John Rasquinha

@FOMOHub , Paediatric doctor with interests in QI, International Health, Informatics, use of data

[Dr Andrew Meyerson @AndrewMeyerson]

Dear 🇬🇧,

Do you want to understand why your NHS is collapsing? Take 7 minutes to watch this and then share with friends, family, and your MP. This assault on our health must end now.

#SOSNHS

[John Rasquinha @johnrasq]

Happy to share our QI experience so far with anyone working in Primary Care or other specialties, within @AneurinBevanUHB or elsewhere! @ABCiAb @WelshBok1

[Clifford Jones @CliffJonesGP]

Many in NHS have a negative opinion of #QualityImprovement activity.
Often seen as distracting from "proper work"
Today our #PrimaryCare teams heard from Paediatrics colleagues about the massive improvements they've made to wait times and services through a focus on QI
1/3

[qipstart @qipstart]

In the current pressures of delivering healthcare improvement at pace, how often do you see people like George thrive, let alone be promoted...

#PDSA
#ContinuousImprovement
#GrowthMindset #Learning
#PyschologicalSafety

#QItwitter
#Peppa

[Hannah Raval @HannahRaval]

This week myself and @johnrasq have been coordinating the Cardiff Medical student’s SSC week on #GlobalHealth
It has been a fantastic week of speakers and workshop, ranging from health inequalities and human rights, to tropical medicine and global surgery!
#GlobalHealthEducation

[FOMOHub @FOMOHub]

Increasing event listings of courses & conferences for specialties across the range from Neonates to Geriatrics with new posts from @GeriSoc , check them out at https://t.co/ALr7xfkd9P

Always free to search & submit, with no log in! Don't get FOMO, get https://t.co/XjddBU8tu5

[FOMOHub @FOMOHub]

Working in Paediatric Emergency Medicine?

Events coming up including the FREE Virtual Conference hosted by @PaedEmergencies on Thursday 9th November!

Check them out at https://t.co/lKFwbZoQSA

[FOMOHub @FOMOHub]

Want to find events by date or location?

Use the filters to narrow down listings to your needs, such as events in January 2024 in Bristol....

https://t.co/XjddBU91jD

[Rob Galloway @DrRobgalloway]

Thoughts on the NHS…..

Einstein said the definition of insanity is doing the same thing over and over again and expecting different results.

But this is what is happening in the NHS right now; hoping things will improve when just giving the same failing medicine.

As an A&E doctor, I am proud of what I do and would not want any other job

But I am getting increasingly demoralised that despite best efforts, it can seem like we are moving deckchairs on the NHS titanic and just applying a sticky plaster to ever expanding gaping wounds of deep routed societal problems.

The relentless pressures are getting worse and we are insane if we think the same solutions will solve the problems we have – even with more money and slightly different politics.

We need to have a different approach if we are to have a functioning NHS in the future

We need to look at the issues and potential solutions

1) A large amount of the problems we see are preventable - problems from poor diet, lack of exercise, smoking, drugs and crucially poverty and people’s lack of opportunity and optimism about the future. Efforts should be made to prevent the problems not react to them

2) We must ask ourselves are we doing too much for people and extending their length of life but not addressing if it gives them a quality of life that they would want. Just because we can do so much for patients, doesn’t mean we should.

3) On the whole, the clinician treating you now, are feeling less happy with taking on risk than those ten years ago – hence why there is often over investigation instead of simple reassurance. The risk of being complained about and being sued is one reason. But how to take risk is not taught explicitly and we are losing significant numbers of highly experienced senior decision makers such as GPs who have learnt these skills through years of practice and are replacing them with much more junior staff who are good at working within their defined skills and protocols but who do not have the training and experience to be good “riskaticians”. This is also true of algorhythm based triage systems where the default position is often 999 ambulance and A&E without consideration of this decisions on other patients whose care is delayed because there are only finite resources.

4) We are providing care in the wrong place. I see so many people who could have been cared for by out of hours senior decision makers who can make a judgment call to treat at home, rather than coming to hospital. Instead, paramedics have to bring these complex elderly patients into hospital where they are then seen by junior staff who often can over investigate and admit which leads to deconditioning and deterioration.

5) Medical services are designed around 9-5 Monday to Friday working. This needs complete overhaul so that the same quality of care is provided 24/7

6) The private sector is not the solution. Where profit becomes before patients there is often a hidden bias to overinvesting and over-treating. The money spent on private sector investment run diagnostic centres may well be used in a better way.

7) Mental health care needs to be prioritised as much as medical care. Both are under resourced but the lack of beds and community care for mental health patients creates enormous pressures on emergency services and crucially leads to unacceptable care for the most vulnerable of patients.

8) Any remodelling of the NHS has to be a phased approach – stabilise the current crisis with investment in community as well as hospital care and then longer term transformation so that we truly become a health service rather than a reaction to illness service,

9) Key to a needed NHS transformation is keeping experienced staff and the only way to do this is empowerment of their decision making, flexible working and appropriate renumeration and recognition. The biggest risk to the NHS is that staff will soon stop caring and just go into self-preservation mode. So worry when people like me stop writing messages like this, rather than when we do!

My biggest worry is that politicians won’t want to face up to these incredibly difficult problems and will try and kid themselves and us that a bit more money and tinkering will solve the issue.

It wont. We need radical new thinking now and the politicians to realise this. Without this, the NHS will wither away to be replaced by privatised medicine and the care which will all deserve, will only be available to the richest in society.

Please feel free to share these thoughts so that politicians of all shades can see the reality and thoughts of someone on the front line rather than just the sanitised version of the NHS they are shown.

Thank you for reading my post weekend literary catharsis

Rob Galloway , a tired but still optimistic (just) A&E Doctor.

📷

[FOMOHub @FOMOHub]

Not enough notice leading to FOMO? We've got courses, conferences and webinars for the next 12 months across Anaesthetics, EM, Oncology, Paediatrics and Radiology hosted by @RCoANews @RCEMevents @RCRadiologists @RCPCHtweets and more at https://t.co/XjddBU8tu5 #medtwitter #MedEd

[John Rasquinha @johnrasq]

#paedsmedtwitter is there a recognised standard list of "Reason for referral" options for paediatric outpatients? May be broader symptoms/signs e.g. "headaches", "concerns around head shape" rather than final diagnoses and trying to encompass the full range and avoid "other"

[John Rasquinha @johnrasq]

@DrNickTwit Need to know you've got enough WTE, may need some flexibility of non working days, so it's important to get everyone's (clinical and admin) perspectives, queries and support from the beginning, culture change but benefits if it works are huge, though manual is big time investment

[John Rasquinha @johnrasq]

@DrNickTwit Yes, did it last year for the whole 6m, manually with Excel but takes time, needs all to understand that there'll be busier runs and less continuity than rolling rota, but the trade off is everyone has their leave and less swaps later on.

[John Rasquinha @johnrasq]

@WelshBok1 and I will be talking about this and more on how we are establishing a QI culture in our Paediatric department at
@AneurinBevanUHB at #RCPCH23 conference, 1445 today
@RCPCHtweets
@ABCiAb

[Aklak Choudhury @AklakC]

Many have pressed for change on how we approach & assess QI for trainee doctors

Pleased @AoMRC have published document on ARCP 👇
https://t.co/U2YAshraKW

Docs no need to lead projects!
No need to do QI from start to end!

Hope all royal colleges adopt this soon!
#Medtwitter

[FOMOHub @FOMOHub]

At #RCPCH23 and great to hear attendees' thoughts on the site!

We've got lots of upcoming events held by @RCPCHtweets and many others currently listed, check them out at https://t.co/XjddBU8tu5 !

[FOMOHub @FOMOHub]

Thank you @CamillaKingdon for sharing about our site in your latest blog as we grow our listings to include wider Paediatric Sub-specialties and other specialties! https://t.co/jZDG9qrisK @RCPCHtweets

[Samantha Lissauer @SLissauer]

#CycloneFreddy has caused unprecedented levels of devastation in #Malawi. My #paediatric colleagues and I have seen unimaginable horror at QECH, Blantyre. The worlds most vulnerable being the most heavily impacted by #ClimateCrisis. And not being reported in global north.

[FOMOHub @FOMOHub]

Thank you @EMTAevents & @RCEMevents for your support!

Site is FREE to Search and Submit, and we will list any event open to national or international clinical staff - https://t.co/zX3Ud6B7Qr

[FOMOHub @FOMOHub]

An exciting week for us with presentations to different groups on our latest developments and plans for https://t.co/XjddBU8tu5 to help you avoid the Fear Of Missing Out on courses, conferences and webinars, which we'll share with you on here as we go...

[FOMOHub @FOMOHub]

Group A Strep Infections - @NPEG12 are opening up their regional session to anyone wishing to join:

https://t.co/K2sOSHIXzV

⏰ 5/1/2023 0900-1230
📍Teams (no pre-registration)

Our page will allow you to add it straight into your calendar and contains the direct Teams Link

[FOMOHub @FOMOHub]

Lots of exciting developments at FOMOHub HQ, as we're automating lots of our processes to get events listed for you as soon as possible!

Always Free to search and submit at https://t.co/XjddBU8tu5 !