There are a myriad of examples of inconsistent thinking when it comes to the NHS and working patterns. I would like to focus on the pre-assessment service for anaesthesia, before you have your surgery as an example relevant to me.
Before you have surgery, you need to be pre-assessed. Your medical history and other relevant details are taken. If extra tests are required are performed, this will be done on the day of your pre-assessment or another day. The purpose of this is to minimise the anaesthetic risk and certain medical conditions or medications may change the way your anaesthetic is delivered.
The clinics are usually run by pre-assessment nurses. These nurses work in conjunction with the anesthetic doctors. Firstly, the anaesthetic doctors provide a set of guidelines for the pre-assessment team to work through and they provide assistance for some of the trickier cases that fall between the gaps of these guidelines.
Now, these pre-assessment nurses are very knowledgeable and experienced but they are not anaesthetists and do not give an anaesthetic. They rely on help from their anaesthetic doctor colleagues and doctors training and helping them from time to time. However, the anaesthetic doctors are not given sufficient and regular time to train them in any meaningful way. As a result, omissions can occur. Patients turn up for their surgery without the spectrum of tests they require for the anaesthetic doctor to proceed safely.
As a result, the anaesthetic doctor is presented with two choices. Try to arrange these tests while running their operating list for that day or cancel the case. Unless the surgery is urgent or an emergency there is little justification for adding additional risk. As a result, the operation is cancelled and the anaesthetic doctor has spare time.
However, the pre-assessment nurses will be busy running their clinics. Arranging teaching requires a commitment to give staff a fixed time to meet and learn. These can not be ad-hoc in an institution the size of a hospital.
The cycle repeats and repeats. If the anaesthetic doctor was given more time to teach and help their colleagues, less operations would be cancelled and as a result, the anaesthetic doctor would be able to anaesthetise more people.
This is a case of inconsistent thinking but also, an overstretched service. Because there is no slack in the system, the ability to be proactive is diminished and hence the service delivers less, further stretching it.
This is exactly the sort of inconsistency I would like a Royal Commission to consider. Rather than getting the most out of one person, how do we get the most out of a service. Find the barriers and remove them in an evidence based, logical and sustainable way.
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