Chump.

Once you wake up, you can never go back to sleep. Mum to two amazing girls. Seasoned NHS nurse. Community staff nurse with an interest in end of life care.

[Chump. @sass_melon]

Looking forward to my night shift tonight. Qualified for 7 years and still get butterflies of excitement and anticipation in my belly before a shift. It’s an honour to look after people during the hardest times of their lives and it’s something I’ll never tire of. #nursetwitter

[Chump. @sass_melon]

@nmcnews Thank you

[Chump. @sass_melon]

@nmcnews is NMC online down? I’m trying to renew my registration but it won’t let me progress past the log in page

[Chump. @sass_melon]

What in the BTEC performance arts am I watching? #OpeningCeremony

[Chump. @sass_melon]

@Betterhelpers hi, my kids start swimming lessons at Rivermead soon. My youngest cannot touch the bottom and can’t swim confidently, am I to get in the pool with her? Tried ringing Rivermead but no answer

[sana @sanelysana]

chandler bing made us ugly laugh when matthew perry was literally tearing apart in his real life. how could he not be special?

i wish him relief. relief from all that he carried. it must have been heavy.

this one will ache a little too much.

[David Baddiel @Baddiel]

Friends has always been a bit sneered at critically - too glossy, too popular - but actually it was an amazingly funny and engaging sitcom, driven by six brilliant comic actors, of which Matthew Perry was the most purely funny.

[Chump. @sass_melon]

@doctor_oxford “Initial stinging sensation”???? I had these and they were genuinely the most painful part of what was a very painful labour

[Vicky - Agent 72601 💚🤍💜 @Silenced_Woman_]

@Lord_Sugar This is how it works:

If it’s one woman, ‘she’s lying’

If it’s a few women, ‘they’re conspiring against him’

If they report after events, ‘why now?’

The only woman to be believed in these scenarios are the ones who say ‘well I dated him, and he was absolutely fine to me.’

[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.

📷

[Chump. @sass_melon]

@nhscaroline @alisonleary1 @DentonGavin ‘The same person who takes bloods for me’ who on earth do you think you are?! Sorry for this wake up call, but you ARE a nurse.If you want to be a doctor, train to be one. Your tweet reeks of insecurity & you sound like a nightmare to work with. I suspect that’s your main problem

[Chump. @sass_melon]

@gemmarawlinson @TrashBat_1111 I could have written this myself. I adore being a band 5 and we definitely need confident, clinically experienced band fives in most clinical areas. On a separate note, most people want to fly up the ladder these days which just leads to erosion of respect for senior roles.

[Gemma Roberts @gemmarawlinson]

Been asked again why 13 yrs in the same job I haven't progressed up from band 5... I have progressed but just not gone into a management role... in that 13 yrs I've developed a true passion for palliative care and gained a wealth of knowledge & experience I want to be hands on

[Chump. @sass_melon]

Attached screenshot does not say anything about mobility issues when booking extra leg room, so therefore a refund should be granted.

[Chump. @sass_melon]

@easyJet 1)My dad struggles with mobility and booked extra leg room seats but when he asked for special assistance, he was told he couldn’t have those seats due to his leg problems. His seats were changed to standard seats which were cheaper but he has been told…

[Chump. @sass_melon]

He is not eligible for a refund as apparently he chose to change the seats. This is not true, he was told he had to by a special assistance officer, who changed them. Please can a refund be arranged?

[Jon Harvey @jondharvey]

It’s only thanks to #Glastonbury that the nation gets to see a full live set by one of pop’s greatest legends on BBC One in primetime. In an era of fractured entertainment and second screens, there’s something cool about the idea of everyone enjoying a gig together. #EltonJohn

[Chump. @sass_melon]

@OfficialRandL hi, I’m bringing my two children with me to Reading but couldn’t find anywhere on the ticket ordering site to enter their details. Do I need to register them somewhere? Thanks

[Chump. @sass_melon]

Stopped between visits today to buy a can of Diet Coke from an ice cream van. The man told me I shouldn’t be buying it, he had a friend who drank too much of it and bled to death from every orifice? I’m hot and thirsty and have patients to see, just let me buy my drink in peace??

[Chump. @sass_melon]

@timricketts_ I brought this up in a meeting at work today. I’m a district nurse and we buy all our own equipment bags, boot organisers for the tonnes of stuff we carry and note books?? What are we doing??

[Chump. @sass_melon]

Regardless of your opinion of the Royal family, you just know the memes are going to be outstanding #Coronation