Category Archives: Responding to media

Ambulance or Nurse?

The Independant have an interesting story where, due to the shortage of ambulances the plan is to send community nurses first for patients over the age of 65 who have had a fall.

This is a bad idea.

But first, as a quick update on my career, I went from nursing into the ambulance service, and then returned to nursing. At the moment community nursing. So I’ve done both of the roles that the article is talking about.

The ambulance role is very much different from community nursing. When a community nurse sees a patient, it is not in an emergency situation. If you have a leg ulcer, or cancer, or a surgical wound that’s not healing as it should, then the community nurse is ideally placed to see to your needs. However if you have fallen and either can’t get up by yourself, or have broken your hip, then what you need is an ambulance.
This isn’t to say that comunity nurses don’t already keep people from going into hospital. Community Treatment Teams (CTTs as they are known in my patch, your acronym may vary) work hard to stop people with chroninc and acute conditions from needing to visit A&E. Unfortunately trauma is something entirely different to the heart failure, asthmatic and palliative patients that these teams see.
An ambulance crew are trained to deal with these acute traumatic incidents. Community nurses are not (as an aside there was some research about how nurses are really bad at first aid. And they are bad).

The plan is for a nurse to give a painkiller, including morphine, and then wait for the ambulance. At least I assume they are supposed to wait. I know I’m not going to give Doris with her fractured hip 10mg of morphine and then leave her on the floor. A big problem with this is that, as a community nurse, my day is already packed with patients (and as the government wants to kick more patients into the community, that will only increase). It is more common than not that I work through my lunchbreak, just in order to do the bare minimum for my patients. Community nurses do not have the time to play at ambulances.

What happens if the nurse overestimates the amount of morphine to give the patient, they’ll need a BVM, and training in how to use it and naloxone and how to give it, maybe some other drugs to counter potential bradycardia. And remember, a nurse doesn’t then have the option to load the patient into the back of an ambulance and whizz off to hospital. They’ve got to sit there.

And then who is going to supply the morphine, where will it be kept? Morphine is a Controlled Substance and needs to be kept in a special locked cupboard inside another locked cupboard. Who is going to provide a stock of morphine just in case it’s needed.

And then there is…

…but you get my point.

This is, yet again, an example of short-term thinking to patch up huge holes in the NHS that have been caused by successive governments. Both the ambulance services and the community nursing trusts need more money, and odd blue-sky thinking by people who are several steps removed from actually meeting patients is not the way.

Lord Warner – A Challenge

Lord Warner has released a report stating that we should pay £10 ‘tax’ to use the NHS and that the NHS is ‘not cost effective’ despite all the evidence to the contrary. Both of these statements are frankly bollocks. However we have grown used to these lies and, as the media keeps pushing them, eventually they will be believed.

I looked up Lord Warner, he is the executive director along with a Suzanne Warner of ‘Sage Advice Ltd.’ A company that has no contact details, no website and no telephone number. At least none that I can find. This doesn’t mean that this ‘company’ is in any way dishonest, but as a simpleton in the ways of business I can’t see the reasoning behind it.

Of course, this, and Lord Warner’s previous job advising Apax Partners (a company that invests in private healthcare) might mean that he has some sort of vested interest in bringing about further privatisation of the NHS.

Sadly the newspapers only printed Lord Warner’s side of the story (i.e. Bullshit) and have not in any way highlighted these vested interests.

So, as I lay in bed trying to sleep but with sparking neurons of flaming anger keeping me awake I came up with an idea. It’s not a cunning idea, and Lord Warner would never agree to it, but it might be nice to dream.

You get a small, agile, hell – even amateur, filmmaker to stage an hour-long debate between Lord Warner and a defender of the NHS. They each have plenty time to prepare and can bring actual, real, evidence to defend their position – and this evidence is added to the debate, maybe even using whizzy computer graphics. Maybe there could be a referee who calls for the evidence to be brought out when one side or the other makes a statement and challenges the participants.

This film then goes up online where anyone can see it and we try to get newspapers (who really should be the people doing this sort of thing) to publicise it.

Every soundbite has to have evidence to back it up, there is no ‘playing to the crowd’, there is only truth.

Not that this sort of thing would ever be allowed – because Warner, (sorry, forgot the ‘Lord’ and tug of the forelock) already has all the power and this sort of truth finding would only have the risk of him seceding power to someone opposed to him. While the defender of the NHS has nothing to lose (except, y’know, the NHS) Lord Warner would have everything to lose by taking part in such a radical idea as a search for the actual real truth.

So, silly idea, but at least it gets this idea out of my head and onto the screen so that I can hopefully get some sleep.

That Forcefeeding Video

I’m going to state right now that for most cases I am completely against force-feeding. There are issues of capacity and sacrifice and so on that would take a post of its own to describe, and that is not what I’m writing about here.
It’s the Yasiin Bey video showing him undergoing the procedure for the force-feeding of a prisoner at Guantanamo bay. It was created to highlight the evil of force-feeding.  

Here it is.

I have serious issues with this video.

Here is another video showing the exact same procedure.

(Here is a video on how to insert one into an eight month old child)

The procedure shown is the insertion of a nasogastric (NG) tube. I have placed more NG tubes than I can remember and I have never seen a reaction as strong as that shown in the first video. It certainly isn’t very pleasant to have a NG tube inserted as it tickles the back of the throat that makes you want to gag (or swallow), but it is not this apparent torture that is being shown.

An NG tube is inserted in hospitals for a number of reasons, sometimes for surgery, sometimes because a patient cannot swallow.

In the first video Yasiin Bey isn’t given water to drink during the procedure, but in many of my patient’s I also couldn’t give them anything to drink to ease the passing of the tube as these patients would have no gag reflex and so giving them water could result in them inhaling rather than swallowing the water. Inhaling water can have side effects that include death.

Yasiin Bey is also shown to be resisting, while the person in the second video is complying with instructions. Many of the patients that I passed an NG tube into had some form of confusion, either due to a stroke, due to dementia or due to a multitude of other causes . In some cases I would be passing a tube into the stomach of someone against their will because they had tried to commit suicide and were under a Mental Health Section.

Even in these cases I never saw a reaction as strong as that of Yasiin Bey.

Note also in the video that at one point Yasiin Bey’s hands and head are restrained, but later on they they are free – all to show how the medical staff have to use physical force to hold him down which makes it look even more brutal.

Once an NG tube is in place you can leave it in. So it is not something that necessarily needs to be done twice a day although in this case they may remove the tube in order to stop the prisoner from hanging themselves with it, or for some other operational issue.

This video is bad for two reasons. First – it makes a medical procedure which is carried out in hospitals up and down the country in the order of probably hundreds of times a day look like torture. As I note, it’s not pleasant, but it certainly isn’t torture.

The second reason is that this video is, in my mind, a lie. The discomfort is exaggerated, the physical restraint is unnecessary, and it is filmed to be as ‘shocking’ as possible.

Similar to what Islamaphobes do this is ‘othering’ the enemy. The people inserting the tube aren’t human, they don’t have faces – they are just shown as unremitting medical automatons. How is this different to how Islamaphobes only show the fully veiled woman or the bearded terrorist?

This video is the equivalent of an anti-vaccine campaigner, thrashing, fainting and drooling after a ‘flu jab. And we would challenge that video as being untruthful. We need to do the same here.

We need to be better than this – the Islamaphobes and warmongers can and do lie, they hide things, they distort and deny. Those of us on the side of peace need to avoid stooping to this level. We need to be better than this, because every time our opposing number can catch us in a lie our support will drop, we’ll be targeted by the media (just look at how the news is now about Snowden himself and not about how the NSA and others spying on us), and what is worse is we’ll lose the support of those who are most likely to be swayed by truth.

Truth sets us free, propaganda keeps us in chains – and in my opinion this is propaganda.

Raised Expectations

There is a simple rule on the internet – and that is you do not feed the Trolls. Trolls being the people who write something in order to start an argument. You know, the sort of people who say that Hitler was an alright sort of bloke in a holocaust support forum.

But… but… The article in the Daily Mail yesterday by ‘Liz Jones – professional troll’ was beyond the pale. It was truly epic in the way it combined unreasonably high expectations, a complete misunderstanding of the NHS, a lack of medical knowledge and inflated sense of self worth.

I’m not going to link to the original story because I don’t want to send visitors to the rag that is the Daily Mail.

Here is the thing – I often deal with unreasonable expectations from the patients that I see, often these expectations are because the patient doesn’t understand what an urgent care centre can provide – and yet with all the people I see who have these expectations, none have pissed me off as much as this article from a fashion writer. Largely because once I explain that the Urgent Care Centre can’t order them an MRI scan they seem to understand a lot better than this supposedly highly educated columnist.

I don’t scrape and scrabble at the coal face of the NHS very often. I was born, I suppose.

Congratulations on not having a long term medical condition.

I have a private GP, gynaecol­ogist, two therapists and a dentist, who charges £900 for a root-canal filling. I don’t drink, smoke or overeat. I don’t have children. I exercise every single day. I’ve been a vegetarian since the age of 11.

And the reason for all this private stuff is…? So you don’t have to mix with the proles? So the GP surgery has nice pictures on the walls? No – I’m sure that the reason you are private is so that you do not place a strain on the NHS. And two therapists?

Let us just say that, so far, I have not been a burden. But, on Friday morning, I found I needed the NHS for the first time in about 20 years, and it let me down. Very badly.

You needed the NHS? I hope you are alright – did you fall off your bike breaking your arm? Heart attack? Stroke?

I am catching a flight to the Horn of Africa tomorrow, to cover the famine in Somalia. In order to obtain a visa, I am required to be inoculated against hepatitis A and B, yellow fever, typhoid, diphtheria, tetanus, polio and so on. On Thursday, I called my GP, a private GP, in London’s Sloane Street.

Oh. Immunisations on a short notice.

‘Yes, Miss Jones, come in any time.’ And so I did. But my doctor could only give me the ‘live’ vaccine, yellow fever; the other jabs would have to be done the following day. The next morning, back home in Somerset, I called my local GP or ‘health centre’.

So the GP you pay lots of money for could only give you one set of injections – I assume that they explained why. And why is ‘health centre’ in quotes? Is it because you work for a ‘paper’.

‘Hello!’ I said cheerily. ‘I am not registered with you, but I live two miles away. I wonder if you could possibly squeeze me in today to complete my jabs for travelling to Africa, and fill in my malaria prescription, as I need to start taking the tablets on Sunday.’

‘Hello, you don’t know me from Adam – normally one pays for these things, so I was wondering if you could see me without doing any of those oh-so tiresome health checks that you have to do when you register with a GP, and then ignore any appointment system you have so I can jump the queue of people with chronic conditions that can’t pay for a private GP. Because – you know – it’s important to me, and so should be important for you’.

‘You are not registered?!’ the woman said, clearly appalled I had made her pick up the phone. ‘We can’t see you then. And we can’t fill out a prescription that hasn’t been written up by us.’

‘But I will pay for the jabs, it only takes a couple of minutes.’

Appalling – Tell you what – why don’t I phone you up and ask you to discuss this story more fully – I don’t need an appointment do I? I’m sure you can put off someone else in order to talk to me. I’ll give you a fiver.

‘But the nurse is fully booked. She can’t do it. I don’t even know if we have the drugs.’

‘Can you find out?’

‘Well, no. I’d have to ask her. And she can’t fit you in.’

Oh goodness – loads of people who can’t afford to go private need medical care – how dare they, can’t they all just die.

‘But this is an emergency. I have never bothered you before in the three years I have lived here. Not with a snotty-nosed kid, not with depression, nothing. Never!’

Yes. an ’emergency’. It’s an emergency because you need some vaccinations that you doubtless had plenty of time to get.

Here is a hint.

A heart attack is an emergency. A stroke is an emergency. Being stabbed is an emergency. Needing vaccinations is not a bloody emergency.

I also find your linking together of ‘snotty nosed kid’ and ‘depression’ a red flag that you know very little about health at all.

‘But we don’t have your notes.’

‘You don’t need my notes. Lots of people go to walk-in centres. You could telephone my doctor if you’re worried about anything.’

I work in a walk in centre – we don’t give vaccinations because (a) we are not funded to do so, so we don’t have the drugs and, (b) we don’t have your medical notes which are, despite what you think, rather important.

‘I don’t have time to do that. Why don’t you go to A&E if it’s an emergency?’

‘I’m sure they wouldn’t classify a routine jab as an emergency. I mean, it’s a global crisis. Millions of people are dying and you won’t put yourself out to allow me to be seen by a nurse, not even a doctor, for five minutes?’


Hold up – I thought you said it was an emergency? And yes, the famine is a global crisis, which is why you need to fly out and cover it with opinion pieces like this? Something starting out with not getting a business class seat on the way out there I suppose.

Here is a hint – you are a journalist, not an aid worker, not with Médecins Sans Frontières. You aren’t going to be saving lives by getting out there immediately. This. Is. Not. An. Emergency.

Last week, the boss of the care company Castlebeck, whose Winterbourne View care home in Bristol was exposed by Panorama for practising routine abuse, used the defence that the home was understaffed, and that the employees needed more training.

Of course that is part of the problem, but it doesn’t explain all of it. I don’t need to be trained to know that it is wrong to slap someone, or ridicule them, or pin them down, or deny them privacy and respect. That is called being a human being. You should not need to be trained to do that.

I always wonder why people who don’t like people go into the caring professions. The problems in the health service and in privately-run homes are not always to do with money. Attitude is often the issue.

So now you confuse criminal abuse with you not being able to jump a queue with a surgery you have not seen fit to register with for a complete non-emergency.

That’s like saying every journalist is guilty of phone-hacking. So – Grrrr. Liz Jones – I hate you because you hacked the phone of Milly Dowler’s relatives.

Andrew Lansley, the Health Secretary, said last week that NHS managers were abusing the system, forcing patients to wait so they either die or go private. The report, by the Co-operation and Competition Panel, said that one trust was insisting patients wait at least 15 weeks for treatment.

Such a time frame is within the 18-week target, but many hospitals can deal with patients more quickly than that. Everyone has become very ‘jobsworth’, doing only the minimum that is required.

I’d say that there is no actual proof of this as yet – and yet you ignore the way that the Co-operation and Competition Panel are rather close to lobby groups for privatised healthcare.

But when you challenge them on their attitude, as I did when I called the ‘health centre’ and spoke to the receptionist, or manager, or whatever she calls herself, they are shocked at your temerity.

Again the ‘journalist’ puts Health Centre in quotes.

How would you like it if you were queuing and someone jumped in front of the line? There you go – that’s why you have receptionists – to stop bossy, over-entitled ‘journalists’ thinking that they are so much more important than anyone else.

They are too used to being bossy. They call the shots, not you, the patient – or at least potential patient. What would it have cost this woman on Friday morning to have said: ‘Sod the protocol – everyone needs to know about this famine, Miss Jones, so I am going to speak to the GP and see what we can do.’

What would it have cost to send a ‘journalist’ to the famine? It would have cost the appointment slot of someone coming in to have their asthma monitored, a chronic leg ulcer dressing being changed, a diabetes check or a renewal of a contraceptive implant.

And the world knows about the famine, because people like the BBC have journalists there. Not ‘journalists’ like you.

Have a serious think and ask yourself – what are you going to add to the reporting? All you are going to add to is the burden of people having to support you while you are out there – unless you are going to carry all the food and water you expect to eat while you are there in your Gucci hand luggage.

But no. People no longer talk in such a way. They follow the rules. They never put themselves out. They never look at the bigger picture.

Madame – you are a douche of the highest order.

And a Troll.

(Article reproduced fully for criticism)

Making More Victims

Once more a man who sits in an office, surrounded by others who sit in an office and is supported by newspaper writers who also sit in offices says that emergency services should put themselves at risk.

And the ambulance and police staff who do this are having their pay frozen and their pensions changed.

I suppose that this means that there is one new way of saving money – we can stop paying for all those ‘Please do not assault our staff’ posters – after all, if ambulance crews and the police are to go into areas where an indiscriminate killer is roaming without armament with which to defend themselves, then all NHS workers can put up with a bit of a beating if it’s for an ’emergency’.

It’s not about the pay, it’s about the job role. When I was in the ambulance service I was there to help people by providing medical support – not to get killed in the line of duty.  Ambulance personnel are not soldiers, they are not police. I wasn’t there to break up pub fights, disarm knife-wielding maniacs or find myself under fire.

Ambulance crews should not be sent into uncontrolled scenes where they, and the people they are looking to help, become a big target with blue flashing lights for someone with a grudge.

Ambulance crews do not have the kit, or the training, to deal with a violent aggressor (apart from ‘run away’, something only slightly more helpful than ‘stand your ground’ when up against an armed assailant). A shot or injured ambulance crew would just become additional victims which would place even more stress on an already overburdened system.

(Of course, then a coroner might suggest that injured ambulance crews go to the back of the line for medical treatment so that ‘the public’ are fully protected, neglecting that ambulance workers are ‘the public’ as well).  It bears mentioning that the first rule of major incident planning is to prevent any increase in the number of people that you need to treat.

I think that should a similar event happen again we should get the nearest coroner and get them to wander around the scene where a gunman is roaming and see how they like it.  Give them a box of bandages so that they can feel useful while doing their tour. Same for the journalists, they can go hunting for the suspect armed with nothing more than a cheap digital camera. After all, is it not the duty of journalists to get the ‘real story’, and for coroners to see out ‘all the information’?