NPR

Jock42 wrote: ↑Tue Dec 22, 2020 8:25 am

Northern Lights wrote: ↑Mon Dec 21, 2020 10:30 pm
How about separate hospitals for coviders you know like we used to do with tb and the like. They’ve had all year to come up with a more effective strategy rather than doubling down on a failed strategy every time they realise it hasn’t worked.

The logistics wouldn't really work. Anyone with certain symptoms is admitted through a covid ward (the infectious disease ward for us) or a secluded area in A&E until tested then moved to a more appropriate ward.

Would 7 months of planning to change those logistics have helped? London is closed and our surge hospital isn’t being bought out to be used.

Good to see the DM with its finger on the pulse. Their headline is a story about Prince William going for a walk

Bimbowomxn wrote: ↑Tue Dec 22, 2020 9:02 am

Jock42 wrote: ↑Tue Dec 22, 2020 8:25 am

Northern Lights wrote: ↑Mon Dec 21, 2020 10:30 pm
How about separate hospitals for coviders you know like we used to do with tb and the like. They’ve had all year to come up with a more effective strategy rather than doubling down on a failed strategy every time they realise it hasn’t worked.

The logistics wouldn't really work. Anyone with certain symptoms is admitted through a covid ward (the infectious disease ward for us) or a secluded area in A&E until tested then moved to a more appropriate ward.

Would 7 months of planning to change those logistics have helped? London is closed and our surge hospital isn’t being bought out to be used.

There's a fairly major staffing problem in the NHs in London at the moment. Over 5,000 frontline care workers (Nurses/Doctors) were unable to work last Friday with either suspected (and waiting on test results) or proven Covid.

Bimbowomxn wrote: ↑Tue Dec 22, 2020 9:02 am

Jock42 wrote: ↑Tue Dec 22, 2020 8:25 am

Northern Lights wrote: ↑Mon Dec 21, 2020 10:30 pm
How about separate hospitals for coviders you know like we used to do with tb and the like. They’ve had all year to come up with a more effective strategy rather than doubling down on a failed strategy every time they realise it hasn’t worked.

The logistics wouldn't really work. Anyone with certain symptoms is admitted through a covid ward (the infectious disease ward for us) or a secluded area in A&E until tested then moved to a more appropriate ward.

Would 7 months of planning to change those logistics have helped? London is closed and our surge hospital isn’t being bought out to be used.

No. If they test negative they then have to be transported to the "green" hospital. The ambulance service here doesn't have the capacity for that.

Jock42 wrote: ↑Tue Dec 22, 2020 9:16 am

Bimbowomxn wrote: ↑Tue Dec 22, 2020 9:02 am

Jock42 wrote: ↑Tue Dec 22, 2020 8:25 am

The logistics wouldn't really work. Anyone with certain symptoms is admitted through a covid ward (the infectious disease ward for us) or a secluded area in A&E until tested then moved to a more appropriate ward.

Would 7 months of planning to change those logistics have helped? London is closed and our surge hospital isn’t being bought out to be used.

No. If they test negative they then have to be transported to the "green" hospital. The ambulance service here doesn't have the capacity for that.

Jock , you’re one of the good guys. I think my point is 7 months would be enough time to increase the ambulance capability for these bottle necks.

Remember we’ve now spent 3 times the annual budget of the NHS .

I like neeps wrote: ↑Tue Dec 22, 2020 8:01 am

Northern Lights wrote: ↑Mon Dec 21, 2020 10:30 pm

I like neeps wrote: ↑Mon Dec 21, 2020 6:35 pm

What strategy would you take? No lockdown in Sweden and the US is going predictably terribly as well.

Both options are absolutely sh*te. I don't want to be locked down. But equally I don't blame the government's for doing so looking at the number of deaths. Wouldn't want that over my head either.

How about separate hospitals for coviders you know like we used to do with tb and the like. They’ve had all year to come up with a more effective strategy rather than doubling down on a failed strategy every time they realise it hasn’t worked.

Slight difference in medical knowledge and infrastructure between TB and now, I wonder if it would be possible to have all those ventilators and staff. But a good idea theoretically.

I agree it doesn't work but neither does the opposite. You have a contagious virus on the loose and you are screwed with no good options sadly.

The world of medicine has moved on from the days of TB hospitals! The separate hospitals doesn't work because we just dont have the staff for them plus we now know covid19 has all sorts of complications so you need access to cardiology, respiratory, imaging, vascular, neurology, etc etc expertise. These are very specialist services and you can't duplicate these across lots of hospitals.

The nightingales were not set up to be real hospitals, they were to either provide a step down facility for those who were recovering and just needed oxygen and rehab or for those who were beyond hope and would leave in a box. They were a sensible reaction to a crisis that no-one really knew what was going to happen.

Hospitals are set up with different zones and when they get too busy then they stop elective work and expand into the space made available. A small amount of this can/has been moved to nightingales i.e. they are using some of the imaging available. However we are struggling to staff up hospitals at the moment. Most staff are knackered and have built up tons of unused annual leave and now we have a major 3rd wave coming and the usual winter pressures.

Bimbowomxn wrote: ↑Tue Dec 22, 2020 9:24 am

Jock42 wrote: ↑Tue Dec 22, 2020 9:16 am

Bimbowomxn wrote: ↑Tue Dec 22, 2020 9:02 am



Would 7 months of planning to change those logistics have helped? London is closed and our surge hospital isn’t being bought out to be used.

No. If they test negative they then have to be transported to the "green" hospital. The ambulance service here doesn't have the capacity for that.

Jock , you’re one of the good guys. I think my point is 7 months would be enough time to increase the ambulance capability for these bottle necks.

Remember we’ve now spent 3 times the annual budget of the NHS .

It takes a year to train as a tech and a further year to train as a paramedic and about 3 months to train a care assistant. I've no idea how long it takes to approve funding for a PTS ambulance but they'll be easier to acquire than an emergency ambulance. 7 months isn't enough time to increase capacity.

Decent (at least to the layman) article on the new strain

https://unherd.com/2020/12/how-dangerou ... -mutation/

Fair enough, though you’ve got unlimited funds for this so much of those issues can be sorted.


Let’s really hope we never get a deadlier disease.

Jock42 wrote: ↑Tue Dec 22, 2020 8:20 am

Northern Lights wrote: ↑Mon Dec 21, 2020 10:28 pm

Jock42 wrote: ↑Mon Dec 21, 2020 9:49 pm
Admissions to the paeds ward in ninewells are down significantly for respiratory conditions compared to this time last year.

OJ,

Do you reckon you have more capacity this year than last or is it the same sort of shitshow as every year or are we actually worse?

You at least are front and centre with this compared to the rest of us armchair gobshites.

Thursday night was my first shift for a couple of weeks but we certainly had a quieter weekend than normal. A&E and the admissions ward were also quieter so certainly on the face of it things seem to be ok so far. Only in the covid ward once but they had capacity.

Impact is pretty variable across the country and even within a region. In Dundee, where Ninewells is located, for instance the are running at 118 cases per 100,000 for last 7 days, which is about average for Scotland as a whole. Highest in Scotland from what I can see is North Ayrshire with 189 per 100,00 for last 7 days. I know that the boards in the west of Scotland have had a really tough time of it over the past few months and have struggled to keep things going. The rest of Scotland has been doing ok and have been trying desperately to get elective work going again and have had some success. However for smaller boards with limited flexibility, such as the Borders, even a small increase in cases is an issue and they have now stopped all elective work. Staffing has been an issue for everyone.

However Havering in London for example has one of the highest no of cases and is running at 1,103 cases per 100,000 which is scarily high and c10 times the rate for Dundee. The modellers can now be pretty accurate about what that number of cases will mean in terms of future hospital admissions, ICU admissions and deaths. They know the detailed demographics for each local authority areas in some depth and will base model on current medical practice, pathways, guidelines, etc. Unfortunately those numbers are 'baked in' in London and the SE and the impact on their NHS in January and February will be horrendous. All this is before the expected spike due to Christmas and the New Year celebrations. Couple this with a more infectious mutation of the virus and things don't look good. The Gov must have been shitting themselves when they saw the modelling for this!

Before Bimbotwat gets his nickers in a twist about Scotland v England comparisons that is not the point I am making! The variation is equally true across parts of England, I pick Scotland cause its where I live, however picking one hospital/area to demonstrate there is NHS capacity is not useful. Also the modelling is now a lot more accurate, they have more evidence now to base it on, and the modelling would have shown, if nothing was done, that the NHS was facing a torrid time in London and SE if the Gov didnt take action. Using bed numbers, especially pre covid19 bed numbers, as a metric for NHS capacity is not helpful either, staffed beds is the real metric and many hospitals have beds they can't open because of lack of staff. Also expanding ICU bad numbers is a real issue and usually involves taking over theatre and recovery areas which automatically reduces surgical capacity and thus elective capacity. Finally, if the UK Gov had taken earlier action, letting some areas get to over 1,000 cases per 100,000 over 7 days is a disaster, some of these impending difficulties could have been avoided. Thankfully all 4 countries are now taking pre-emptive actions.

Bimbowomxn wrote: ↑Tue Dec 22, 2020 9:47 am Fair enough, though you’ve got unlimited funds for this so much of those issues can be sorted.


Let’s really hope we never get a deadlier disease.

It doesn't really, not for this point in time. You can't train clinicians in 7 months no matter how much money you have. Emergency ambulances are bespoke and come from Germany I believe. The SG might have unlimited money but the SAS don't and I doubt the NHS at large does. Its one thing throwing up field hospitals at the start of this it's another thing setting up permanant (or semi) hospitals for covid + patients. The nightingales were for patients that were stable, an actual covid hospital would need to be set up for patients that are or could become critically ill which is a completely different ball game. So now you need to train nurses and doctors and other specialists to staff these hospitals because NHS Tayside doesn't have that capacity.

Jock42 wrote: ↑Tue Dec 22, 2020 9:33 am

Bimbowomxn wrote: ↑Tue Dec 22, 2020 9:24 am

Jock42 wrote: ↑Tue Dec 22, 2020 9:16 am
No. If they test negative they then have to be transported to the "green" hospital. The ambulance service here doesn't have the capacity for that.

Jock , you’re one of the good guys. I think my point is 7 months would be enough time to increase the ambulance capability for these bottle necks.

Remember we’ve now spent 3 times the annual budget of the NHS .

It takes a year to train as a tech and a further year to train as a paramedic and about 3 months to train a care assistant. I've no idea how long it takes to approve funding for a PTS ambulance but they'll be easier to acquire than an emergency ambulance. 7 months isn't enough time to increase capacity.

Jock's correct. NHS Scotland are training lots more techs/paramedics and have brought forward training investment but it takes time.

The green/red site was looked at in great detail in Scotland as an option but it was quickly dismissed as completely unworkable for all the reasons listed above plus lots more. Trust me when I say every option has been looked at for making the maximum and best use of all the NHS facilities by folk far more expert than any of us, and I mean clinicians, money was never an issue. I am pretty sure similar process happened in England, Wales and NI.

My personal view is that after years on ongoing real cuts in spending there is really very, very little spare or additional capacity within the NHS. Numbers of beds, doctors, nurses, CT/MRI, theatres etc are all well below what they should be and have been run 'hot' i.e. over 90% bed capacity for too long. It is in times of crisis, as we are in now, that this short sightedness or political dogma comes home to roost.

We're training "lots" more. We're nowhere near the amount we need for a normal capacity and with all the other specialisations we seem keen on doing because it looks good for the SG we are losing paras quicker than we can replace them in my area.

Thankyou Jock .


It’s worth pointing out my scenario was budget free. I see the biggest issue being trained staff. Hopefuls the acceleration of training will add to that pool.

Running something 90% full btw is a decent achievement and something to be aimed at.

Jock42 wrote: ↑Tue Dec 22, 2020 10:05 am

Bimbowomxn wrote: ↑Tue Dec 22, 2020 9:47 am Fair enough, though you’ve got unlimited funds for this so much of those issues can be sorted.


Let’s really hope we never get a deadlier disease.

It doesn't really, not for this point in time. You can't train clinicians in 7 months no matter how much money you have. Emergency ambulances are bespoke and come from Germany I believe. The SG might have unlimited money but the SAS don't and I doubt the NHS at large does. Its one thing throwing up field hospitals at the start of this it's another thing setting up permanant (or semi) hospitals for covid + patients. The nightingales were for patients that were stable, an actual covid hospital would need to be set up for patients that are or could become critically ill which is a completely different ball game. So now you need to train nurses and doctors and other specialists to staff these hospitals because NHS Tayside doesn't have that capacity.

It really is even more complicated than that! You can't train folk easily during a pandemic - many doctors, nurses, physios, etc have had training interrupted because of the pandemic. They all need practical experience supervised by a trained clinician and need to be deemed competent and safe before qualifying and handling patients. Many couldn't achieve this or even get a training placement because of covid19, many stopped training in order to help out on covid19 wards in wave 1, physios can't train and qualify by giving physio over zoom they actually need to touch people but couldn't due to infection control issues. Many of the trainees' supervisors couldn't free up time to supervise, train or examine students/trainees because they were working 12 shifts in covid19 wards. Elective ops were stopped or radically reduced so trainee surgeons couldn't accumulate the experience required to progress training. Many trainees were shielding or had caring responsibilities and couldn't work or train. End result is many of the trainees will see their training delayed and they might qualify later than expected. Many planned training intakes didnt happen because placements etc weren't guaranteed. The NHS, Uni's, training and regulatory bodies like Deaneries and GMC, etc have all moved heaven and earth to keep training going but is has been very very difficult.

It takes 4 years to train a nurse to a basic level, 10 years to train a GP, 14 a hospital consultant, 5 years a pharmacists, etc.To suggest money can sort these issues in less than a year is foolish in the extreme.

Bimbowomxn wrote: ↑Tue Dec 22, 2020 10:30 am Thankyou Jock .


It’s worth pointing out my scenario was budget free. I see the biggest issue being trained staff. Hopefuls the acceleration of training will add to that pool.

Running something 90% full btw is a decent achievement and something to be aimed at.

Afraid you are wrong Bimbo. Max 85% bed occupancy is the recognised international measure. Once you get beyond that you create more inefficiency and safety issues such as boarding patients, blocking flow from A&E, backing up of ambulances at front door, not having headroom for unexpected peak activity, delayed discharges etc. Operating beyond 90% actually creates more inefficiencies, costs more and leads to increasing patient safety issues - as you can imagine from the issues above. It is all about creating flow through the system.

dpedin wrote: ↑Tue Dec 22, 2020 10:38 am

Bimbowomxn wrote: ↑Tue Dec 22, 2020 10:30 am Thankyou Jock .


It’s worth pointing out my scenario was budget free. I see the biggest issue being trained staff. Hopefuls the acceleration of training will add to that pool.

Running something 90% full btw is a decent achievement and something to be aimed at.

Afraid you are wrong Bimbo. Max 85% bed occupancy is the recognised international measure. Once you get beyond that you create more inefficiency and safety issues such as boarding patients, blocking flow from A&E, backing up of ambulances at front door, not having headroom for unexpected peak activity, delayed discharges etc. Operating beyond 90% actually creates more inefficiencies, costs more and leads to increasing patient safety issues - as you can imagine from the issues above. It is all about creating flow through the system.

Headshot. Although I suspect he's Goalposts ---------> already.

Sandstorm wrote: ↑Tue Dec 22, 2020 10:43 am

dpedin wrote: ↑Tue Dec 22, 2020 10:38 am

Bimbowomxn wrote: ↑Tue Dec 22, 2020 10:30 am Thankyou Jock .


It’s worth pointing out my scenario was budget free. I see the biggest issue being trained staff. Hopefuls the acceleration of training will add to that pool.

Running something 90% full btw is a decent achievement and something to be aimed at.

Afraid you are wrong Bimbo. Max 85% bed occupancy is the recognised international measure. Once you get beyond that you create more inefficiency and safety issues such as boarding patients, blocking flow from A&E, backing up of ambulances at front door, not having headroom for unexpected peak activity, delayed discharges etc. Operating beyond 90% actually creates more inefficiencies, costs more and leads to increasing patient safety issues - as you can imagine from the issues above. It is all about creating flow through the system.

Headshot. Although I suspect he's Goalposts ---------> already.

Yeah, you can see him moving the goalposts with every reply. Can’t actually admit to himself that he was wrong.

Margin__Walker wrote: ↑Tue Dec 22, 2020 9:47 am Decent (at least to the layman) article on the new strain

https://unherd.com/2020/12/how-dangerou ... -mutation/

I hope they all used gloves when wrapping the presents and writing Xmas cards.

Likewise using gloves to unwrap /open things.

Bimbowomxn wrote: ↑Tue Dec 22, 2020 10:30 am Thankyou Jock .


It’s worth pointing out my scenario was budget free.

I'll have another pay rise and a critical care post then please.

Getting harder and harder to find Covid free zones...

Glaston wrote: ↑Tue Dec 22, 2020 10:51 am

Margin__Walker wrote: ↑Tue Dec 22, 2020 9:47 am Decent (at least to the layman) article on the new strain

https://unherd.com/2020/12/how-dangerou ... -mutation/

I hope they all used gloves when wrapping the presents and writing Xmas cards.

Likewise using gloves to unwrap /open things.

I open all packages and letters with my teeth. Grrrrrrrr....

tabascoboy wrote: ↑Tue Dec 22, 2020 11:23 am Getting harder and harder to find Covid free zones...

My office. We have 2 colleagues now vaccinated.
The others part of the siren study with lat flows and PCR and antibodies done regularly.

We all work with AGPs etc daily, yet none have had covid or any antibodies positive.

More luck than judgement I wager.

Torquemada 1420 wrote: ↑Tue Dec 22, 2020 12:30 pm

Are you naughty French going to starve us?

Sandstorm wrote: ↑Tue Dec 22, 2020 10:43 am

dpedin wrote: ↑Tue Dec 22, 2020 10:38 am

Bimbowomxn wrote: ↑Tue Dec 22, 2020 10:30 am Thankyou Jock .


It’s worth pointing out my scenario was budget free. I see the biggest issue being trained staff. Hopefuls the acceleration of training will add to that pool.

Running something 90% full btw is a decent achievement and something to be aimed at.

Afraid you are wrong Bimbo. Max 85% bed occupancy is the recognised international measure. Once you get beyond that you create more inefficiency and safety issues such as boarding patients, blocking flow from A&E, backing up of ambulances at front door, not having headroom for unexpected peak activity, delayed discharges etc. Operating beyond 90% actually creates more inefficiencies, costs more and leads to increasing patient safety issues - as you can imagine from the issues above. It is all about creating flow through the system.

Headshot. Although I suspect he's Goalposts ---------> already.

If you maintain 85% then (haha for the 5%) then that’s a great achievement. The hospitals in the UK are currently less busy than the equivalent date last year.

I love the “internationally recognised “ though. A wonderful and unprovable claim. I stand corrected though and will happily say wasting 15% of resources is a gold standard ....

Biffer wrote: ↑Tue Dec 22, 2020 10:51 am

Sandstorm wrote: ↑Tue Dec 22, 2020 10:43 am

dpedin wrote: ↑Tue Dec 22, 2020 10:38 am

Afraid you are wrong Bimbo. Max 85% bed occupancy is the recognised international measure. Once you get beyond that you create more inefficiency and safety issues such as boarding patients, blocking flow from A&E, backing up of ambulances at front door, not having headroom for unexpected peak activity, delayed discharges etc. Operating beyond 90% actually creates more inefficiencies, costs more and leads to increasing patient safety issues - as you can imagine from the issues above. It is all about creating flow through the system.

Headshot. Although I suspect he's Goalposts ---------> already.

Yeah, you can see him moving the goalposts with every reply. Can’t actually admit to himself that he was wrong.

I’ve already admired my errors you lying cunt.

Jock42 wrote: ↑Tue Dec 22, 2020 11:09 am

Bimbowomxn wrote: ↑Tue Dec 22, 2020 10:30 am Thankyou Jock .


It’s worth pointing out my scenario was budget free.

I'll have another pay rise and a critical care post then please.

Maybe you can have another round of applause on a Thursday when it's warmed up a bit

Bimbowomxn wrote: ↑Tue Dec 22, 2020 12:46 pm
I’ve already admired my errors you lying cunt.

2 weeks off - you've been warned multiple times to keep it civil

We'll have to start another Justice for Bimbo thread (again)

Zapp Bannigan wrote: ↑Tue Dec 22, 2020 12:52 pm

Bimbowomxn wrote: ↑Tue Dec 22, 2020 12:46 pm
I’ve already admired my errors you lying cunt.

2 weeks off - you've been warned multiple times to keep it civil

Great timing! Bimbollox free Xmas/New Year!

Anyhow, spoke to a neighbour who like me goes to the surgery at the other end of town - she had her annual flu jab cancelled as they advised against travel as the Covid is much worse up there, just a mile away...

More positive news on the Pfizer vaccine - it turns out that on average each vial contains 7 doses rather than 6, so rather than 40 million doses we actually have 46.6 million doses on order.

frodder wrote: ↑Tue Dec 22, 2020 1:28 pm We'll have to start another Justice for Bimbo thread (again)

Shirly it was a typo.

frodder wrote: ↑Tue Dec 22, 2020 12:42 pm

Torquemada 1420 wrote: ↑Tue Dec 22, 2020 12:30 pm

Are you naughty French going to starve us?

Just trying to help your NHS by keeping you lean :)

Saint wrote: ↑Tue Dec 22, 2020 1:33 pm More positive news on the Pfizer vaccine - it turns out that on average each vial contains 7 doses rather than 6, so rather than 40 million doses we actually have 46.6 million doses on order.

Theres only 5 in ours with a little bit for waste when drawing them up.

Zapp Bannigan wrote: ↑Tue Dec 22, 2020 12:52 pm

Bimbowomxn wrote: ↑Tue Dec 22, 2020 12:46 pm
I’ve already admired my errors you lying cunt.

2 weeks off - you've been warned multiple times to keep it civil

This has got to be a joke surely

Saint wrote: ↑Tue Dec 22, 2020 1:33 pm More positive news on the Pfizer vaccine - it turns out that on average each vial contains 7 doses rather than 6, so rather than 40 million doses we actually have 46.6 million doses on order.

I heard it was 6 rather than 5

Zapp Bannigan wrote: ↑Tue Dec 22, 2020 12:52 pm

Bimbowomxn wrote: ↑Tue Dec 22, 2020 12:46 pm
I’ve already admired my errors you lying cunt.

2 weeks off - you've been warned multiple times to keep it civil

Ah great. Now he’s going to think I reported him, which I didn’t.

Biffer wrote: ↑Tue Dec 22, 2020 1:55 pm

Zapp Bannigan wrote: ↑Tue Dec 22, 2020 12:52 pm

Bimbowomxn wrote: ↑Tue Dec 22, 2020 12:46 pm
I’ve already admired my errors you lying cunt.

2 weeks off - you've been warned multiple times to keep it civil

Ah great. Now he’s going to think I reported him, which I didn’t.

Good thing too- reporting is for complete ninnies