Monday 10 December 2007

No work

Disillusioned kindly posted comments 'bout Day Hospital but then interestingly mentioned how staff sickness meant that the work didn't get done.

This got me thinking.

If a Consultant Psychiatrist is off sick for a short time (a few day), any routine work isn't done but any urgent work is covered by colleagues, being absorbed in to their working week. If off for any length of time, a locum is brought in to fill the post and do the work. Although I've not had a day off sick this year, nor have others I work with, I think that it's understandable that if I am off sick, 'phoning in that morning to say I'm on my death bed, then the clinic list for that day would have to be cancelled. Given that the work isn't done by anyone else then has to be done when I return to work, on top of everything else, it's usually easier to soldier on and do the work rather than take time out one week then have 2 weeks' work to do the next. But anyway, short term sickness will occasionally occur and will occasionally impact on appointments.

For nursing staff, the story's the same for short term sickness too. If colleagues are off for a short time then urgent stuff is dealt with and some it's understood that appointments for that day may need to be cancelled. Going through all activity since April 2008, we've actually not had to do this terribly often, since either other CPNs* or I have done the visits instead. Thus, we can count on one hand the number of patients who've had cancellations through sickness. We don't like to mess patients around so if we can sort it out we rather would do, then we're up to date and the patient's had the input we'd all felt was needed.

Long term sickness is different, though. I've little sympathy or understanding for why long term sickness should affect patient visits and support at all, since it's long term (so plans can be made to address this).

Disillusioned said that staff off long term do have impact on support. Needs identified and planned for within the Care Programme Approach (CPA) should, obviously, be met. The whole point of it is that you're looking at needs and planning medical, social and nursing care to address these needs.

For a service to have folk, with CPA evidencing the service provision nececssary for their health, to then fail to deliver, seems wholly inexcusable. Okay, if through short term sickness I'd concede as above that the odd visit may not happen, but for people to just do nothing is unbelievable. It's embarrassing.

In what other area could someone be off work, have patients in need of support, and still no support is given and no work gets done?

* Apologies to anyone who's a Integrated Developed Independent Outreach Team (IDIOT) nurse and not a CPN, but I can't get my head around new jargon for new jargon's sake ;-)


Jan said...

Interesting that you mentioning longer term absences and the concept of PLANNING. I've had a number of consultant appointments cancelled at short notice due to (as the letters said) "holiday". I thought holidays were planned in advance, or is there some secret contractual condition that allows a consultant to head for Ayia Napa as soon as the mood takes?

Disillusioned said...

Thank you for this. I have actually had appalling experiences of lack of provision due to long term sickness. Long term absence of my Care coordinator meant, on two occasions, no support. The second time coincided with my return to work after long term sickness (incidentally, I am a teacher, and yes, I was covered!) my GP's absence on holiday (it's OK, he's allowed to be on holiday, no complaints there) and the ending of psychotherapy sessions. Yet requests for the "telephone and email support" and the "monthly visits" outlined in my care plan were refused. Various reasons have since been given, all contradictory. I have no idea any more which are true, and don't really care - what matters to me is that I was left without support when I was in serious need of it and then went into crisis.
Where's the service there?

I have no issue with holidays; no issue with short term sickness not being covered - but absences of 8+ weeks (as was the case for me twice) should surely be provided for, with no questions asked. Shouldn't they? Or is it just that the Trust by which I am "served" operates on a different set of guidelines?

The Shrink said...

Jan, I give 6 weeks notice for all leave. Most clinic appointments aren't booked that far in advance for me so often it doesn't cause inconvenience (pulling off my clinic lists for the last 12 months shows I've cancelled 7 clinics, but no patients at all). Our Trust requires a minimum of 4 weeks notice (a neighbouring Trust I also work in needs 6 weeks, hence my habit), most Trusts don't let medics skip off at short notice without good reason.

Disillusioned, you've said it as it is. Holiday and short term sickness should have minimal impact on the service but may result in the odd shuffling of support. Long term sickness really shouldn't affect services at all.

And my whole point of the post was precisely what you're getting at - doing no work for our patients and providing no support for our patients because our service is down a team member seems inexcusable.

Resource limitations mean we can't give everyone everything they want all the time but it isn't ever an excuse for not providing what someone needs.

AS such it's unacceptable, so can't be accepted, so complaints should be made.

Disillusioned said...

Ah... complaints... no, I really shouldn't get started on that... But complaining to a Trust where the complaints staff can't / don't follow their own complaints policy seems rather more pointless than not. See my blog for the gory details - I won't clog up yours with them! The lowest point was (possibly) having my complaint investigated by the member of staff the complaint was about - but there is competition for that dubious honour. Suffice it to say I am gathering strength, after 5 months battling, to move on to the HCC.
I repeat what I keep saying - can I come and be a patient in your area, please?

Elaine said...

Another interesting post, Shrink. I have a suspicion that the lack of cover is down to a deliberate management policy to save mooney - in the same manner as vacancies are not filled, often for six months.

Fiona Marcella said...

Even short term absences can cause problems in a service which is already understaffed and which has gone through a major "reconfiguration" the trauma of which seems to be still being felt some 11 months on. If the majority of care is being provided by short term locum services anyway then someone having just one day off sick can leave service users who are already confused and unhappy even worse off - not that this should stop staff taking sick leave if they really have to of course.

The Shrink said...

Marcella, I've little sympathy for that school of thought.

At the end of the day the service fits around the patients, not the patients fitting in to the service.

The "reconfiguration" you mention has happened in my corner. I had 29 inpatient beds two years ago, with ward closures I now have 9. I had a busy CMHT, now I have 1.8 qualified CPNs. Even with massive reconfiguration and reduction of resources you can still have a great service that sees everyone in a week or so and always follows folk up appropriately.

Disillusioned said...

Elaine, my own Trust in recent Board minutes made reference to the fact that savings on the budget had been made by "not covering maternity leave".
Made me sit and ponder...

Fiona Marcella said...

I think I need to make it clear that sick leave has never meant a total cancellation of service- rather the opposite, when it has occurred meetings have gone ahead as scheduled, but with alternative professionals attending. There IS cover available, and resources have been put into our case. It is just that with a seemingly constant change of personnel it has been hard for both service user and professionals to have to catch up with the history, repeat what is already in the notes etc. The knowledge that there is a team who would be available and have had the same constant (over worked and under pressure but constant) membership and purpose but who we for complex reasons choose not to see just makes the guilt worse!