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Service Hospitals

I only ever made it to the Sick Bay In Patients in HMS Terror.

We were allowed to stay in bed all day if we so wished. Play cards or putting on the balcony. Go to the Armada Club (I Think its called) at night in dressing gowns and sandals to watch football and have a pint or two.

The chap in the next bed to me was a Tiffy attached to the Malaysian Navy and was RA down JB way. He came in each day at 8 am undressed got into bed. At 4 pm got up dressed took his little case and went home. No duty watches either, must have had a brown card.

Mind you no QARNN's for us only hairy scab-lifters.

Nutty
 
I once required a few stitches after a scuffle ashore while serving on the Nubian, I don't know who was the most pissed the Doc or me, having said that he made an excellent job of it and I never felt a thing :wink:
 
come_the_day said:
The Royal Hospital Haslar is the last UK hospital with current Service connections

Not so.

NHS Hospitals with MOD Hospital Units attached:

Derriford (Plymouth)
QA (Portsmouth)
Frimley Park (Surrey)
JCUH (Middlesborough) - transferring from Northallerton
Peterborough
QEH (Birmingham)

A Pedant.
 
all_purple_now said:
come_the_day said:
The Royal Hospital Haslar is the last UK hospital with current Service connections

Not so.

NHS Hospitals with MOD Hospital Units attached

Derriford (Plymouth)
QA (Portsmouth)
Frimley Park (Surrey)
JCUH (Middlesborough) - transferring from Northallerton
Peterborough
QEH (Birmingham)

A Pedant.
I wasn't clear enough for pedants, obviously!

RH Haslar is the last hospital in UK run by the Services. Of course the MDHUs have Service connections, tenuous though they are, but the Services merely supply personnel to be managed by the NHS.

If, and when, the Chiefs of Staff realise just what they will lose in 2007, 8, 9 or whenever, i.e. any control over the hospital services at their disposal, maybe they will look at the pifflingly small comparative outlay and retain a Service-owned, Service-run and Service-manned secodary care asset where Service personnel of whatever hue can be treated or parented while needing treatment until fit for duty or ready for discharge. Perhaps then Service people will feel that any of their senior managers care enough about them to provide a decent standard of care among their peers.

Service people are targets in their operationally deployed lives and do not need to be subject to that privilege courtesy of the NHS.
 
come_the_day said:
If, and when, the Chiefs of Staff realise just what they will lose in 2007, 8, 9 or whenever, i.e. any control over the hospital services at their disposal, maybe they will look at the pifflingly small comparative outlay and retain a Service-owned, Service-run and Service-manned secodary care asset where Service personnel of whatever hue can be treated or parented while needing treatment until fit for duty or ready for discharge. Perhaps then Service people will feel that any of their senior managers care enough about them to provide a decent standard of care among their peers.

The whole thing was a bit of a cock up, IMHO. I've heard it said that the services should have retained Wroughton as it was a relatively new building, relatively central (off the M4 & not far from Brize) and didn't have any of the historical baggage that prevented the AMS from taking to Haslar. Don't get me started on the subject of 'RCDM'/MDHU(B)

I understand that the feeling at the time was that the Service Hospitals did not offer enough clinical experience to ensure an adequate standard of training & skill maintainance for the clinical staff - this seems to be borne out by some of the stories I've heard; however, perhaps one who was there might be able to comment?

The problem with the MDHU's is that the hospital management's priority (and the NHS is an organisation which exists to meet DoH targets, not to deliver healthcare) will always differ from that of the DMS.
 
[quote="all_purple_now

I understand that the feeling at the time was that the Service Hospitals did not offer enough clinical experience to ensure an adequate standard of training & skill maintainance for the clinical staff - this seems to be borne out by some of the stories I've heard; however, perhaps one who was there might be able to comment?

The problem with the MDHU's is that the hospital management's priority (and the NHS is an organisation which exists to meet DoH targets, not to deliver healthcare) will always differ from that of the DMS.[/quote]

I was there in Naval hospitals, then RH Haslar and MDHUs. Whilst it is true that the old Service hospitals could not provide the breadth of experience that could be gained in the NHS, the difficulty came for us when we lost control of placement of Service people. Most Service doctors, nurses and paramedics are quality people, whose introduction to the Nash has been a great success, although their repeated deployment has meant a loss of trust among NHS people.

The NHS is tied up with targets, it's true, although it does not exist to meet DoH targets, it has just been abused by the current government to seem like it.

I'm not certain about the DMS having any more pure dedication to achieving good healthcare for Service people, as it seems to me that it exists to perpetuate the position of the medical profession in the Armed Forces.

Why does it train its own doctors, at huge expense, only to send them on their merry way having given only a tiny proportion of their Service time to supporting Operations. And, while we're at it, does it pay senior doctors to act as managers, for which role they are patently unqualified and unsuccessful, while still paying the massive premium that they receive over their general Service counterparts, simply for being doctors. Happy for them to have all the stars they want, as long as, once they have stopped practising medicine, they take a normal military salary!
 
come_the_day said:
I'm not certain about the DMS having any more pure dedication to achieving good healthcare for Service people, as it seems to me that it exists to perpetuate the position of the medical profession in the Armed Forces.

Why does it train its own doctors, at huge expense, only to send them on their merry way having given only a tiny proportion of their Service time to supporting Operations.

The suggestion that the DMS trains its own doctors is slightly inaccurate. The vast majority of regular MO's join after qualification; those that don't are only eligible for a 3-year cadetship, as with all university cadets. Those in the reserve get no subsidy except the pay they already get for training. In addition, many of the regulars I know have spent large parts of their time deployed - 3 years' general duties out of a six-year commission is hardly 'tiny amounts'.

We are, perhaps, losing sight of the entitlement of our service people to the highest standards of clinical care we can provide - how we are meant to achieve this without adequately trained medical officers is unclear, and if the cost of this is people spending 5 years in the NHS as a military SpR, then so be it.

APN
 
andym said:
If i had a serous RTA in Gosport,i wouldnt want the trip to Cosham!ts bloody daft.They have an MOD wing in the Edith Cavell Hosp in Peterborough,the conflicts between military way of doing things v the civvy way are immense"!

the sooner it goes the better i say, had many a trip to service hospitals and always ended up getting NHS hospital to rectify the F up/lack of correct treatment!

they always say the chefs course is hardest as nobody has passed it, is there any courses for scab lifters and beyond????
 
[quote="all_purple_now
The suggestion that the DMS trains its own doctors is slightly inaccurate. The vast majority of regular MO's join after qualification; those that don't are only eligible for a 3-year cadetship, as with all university cadets. Those in the reserve get no subsidy except the pay they already get for training. In addition, many of the regulars I know have spent large parts of their time deployed - 3 years' general duties out of a six-year commission is hardly 'tiny amounts'.

We are, perhaps, losing sight of the entitlement of our service people to the highest standards of clinical care we can provide - how we are meant to achieve this without adequately trained medical officers is unclear, and if the cost of this is people spending 5 years in the NHS as a military SpR, then so be it.

APN[/quote]

Thanks for putting me right on training doctors APN. Wouldn't be one would you? Calling GD "deployed time" is a bit rich in the current operational situation, as those on GD have hardly any experience, as if they ever did. I was talking about deployed time after either achieving fully-fledged GP or consultant status. Some consultants never deploy, because their consultancy is in a non operational requirement specialty. Those who do are deployed in short bursts so that they do not suffer "skill-fade" and I'd bet that very few do more than 6 months deployed in their whole career.

Medical deployments are almost invariably in support of the Army for RN personnel. If they were to spend 3 or 6 months away, it would be more palatable, especially when the real team often has to suffer changing practice to suit the individual consultant.

I would love to see a transparent breakdown of the financial cost of getting a Service doctor to consultant status and the value they add to the Service thereafter.

Maybe the current Op Med Cap study will come up with a few good suggestions for the future, like ending Service funded training for doctors, dentists and nurses and using the money saved to pay the reserve medical Services properly for their commitment and keep a good sized Service secondary care facility at RH Haslar (only because it's the only one left!), where Servicemen could be managed by Servicemen. My guess is that we will be left with more of the same: a widely dispersed medical community with little involvement in managing Service patients until they are seen during operations and a service run by doctors for doctors.
 
Some consultants never deploy, because their consultancy is in a non operational requirement specialty. Those who do are deployed in short bursts so that they do not suffer "skill-fade" and I'd bet that very few do more than 6 months deployed in their whole career.

Medical deployments are almost invariably in support of the Army for RN personnel. If they were to spend 3 or 6 months away, it would be more palatable, especially when the real team often has to suffer changing practice to suit the individual consultant.


While I wouldn't want to suggest you might have an axe to grind... (TFIC)

I agree with you on some points - notably the retention of a triservice secondary care facility (although I feel that the Gosport peninsula was never an appropriate place for this) & proper funding of the reserves.

However, I do feel you are being a trifle unfair on my consultant colleagues - I know several who are on their third or fourth operational deployment, and these are usually at least 3 months. Due to the spectre of Clinical Governance, word has it that the inexperienced, deployed GDMO is likely to become a thing of the past in the near future - these will need to be replaced with accredited & trained GPs. Similarly, most of the deployed secondary care should be delivered by consultants, as training grades should (in theory, at least) have local consultant supervision.

As regards deploying in support of the Army, the DMS is pobably more integrated than any other part of the services, for better or worse, and we have to go where the requirement is - dark blue, green or light blue.

I may well be a medical officer - but I can assure you I wasn't on a cadetship. You?

APN
 
APN. I don't suppose there are many who contribute to this forum, or any other, who have no axe to grind. I may be being unfair to your consultant colleagues, as you say, but the standard deployed time for a consultant is less than 6 weeks, due to their special requirements re skill fade. Some would like to do longer, as they have to complete at least 3 weeks training per deployment. The Barmy, of course will not accept that the individuals have trained enough if they have completed that training period in the previous 12 months, but we are taliking about an organisation that considers you out of date for training after 1 April, even if you trained in March!

I don't really have a problem with consultants per se, but I wonder if they are value for money in the Armed Forces. I do not think so.
 
I don't suppose there are many who contribute to this forum, or any other, who have no axe to grind.

Undeniably true... :)

I may be being unfair to your consultant colleagues, as you say, but the standard deployed time for a consultant is less than 6 weeks, due to their special requirements re skill fade.

I was under the impression that the standard deployed time was 3 months - however I am a bit out of the loop at the mo, so I may be wrong about that. You seem a bit sceptical about skill fade. It does exist, as for all skills. The difficulty in medicine is that, unlike, say, piloting, there is no convincing means of simulating the real thing for training purposes. Unfortunately, military trauma surgery (and limited amounts of that) does not maintain one's skills in, says, complex cancer surgery, or joint replacement. In fact, there are several NHS consultants I am aware of who will not schedule complex surgery for the week following their return from holiday, never mind 3 months' deployment.

I don't really have a problem with consultants per se, but I wonder if they are value for money in the Armed Forces. I do not think so.

It is certainly apparent that you don't feel service consultants represent value for money; however, as acute secondary care on deployment is essentially consultant delivered, there is no other option. The reserves can and do provide a capability, but there is a certain amount of political difficulty inherent in the repeated deployment of reserve consultants.

In addition, there are service-specific roles such as CCAST which require consultant cover. Do you feel these are dispensable?

APN
 
I hear what you say about the availability of doctors for deployemnt and I can see the logic used, but is it the correct logic. Yes if you have a consultant or a consultant led team you have the ability to deal with almost 100% of the problems expected, but if that means if no consultant is available then you have no doctor at all then you are in a situation where a very low percentage of the problems can be dealt with. Deploying a slightly less qualified doctor will actually give yo a better level of cover than no doctor at all, and in reality with modern communication your consultant supervision is still availlable.

My father was a consultant and in the 60s he supervised in several hospitals up to 4 hours drive away, with modern communications this remote supervision can be done much more effectively.

Perfection is rarely possible, but to effectively give up because of that is in my view foolish.

Peter
 

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