usually get there, they show you a film, feed you and give you a seat. The fact that you can choose to fly in club, with a range of movies, a more comfy seat and nicer food - and pay more for the privilege - does not seem to be an assault on our right to go on holiday.

Interestingly, if you have a crap pilot, your chance of having a bad landing or crash is as likely in first class as in cattle class - a good analogy to the surgeons who maintain both a good NHS and private surgical practice.

So, if someone wants to pay extra to ensure that they see a consultant, have a nicer waiting room, a private room with a TV and a bowl of fruit, should they not be allowed to do so? Given that they actually take some of the pressure off the NHS system, by removing themselves from NHS clinics and waiting lists for investigation or treatment, should they not receive some recognition for that from the Inland Revenue to say: “Yes, we know that you are taking some financial responsibility for your own healthcare”?

In other countries, this is a no-brainer. In Australia, if you have a condition requiring emergency treatment, you generally get treated quickly and efficiently. If you have an elective condition, you wait…often years. If people complain about this, they get short shrift. “If you want quick elective treatment, get health insurance”. No-one seems to complain - they know the score.

Unfortunately, in the UK, the government has promised the public a universal healthcare system, with waiting times that challenge the private sector, and salubrious surroundings to boot. It costs a fortune and is undeliverable. Let’s stop pussy-footing around this and tell the truth.

No matter how socialist your ideals, let’s admit that a fully functional modern health care network cannot be delivered just through public funding, and let’s allow the two  systems to symbiotically develop, while educating the public of the need to take a bit more physical and financial interest in their own healthcare.

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Keep solicitors out of coroners’ inquests

By Paul Thorpe - 28th July 2009 1:18 pm

I had my first experience of an aggressive inquest this week. A sad situation where an ill lady broke her arm, went home but then developed complications that ultimately led to her death.

The unexpected part for me was that the family turned up with a solicitor, who proceeded to cross examine myself, the GP and the hospital staff involved very closely. They used lines of questioning that inevitably implied that this was all the fault of the medical services and had we been more vigilant, the lady would have survived. An uncomfortable and distressing allegation for any doctor.

We were not informed that legal eagles (or should I say vultures?) would be present, and therefore had no opportunity to put our own questions, or have assistance with our defence. Happily for us, but unhappily for the poor family, the coroner commented that had the patient or her family sought help from their GP and the hospital earlier, the patient may well have lived, and came to a verdict that was close to being uncomfortably critical of the ‘friends and family’ of the patient. I’m sure this was an outcome that their solicitor didn’t warn them was a possibility when engaging their services.

Why do we feel that solicitors are a good way of finding out what happened when a relative dies? We have a robust and functioning complaints service, that requires an in depth analysis of any particular case. We have the coroner - who will not fight shy of criticising any lapses in care they find in an inquest. We have audit and mortality/morbidity systems in hospitals and, as a profession, doctors are actually quite good at trying to find where things could have been done better.

Introducing an articulate shark simply seems to me to ramp up the costs, and increase the distress for all. I’d like to know, in percentage terms, how often solicitors are actually successful in getting any cash for a family or patient who alleges negligence.

We seem to see fairly regular ‘fishing’ letters in the NHS. While a quick review of the notes and a medical report usually sort them out, it’s all extra work. I’d also like to know, in percentage terms, what proportion of the cash involved in any claim - costs as well as award - goes to the patient, and how much to the lawyer?

There’s no doubt high lawyers’ fees can damage NHS budgets. In a recent case solicitors E Rex Makin put in a huge claim to the NHS while acting on behalf of parents involved in the Alder Hey organ (or should I say histology slide) retention scandal. They claimed £4,479,957.06 (don’t forget the 6p guys), probably expecting the somewhat naïve NHS to simply roll over and cough up. Well, good luck to them, the NHS Litigation Authority challenged the claim and - guess what - after negotiation it was reduced to £430,000. Yes, that’s right, £4,049,957 (and 6p) less than the original claim.

Next time I ask for a pay rise, I’ll remember to hike it by a factor of 10 and reduce it in negotiation - or perhaps I’ll don a sharp suit, become a solicitor and start chasing ambulances…

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‘Timeously’ incapacitate the DWP to benefit doctors

By Paul Thorpe - 21st July 2009 9:44 am

I received a threatening email this week. Our poor beleaguered managers have been chased by the Department of Work & Pensions - yes, those dear civil servants who strike gloom into your heart when you open the manilla envelope, hoping in vain for compromising pictures of your clinical director, but facing the inevitable DWP message: “We are writing to you about Mr X who is claiming (in our opinion) fraudulent amounts of incapacity benefit…”

You then have to answer 30 ridiculous questions about whether a patient you saw once, 6 months ago, in a 50 patient fracture clinic can carry a saucepan 5 yards, 10 yards, 50 yards; lift a bag of shopping up 5 stairs, 10 stairs, 50 stairs; make love every 5 days, 10 days, 50 days - and other such nonsensical details that even a consultant psychiatrist, with two and a half hours to take a history, wouldn’t bother with.

So, you grit your teeth, pick up your pen, and exercise your discretion as a fully trained NHS consultant by writing: “Please pass to the registrar,” on the front of the form.

As a registrar, I had the rare talent of actually extracting some cash from the (then known as) Benefits Agency for the honour of filling these out. It was only about 20 quid, and it required about 32 forms to claim it, but I knew how much the civil servants hated administering it, so it was worth every underpaid minute in childish satisfaction.

As a consultant, these forms constantly dog you, and also lead to a string of patients seeking review appointments, so that they can tell the DWP: “‘I’m still seeing my doctor,” when their benefits start to get cut.  

Imagine my distress when finding the DWP have actually pulled the rug from under our feet, presumably by negotiating with some national terms and conditions committee to stuff us on the forms. They wrote: “Under a longstanding agreement, hospitals are obliged to provide factual reports on request, within laid down timescales (10 days) and free of charge to the Department for Work and Pensions, the Veterans Agency and contractors working on their behalf. I am afraid your hospital is very slow to respond to requests for information with several consultants refusing to complete the reports. This in turn delays decisions on entitlement and can cause distress to our customers. I would be grateful therefore if you could remind your staff of the longstanding agreement and the importance of responding to requests timeously.”

Well, I’ll be stuffed if I am going to slog my guts over a stupid form, with questions I can’t answer, simply to release the DWP from their responsibility for examining their own ‘customers’, and allowing them to tell the very same ‘customers’ that it’s all my fault that their benefits got cut - which is the entire reason for these damn forms turning up on your desk.

I plan a campaign of disobedience with these forms, and would ask all readers to do the same - there are several ways to approach them:

1. Put the form through a shredder, place the bits in the Reply Paid envelope and send it back to the DWP - they will never know who it came from without a lot of time and sellotape

2. Write in every box - “unable to assess, needs DWP medical examination” - that will soon cost them a fortune and clog up the in trays of the doctors who are actually meant to be making these assessments

3. Write on the form – “this is one of the most disabled patients I have ever met, and I recommend that they get full Incapacity Benefit, Mobility Allowance, a War Pension, a full refit of their bathroom and kitchen - and chuck in an Orange Parking Badge for good measure.” You’ll get a really grateful patient, and know that the stupid form cost the taxpayer a good few thousand a month.  

All of these should be guaranteed to stop the DWP holding us to our longstanding agreement, and we can get on with our job of ‘timeously’ (?!) looking after patients.

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For brave read stupid on altruistic kidney donation

By Mr Paul Thorpe - 26th June 2009 11:53 am

We have two kidneys for a reason - if one packs up, we can live on the other. So what would bring you to getting rid of one of your giblets when you still definitely require it?

It is, of course, incredibly sad when someone experiences the hellish existence of life with a failing vital organ. I can fully understand that if a blood relative or lifelong partner is likely to die while on a transplant list, then one would consider a live donation.

However, am I alone in not sharing the same journalistic enthusiasm championing the rise in altruistic donation this week?

Dewy eyed reporters were in raptures over the ‘brave’ people who willingly gave up their kidneys for general use on the transplant list. In medicine, the term ‘brave’ is often a polite way of saying ‘stupid’ or ‘reckless’, and this lot fall firmly into the same category.

Has anyone spotted the flaw of middle aged people giving up a kidney with 20 years plus expected of the singleton? What happens when their own renal function starts to pack up? Won’t they just be contributing to the problem they are trying to solve, having to go out and find their own altruistic donor?

The claims that ‘live’ organs are rejected less than post mortem ones may be true, but surely the point here is that we need a more open and aggressive policy towards increasing the number of donors - like the Iberian countries, where not only are you more likely to be placed in a persistent vegetative state by another road user, but there is also an ‘opt out’ rather than ‘opt in’ organ donation/harvest policy.

Needless to say, they have fewer people on the waiting list.

Call me selfish, but I want to keep my filtering tanks the way they are, and only my family need apply for any consideration - the rest of you - hands off my kidneys!

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Doctors shouldn’t pay the price for the downturn

By Paul Thorpe - 9th June 2009 2:50 pm

How would you like to earn £62 million? Well, I’m sorry, forget it because you’re a doctor and not a Brazilian footballer transferring from one indebted European club to another.

At times of economic crisis, it is natural to examine the value placed on one’s role in society, or what we find it acceptable for money to be spent on. Our MPs are essentially getting a taste of their own medicine in this, as their expense claims for duck islands or porn videos are raked over - and they are asked to stand in the full glare of the media lights to justify these.

This followed hot on the heels of Alistair Darling lumping most doctors in with Fred the Shred in his last budget.

Those who contributed to the causes of the economic crisis would be those expected to pay for it. Well, Alistair - what did I do wrong? I trained for 12 years and work in excess of 60 hours a week to earn more than £150K. Is that your justification for taking away my right to a personal tax allowance and allowing you to steal 60% of anything I earn?

Sorry, I was actually under the impression that the government and the bankers were the cause of the crisis. I’m regulated by the GMC; they allowed the bankers to escape regulation. I didn’t decide to sell off a large portion of the UK gold reserves at the lowest gold price ever seen. I didn’t rape the pension system. I didn’t bankrupt the future of the country with PFI.

The problem now is that even those who work hard for their money - and I don’t include Kaka in that group - are going to get nailed by the public for what they earn, and the taxman for what they can get.

In the meantime, the people earning the really unfair sums of money - footballers, pop moguls and bankers - will either earn so much that they still have a lot after tax or avoid paying it altogether.

This will be happening while I’m on a sponsored bike ride trying to raise money for an operating table. Or as we wait on tenterhooks to see if we get the wartime wing of our hospital (that currently requires the careful placing 52 drip-catching buckets when it rains) replaced by a new build.

It’s time for a re-evaluation by society of what and who we spend our money on - and, I venture, a cap on the acceptable maximum for any one person’s earnings. However, at the same time we need to understand that at times of crisis, we all have to pay, middle and working class as well, and there should be a cap on the acceptable maximum that the state can ask from any one person.

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Why postpone the inevitable WTD

Mr Paul Thorpe, consultant spinal surgeon, Taunton - 19th April 2009 10:48 am

I can’t believe those filthy Europeans are trying to limit our working hours again. No wonder my esteemed colleagues at the Royal College of Surgeons, British Orthopaedic Association and Association of Surgeons in Training are getting hot under the collar.

Interestingly, juniors in this country were firmly in favour of a 48-hour week at that time and, more interestingly, that was not specialty specific i.e. the surgeons wanted to lay about as much as everyone else.

They’ve barely had 13 years to get used to the idea. It was just yesterday, in 1996, that the BMA’s Junior Doctors Committee (JDC) started warning the Department of Health (DoH) and Royal Colleges about the implications of the European Working Time Directive for doctors in training.

As usual, one half called the JDC shroud wavers, the other thought we had designed the legislation so that ‘layabout’ GPs and psychiatrists could have an easy life. I spent a large portion of my time in the BMA shuttling to Brussels to try and mitigate the impacts of the EWTD, and surveying what juniors actually thought about it (at least what they thought about it when their boss wasn’t listening).

Unfortunately, the DoH and royal colleges didn’t grasp the nettle of changing how we work and train until EWTD was upon them. Now that it is getting tough, and juniors and hospitals alike are feeling the pinch, what is their answer? Let’s see if we can opt out.

I have a prediction for them. The Government will say that we have to implement it and the EU will agree. Trying to close your eyes and hope it goes away may have worked for monsters under the bed – but this monster is under your quilt with you already, and is licking your thigh getting ready for a big bite.

Why don’t we use this opportunity to really change the way we do training in the UK? The JDC had a plan then, I have a plan now (happy to discuss with anyone interested enough to listen), or we can keep walking out on the beach wondering where the sea has gone, with the inevitable result when the law of geophysics reasserts itself.

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