Ian Sturgess

@NHSE. Who has driven the ED and handover delays - NHSE! Local optimisation doesn’t work vs system level flow which does. NHSE are a failure!

@jim_crawfurd @MarinaPurkiss Agree, it will be very difficult, but what else?

@sticklerian @MarinaPurkiss Agree that two state solution is the only sensible option, but with all that has gone on recently I have serious doubts that it would be enough to bring peace 😢

Someone… Please Explain to me & the rest of us who are losing our last shreds of faith in humanity How TF can it be… That a massacre of 70% women and children With those children mostly between 5 & 9 …can still be labelled as self-defence. This world disgusts me.

Have #elon_musk #DonaldTrump just approved China’s legitimate rule over Taiwan and the South China Sea Islands. China appears to have taken control of the Pacific!

@nexta_tv USA always late to the ‘party’, WW1 and WW2! We won’t protect Taiwan nor Japan. Taiwan is China!

Foreign Ministry: Dialogue between Zelensky and Trump already established, meeting to be prepared Foreign Minister Andrii Sybiha highlighted that the swift phone call following Trump’s election win indicates an existing line of communication.

@nexta_tv USA needs to give up Alaska to Russia as part of the deal between Ukraine and Russia!

The Conservative Party have voted for oblivion today. Thank goodness!

@clare_eliza The only performance metric that matters is how effectively the rest of the organisation/system downstream of the ED are absolutely focussed on delivering zero exit block from the ED. The 4 hr standard is not a measure of ED performance it is a measure of system collaboration.

@j59dd @VickyKomrower Hi, it’s called ‘demand curve management’, ‘admitted flow stream management’ and ‘discharge flow stream management’ Understanding Ra , Rd across admitted compartments and the overall MCR is key. Let alone the pre/after load compartments. We need to learn from logistics.

@VickyKomrower One of the behaviours I am seeing from execs and others in some places is to “blame” acute medicine for delays in assessment, when it’s a system flow issue. Acute medicine has a vital part to play in early assessment, but can only do this when the whole system pulls together.

Reflecting on the recent SAM conference whilst I listen to other talks. Interesting how many people at mentioned the effect of feeling undervalued as an acute medic. We can and must restore pride in acute medicine whilst banging the drum about how much of a difference we make.

@jim_crawfurd @PaulbernalUK @bmay SMEs pay corporation tax at 19% rising to 25%. So you are saying that those who build businesses should pay double tax. That’s ok, but logically that means we remove tax relief on pension contributions and remove the tax free lump sum for all - including NHS is equally fair.

@PaulbernalUK @bmay 2/2 If you have worked to build the business and taken payment in shares, not a salary, should you not be taxed on that share income same as if you took a salary? Ultimately he’s trying to delineate between “rich” and “just getting by”.

@jim_crawfurd @salmannaeem217 @ShaunLintern Muscle memory can’t just kick in straight away!

@jim_crawfurd @salmannaeem217 @ShaunLintern Yep - spot on - I spend 95% of my improvement time downstream of ED. When ED has no exit block - handover delays collapse within 2 weeks! Note I do not expect EDs to move from Type 2 behaviour - safety rounding etc, to Type 1 behaviour, tempo and decision making within 2 weeks

Ambulance waiting times in the news again. NHSE says all ambulance services should leave hospitals after 45 mins.

@SueSuezep A really balanced response - not. Someone choosing to commit suicide having been driven to despair, is of course their choice, yet please have compassion for what would have driven him there. Rotherham, Oldham, Gary Glitter, Jimmy Saville etc abusers - was he worse than them?

Peter Lynch's punishment was a prison sentence, he was not killed by the UK judicial system or Starmer. Lynch was not a political prisoner, he committed a crime of violent disorder, abused the police & hurled racist abuse. Outrageous statement from sitting idiot MP Tice

@jim_crawfurd @clifford0584 @Neal94G @LiamThorpECHO Simple rules for complex adaptive systems!

@clifford0584 @Neal94G @LiamThorpECHO 2/2 Also, onboarding process for home IVs is often painfully time-consuming and still often met with “sorry, no capacity today” after taking the time to fill out the online referral form😬

In a hospital in Liverpool, people are lying across the floor as they wait for a bed on one of the hospital's wards. One woman has been in Accident & Emergency (A&E) for 30 hours, she will wait another 17 in this packed room. A grim thread which shows NHS winter crisis is here

@jim_crawfurd @clifford0584 @Neal94G @LiamThorpECHO Jim, agree on both comments. EDSSU should be a ‘closed unit’ just like ITU - only Senior ED decision makers (NO ONE ELSE CLOCK STOP USE = P45) should be able to admit to ED SSU, patients on defined pathway - max LOS ‘one period of darkness’. OPAT just needs to say yes! Easy 🤔

@TJCoats @mattdiscombe Hi Tim, agree but even more radical is the certainty that Monday follows the weekend! Who would ever have thought of that!

@mattdiscombe Radical idea - how about realising that winter comes every year and having plans A, B and C in place to be executed depending on finance available? Winter pressure should not be a surprise. The lack of planning is staggering.

NEW: Winter pressures funding leads to ‘panic buying,’ says NHS trust chief CEO says “unplanned” winter funding for urgent care was “not always well spent”. NHSE has confirmed there will be no extra funding for winter this year hsj.co.uk/emergency-care…

@RCEM_VP @majorbaps @RCollEM Hi Higgi, 👍. Exit block aX the hosp journey - ie back door thru to front causes the exit bloc - 3 main solutions to it - 1. Get ahead of the admitted demand curve by admitting teams. 2. Fail to optimise simple Dx. 3. Fail of ‘complex’ Dx - HC vs SC - HC - rehab not PoC!

The data is clear, when patients are in corridors, patients somewhere are dying unnecessarily. @RCollEM and our members know overcrowding can’t be fixed overnight but it’s time to stop pretending we can provide proper safe or dignified care in corridors. channel4.com/news/there-wil…

@jim_crawfurd @salmannaeem217 @ShaunLintern The message is important. Most older people leaving hospital need rehab - a HEALTH requirement. We must stop dumping on social care!

@sticklerian @salmannaeem217 @ShaunLintern I can’t speak for RCEM and can only speak from our local experience, which is that social care is the biggest issue. I will admit that I often say “social care” when I just mean “getting people out of the back door of the acute hospital” whether that be social care or rehab.

@jim_crawfurd @salmannaeem217 @ShaunLintern It’s not you Jim, it is lack of understanding of system! RCEM has no skill set in this!

@sticklerian @salmannaeem217 @ShaunLintern We’ve been here before Ian. I freely admit that I don’t have a good understanding of rehab, but I do know how to run my ED thanks.

@jim_crawfurd @salmannaeem217 @ShaunLintern Yes - but not as well as it should be! I can empty most systems by a focus on unnecessary waiting - across the system - all partners need to engage! Takes time but ‘blaming’ does not help!