Umesh Prabhu's Comments
Comment on: Analysed: The renegotiation and future of junior doctors' contracts
There is an elephant in the room and that elephant is ‘non-trainee junior doctors about whom no one wants to talk about. Sadly many Trusts middle grade rotas are run by non-trainee middle grade doctors and most of them are in a dead-end job with no future. Most of these jobs are filled by overseas trained and locum doctors and with immigration regulations this pool of doctors coming from non-EU countries is drying up. More and more non-UK EU doctors are filling these posts. Most of them are very good but due to their basic training is done in their own language and not in English, some of these doctors do struggle in the NHS. We got to have better workforce planning to see how we are going to recruit good doctors to these dead-end jobs. Simply looking at junior doctors who are in training posts and revamping their working conditions will not sort out the problem of non-trainee junior doctors. We got to look at the whole NHS and may be the time has come for us to develop consultant delivered service with merger of the Trusts to provide 24 hours, 7 days a week, 365 days service delivered by consultants for a larger population of around 500,000.
Comment on: Chief executives are running scared
NHS has too many masters, fragmented management streams and structures like Primary care, Acute Trust, Community Trust, Mental Health Trust and Social Care which is completely under different management, confusion around co-operation and competition, too many reforms, poor fragmented IT systems, leaders with personal agendas and too many political interference! Current financial challenges and economic pressure should act as a catalyst for everyone to work together, putting patients at the heart of everything we do and we need strong leadership with integrated management structure with clear line of accountability providing service for 500, 000 population with excellent primary and community care, community based 7 days, 365 days elderly care service and the most important single point of contact for triaging for any out of hours service. We also need single paperless medical record.
Comment on: Chief executives and chairs in New Year's Honours list
Well done Shahnaz, Well deserved recognitions. I sincerely hope the country not only recognises excellent leaders like you who have contributed so much for true equality and diversity but also implements you wonderful work across the country and throughout the NHS. NHS cannot afford to continue to have ‘club culture, ‘old boys network way of doing things for appointing leaders or promoting people. NHS must have ‘Fair and open; culture, supportive and learning culture and should make all its staff feel valued, involved, engaged, nurtured and supported. Hopefully your recognition will give the importance to your work and it will be implemented across the NHS soon. You should be very proud of your work.
Comment on: GMC: Most struck-off doctors are trained abroad
I fully agree that HSJ or no media should ignore these details but it is equally wrong to make sweeping generalisation of overseas trained doctors. Let us discuss the solutions; 1. As far as possible UK should be self sufficient and should recruit only UK trained doctors. 2. These doctors must be properly trained not only in their clinical skills but also non-clinical skills of being good doctors like patient safety, quality, governance, patient empowerment and involvement, respecting and valuing patients as fellow human being, communication, team working, professionalism, duties of doctors, why doctors make mistakes and how to avoid them, dealing with complaints, litigation and so on. 3. All doctors must have proper induction, help, support and guidance as to who can help them and where they can get support if they are stressed, over worked or have health or alcohol and substance misuse problems and do not get adequate support from their employers. 4. If the doctor makes any mistakes – whom to inform, how to be honest with patients and families that too if the patient has suffered due to their mistake. 5. Doctor whose performance deteriorates must be helped, supported and guided and remediated. They should be identified early so that patients are not harmed. 6, Bad doctors, incompetent doctors and doctors who show gross disregard for patient safety should be removed irrespective of their race, gender, ethnicity or place of qualification. 7. All Trusts, CCG, Deaneries must have fair process to deal with any concerns and action taken must be proportionate and most doctors need help, support and guidance and rarely and when appropriate these doctors must be reported to the regulator and the regulator must have fair process. 8. Every Trust, CCG, GMC, Colleges and Deaneries must comply with Race relations act and the decision makers and experts ethnicity must reflect the ethnicity of the staff working in the Trust or in each of these organisation. 9. All decision makers must be performance managed for their fairness and proportionality. 10. Patient safety, quality and wellbeing should be the primary aim in any regulation but action taken must be proportionate and should not depend on race ethnicity and gender.
Comment on: Morecambe Bay review 'must get things right'
1. Excellent organisational culture and leadership not simply at the level of Trust Board but at each and every Division, directorate, wards and departments. 2. Excellent organisational energy where patient safety, quality, wellbeing are the priority and everything else is secondary. 3. The organisation with safety culture, learning and supportive culture and not a blame culture but culture of accountability for all. 4. Excellent governance and quality assurance systems in each and every department. 5. Complaints and feedback from patients, public and staff are taken very seriously and addressed very constructively and all lessons are learnt and implemented. 6. No staff is afraid to challenge each other including consultants and when they do, they do with mutual respect and professionalism and their concerns are properly dealt and responded and staff are encouraged to raise concerns even about seniors, Board members and everyone is treated with respect, dignity and humanity 7. There is zero tolerance for bullying victimisation and discrimination and every staff member feels integral part of the organisation and feels valued, involved, engaged nurtured and supported. 8. Where patients feel proud to visit and are looked after by kind and caring staff who are not simply clinically competent but are nice human beings who put patients at the heart of everything they do. 9. Where staff sickness rate is low and there are adequate numbers of staff with good skills mix to do their job and do a very good job and feel proud to work. 10. Where leaders walk to floor and everyone knows leaders by their first names and everyone feels equal.
Comment on: Chief executives not confident on out-of-hours safety
Mark and David, I think some of us must meet with the Royal College of Physicians (as they have a working party looking at 7 days working with 8 am to 11 pm consultant delivered service) and come up with action plan to reduce weekend mortality and to improve weekend and out of hours safety of our hospitals. At least we can pilot it in some well performing organisations and then lessons learnt can be implemented across the country. If we all appoint more consultants in acute specialities now then there won't be enough number of trained consultants in the country and this would create an artificial shortage of consultants in these specialities and will drive the cost and locum use. So, just wonder if few hospitals should pilot this. Knowing both of your commitment to safety, quality and governance, I would like our Trust to join you as well.
Comment on: GMC: Most struck-off doctors are trained abroad
First of all, let us not take the number of doctors erased out of context. There are 220,000 doctors working in the NHS and nearly 60,000 of them obtained their primary qualification outside the UK so called overseas trained doctors. So 39 doctors stuck off out of 220,000 doctors is 1 in 5,500 doctors registered with the GMC and 29 out of 60,000 doctors is 1 in 2,000 overseas trained doctors are erased by the GMC! This obviously means more than 99.9% of doctors must be good, provide good quality care and look after patients very well. Having trained in India and having worked in the NHS for nearly 32 years, I have met lot of wonderful patients and colleagues from all walks of life. Soon after Christmas when we had huge number of ill patients coming to our hospital I saw nothing but had work and dedicated staff who are trained UK as well as abroad and they all made me very proud. All they were interested in was looking after their patients. Bad doctors exist amongst those who are trained in UK as well trained abroad but fortunately they are rare. Let me remind all your leaders that Shipman (killed 247 of his patients), Richard Neal and Rodney Ledward (Gynaecologists butchered their patients); Kerr and Haslam (two Psychiatrists sexually molested their patients) were all UK trained doctors! The important thing is to protect our patients and it is their safety, quality of care and wellbeing which should be at the heart of our duty as doctors and any doctor who is unfit to be a doctor should be removed irrespective of whether they are trained in UK or abroad. NHS is very well known for Club culture and Old boy’s network. GMC can only deal once the doctors are referred to them by the Trusts. If the Trusts do not refer bad doctors then GMC can not deal with them. By not dealing with bad doctors simply because they belong to certain club or network, the NHS is not only discriminating but also putting patients’ lives at risk. I often wonder if only Shipman, Ledward, Neale, Kerr and Haslam were Black and Minority Ethnic doctors or overseas trained doctors probably they would have been stopped early and many patients lives would have been safer and many would have been alive today! NHS can not afford to ignore these cultural issues which exist in the Institution. Our patients need better protection. Of course, it is equally wrong to use ‘race card’ to protect bad doctors from BME whether they are trained in UK or abroad. Patient safety is not for compromise and doctors must be held to account but action taken must be fair, proportionate and should not depend on race, ethnicity, gender or place of qualification.
Comment on: Chief executives not confident on out-of-hours safety
In an ideal world all patients should be seen by a consultant and there must be consultant presence for all acute specialties 24 hours, 365 days. But this is very costly and simply not a reality under current financial challenge facing the NHS. But we must have more consultants in the weekend and also out of hours and there must be consultant delivered service from 8 am to 11 pm night and this could be good value for the money and this would reduce admissions, facilitate early discharge. Reduce length of stay and reduce unnecessary investigations and also patients get the best care first time and every time. But for this we must have adequate number of consultants as burnt out consultants are no good for anyone. Consultants must work only 48 hours a week maximum and should be rewarded appropriately for working during unsocial hours. This is possible only if there are 10 consultants to take part in the rota. We must have this for acute medicine, Paediatrics, Obstetrics, A&E, Trauma service, Radiology and Pathology and acute surgery. There must be much better Primary care, pharmacy, therapist services and social care in the weekend and out of hours. For this to be a cost effective service and good value for the money such a service should be available for 500,000 population which means service re-organisation and merger of the Trusts which is rather challenging under current Foundation Trust legislation. Hope the Monitor, Commissioning Board and CQC will work together, putting patients at the heart of everything they do and rationalise services. Hope there won’t be any political interference either by the Public or local politicians when services are merged. We simply cannot continue to provide safe and good quality care by simply doing what we have always done.
Comment on: How to reduce A&E use by targeting diversity
What an excellent initiative. This team must meet the team which organises ‘Health Mela’ in Preston temple which has been going on for nearly 6 years.
Comment on: Nurses need freedom to do their jobs properly
It is pleasing to see NHS Leadership academy commenting very positively about their work on leadership in the HSJ. But the sad reality is that many NHS Chief Executives feel bullied! This is at odds with the true leaders we need to lead NHS. Bullying has no place in the NHS. NHS needs strong leaders and not leaders who feel bullied or bully others. NHS must have ‘Fair and open’ culture and supportive and learning culture. Nurses should feel empowered to do their job and should raise any concerns they have about safety and quality with those who are in authority. These concerns must be taken seriously and should be dealt properly. Time is right for the NHS leadership academy not to simply produce guidance but to do a study to see how many leaders actually have the leadership skills, and qualities.
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