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February 2010 the NEWSLETTER for ENT PROFESSIONALS

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February 2010 the NEWSLETTER for ENT PROFESSIONALS ENT•UK BRITISH ASSOCIATION OF OTOLARYNGOLOGISTS HEAD AND NECK SURGEONS www.ENTUK.org Vol. 20, No. 1, February 2010 THE NEWSLETTER FOR ENT PROFESSIONALS Vote early and vote often Contents Tony Narula Vote early and vote often aving been elected to the have dried up follow- Council of the Royal Col- ing the change in immigration Managers- lege of Surgeons in 2004 rules last year. it is time to take stock of don‟t you just love them? H what is going on in the medico- SAFETY political landscape as I seek re- Patient safety is the new buzzword Procedure Based election in early 2010. being used by everyone from Sir Assessments (PBAs) Liam Donaldson downwards EWTD (upwards?). It‟s a bit like mother- Members of ENT-UK will have seen hood and apple pie: everyone is in Independent practice acres of comment on this issue. favour of this but being in favour survey Especially from the President of doesn‟t make it happen. All sorts the RCS John Black. I have fully of new institutions have sprung up Notes supported his stance that rules like the National Patient Safety introduced to protect truck drivers Agency to protect the public. Re- Goodbye to All That or production line workers are not validation also comes into this appropriate for professionals. On (see later). In fact Safety will be- the other hand no-one can deny come a fig-leaf to close hospitals. English college council that in certain specialties (eg The CEO of the NHS has said quite report 2009 Emergency Medicine, Obstetrics) explicitly that he wants to transfer prolonged hours are unreason- huge swathes of activity into the ENT UK charitable able. But for most surgeons community and that hospitals will (including ENT) a maximum of have to „change‟. As Safety/ Qual- conations & „The about 60 hours on call allows TM ity are mentioned more and more Giving Machine ‟ avoidance of shifts (which are uni- we can predict some conse- versally hated) and also time to quences. For example the arrival On the other hand- BACO gain enough experience – espe- of designated „stroke‟ centres fees cially in emergencies. This figure means that not all existing hospi- chimes with experience from the tals will take unrestricted emer- OME / adenoid position USA and Germany. What has been gency referrals. This is in con- sad is the failure of other major junction with the related major paper ENT-UK 2009 Royal Colleges to publically align trauma centres. Thus if your hos- themselves with the RCS – what- pital is not in either category your Indications for ever they may have said in private. A&E is at risk and soon thereafter tonsillectomy - ENTUK Interestingly the College of Emer- your acute status in general is at position paper gency Medicine have said they risk. That will swiftly be followed cannot sustain a 24 hour A&E by downgrading to a community without a surgical presence. Cur- hospital with large budgetary sav- Just a short talk (RSM!) rently it appears that many hospi- ings as staff will no longer be re- tal rotas are shams with unfilled quired at previous levels. Developing links between posts in order to be EWTD compli- NoE-ENT & ENT in ant and increasing problems filling REVALIDATION Many of you will know that I am Malawi these rota gaps as locums seem to Vol 20, No, 1 Page 1 the RCS revalidation lead. Each spe- three day selection process that cialty is working hard on this to set Managers—don‟t you sounded as if it was modelled on „The appropriate standards and describe the just love them? Apprentice‟. She must have been scarily means of demonstrating adherence to clever as the ratio of applicants to those standards. In practice the DH is places was a staggering seventy to one. uncertain of the point of revalidation: Ray Clarke The training programme as she out- sometimes it is to prevent another lined, involved rotating appointments serial murderer (Dr Shipman) and at Contact with „twenty-some- in various trusts, on-the job training, other times it is to enhance safety and thing‟s‟ is hard to come by shadowing senior managers, some quality of patient care. Without a clear at my age so I am always classroom-based teaching on NHS fi- statement of aim it is hard to see how glad to see the medical students. They nances, commissioning, providing this innovation will help us or our pa- update me on the soaps, the X factor services and a good deal of exposure to tients. One can however predict the and the perverse selection process for clinical practice - hence the clinics. She risk of a massive increase in bureauc- Foundation Programme jobs. They tell will do a series of rigorous assessments racy. Sometimes I just think a 5 yearly me about their exotic gap-years, their and gain a postgraduate qualification in exam would be simpler: that‟s a meas- elective in the Seychelles, the best health service management. She was as ure of how worried I am about this nightclubs on Merseyside and where enthused and excited about the pros- topic, not because I think an exam is a the twenty-four hour shops can be pect of improving patient care as were good idea found. I get to hear of the prohibitive any medical students I have ever cost of apartments on the docks and of taught. I know it is fashionable- almost QUALITY ACCOUNTS how tough it is when you have a mod- a rite of passage- for us doctors to All NHS Trusts will have to publish est sports car and a vibrant nightlife to sneer at managers and assume they are quality accounts in the near future. I run on nothing but a measly and unfeeling, devilish, horned creatures have looked at the draft standards and grudging parental supplement and a whose „raison d‟être‟ is to save money, am afraid that this is just another box student loan. In return they get to lis- obstruct medical initiatives and en- ticking exercise with quality as a ten to a grumpy old curmudgeon going sconce themselves in plush offices smokescreen. If it means re- on about the latest crazy management where they are insulated from the coal- introduction of Performance Indicators initiative, what a disgrace our politi- face of clinical encounters. Isn‟t is us by another name it is a regressive step. cians have become, how hard we all doctors who have a monopoly on em- As always, if you make it important to worked when I was a junior, and how pathy and caring, looking after pa- measure something, that thing soon only one lad in our class- now an emi- tients, responding to their needs, advo- becomes important by virtue of meas- nent professor of surgery- had a car cating for them, driving services for- urement not because it has intrinsic and we all had to cadge lifts off him in wards, and keeping the nasty managers value. This is often known as MacNa- return for either lecture notes or pints out of our conspirational rapport with mara‟s fallacy as experienced during of Guinness. If we are on a good run in patients? Well, no, it isn‟t and we don‟t. the Vietnam War when the Body Count clinic and there is extra time I get them Medical graduates – like humanities was announced every day by the Penta- to take some of the histories, show graduates and everybody else- can be gon even as the USA was losing the them how to use an auriscope, and remote, self-absorbed, belligerent, war. In the same way we have recently dispense the odd pearl of wisdom, all stubborn, mendacious, duplicitous, had the spectre of Basildon Hospital the while peering at them over the rims manipulative and venal. Managers don‟t being criticised for being filthy even of my reading glasses. It‟s a „win win‟ have exclusive call on these qualities. though the Trust had awarded them- really. Many managers- as is the case with selves 6/7 points for cleanliness when many doctors- are exceptionally compe- filling in the forms! Nothing beats a I was hesitant recently when the clinic tent, idealistic, committed, and care site visit as any Royal College could tell manager asked me if a management deeply about improving the lot of pa- you from the days of regular (5 yearly) student could sit in my clinic. A medi- tients. It will pay dividends for us all if visits to accredit surgical training. cal consultation after all is a private we nurture, encourage, train and re- encounter; patients don‟t always want ward them. We should support and FINANCIAL ISSUES an unqualified observer listening to advocate graduate training schemes I have been Honorary Treasurer of the their medical histories- hence I always that ensure the most talented of our RCS since July 2008. Like every other ask if they are happy to have the stu- youngsters think about NHS careers organisation (and the UK Treasury) we dent doctor present. How would they rather than being seduced by large have experienced a difficult time. How- feel about a non-clinical student? Worse salaries in the city, retail, and banking. ever, we have avoided any compulsory still, one who was planning to be a Even more pertinent for us, we –and redundancies and maintained our im- manager? After some thought I agreed. our patients- can profit hugely from portant work streams throughout the I then reflected on the unspoken cama- working closely with our managerial past 18 months.
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