Just as we’ve got used to excuses about the wrong types of leaves on the line and even the wrong type of snow when we wait for a train, we’ve also now become so accustomed to the wrong type of bureaucracy in the NHS that almost any form of management is resented.
Take venous cannulas, for example—a deeply unglamorous topic, admittedly, and the bane of many junior doctors’ lives. A new batch arrived on our ward a couple of months ago, a special safety model that looked pretty much the same as any other cannula. However, when the needle was retracted from the plastic cannula, a metal device clipped over the end to prevent needlestick injuries. The inherent cynic in me then made me try to stab myself with the needle repeatedly, and then I tried to prise off the safety device with an old biro, all to no avail.
Wonderful, I thought. A genuine leap forward, with the potential to abolish instantly all cannula needlestick injuries. Everyone has attended cardiac arrests or trauma calls where needles are left scattered all over the patient at the end. Who hasn’t had a friend or themselves injured by a stray needle?
So, it was with some dismay when I noticed a few weeks later that the old type of cannulas were back. I spoke to the ward sister about this and was met with the response: “Too expensive.” And that was the end of the conversation.
About 100 000 needlestick injuries occur in the NHS each year, more than 250 a day. If 100 000 patients (rather than staff) each year were being exposed to other people’s blood, how long would it take before this sort of recklessness on behalf of the NHS was remedied? Unfortunately even though we have a National Patient Safety Agency—issuing directives such as that advising that covering patients in paraffin may make them prone to immolation—the prospect of a similar scheme for staff seems far off. Would British Telecom or ICI try to economise for the sake of a few pennies when the very real potential consequences include contracting fatal illnesses?
This is a prime example of the need for a bureaucracy—where people in power make important decisions affecting the entire organisation in days not years. The reality is that the ward sister has to pay for important safety equipment out of a fixed budget and is castigated for overspending. Of course, any adverse events (“claim sensitive” events in management speak) come out of a separate budget so don’t affect those spending the money in the first place.
What will it take for this to change? A scandal more profound than that of healthcare professionals contracting hepatitis C or HIV? Until then, I suppose we just have to be as careful as we can. Because, as we all know, tomorrow it really could be you.