Personal... NHS_Training_in_Primary_Care_General_Practice

If you could still get out and about, where would you go?

The seaside, maybe?  Shopping?  How many would chose a walk in the country side.  The clear blue skies, the unusually super-clean air, the rolling hills, bird song… if only.

I bet you’d never guess that the fields, full of whatever farmers plant this time of the year, or the cows and sheep and all the other livestock, add-up to one of our most dangerous working environments.

The injury rate for agricultural workers is 4.3%…. puts a new value on a pint of milk or a bowl of spuds.  Farming is the most dangerous occupation in Britain.

After farming comes construction, 3.1% followed by roofing and scaffolding, where falling off something accounts for 29% of all workplace deaths.

Healthcare is number six on the list; one of the highest sickness rates, 4.6%, complicated by work-related injury and stress.

The bin-men have a 4% sickness record, mainly from exposure to harmful bacteria.  There are around 8,000 cases a year.

The men and women who abseil down the side of sky-scrapers, cleaning the windows looks dangerous to me.  But, they have modern equipment and expert training.  Accidents are rare. 

In 2018, there were 61 deaths in the UK Regular Armed Forces.

So far, this year, over 100 health and care workers have died of the Corona Virus.  Working on the front-line of healthcare is Britain’s most dangerous occupation.  When we come through the other side… who knows what the losses will be.

Caring for patients with CV-19 is high risk.  A risk that is mitigated by wearing the right PPE.  What is the right PPE?  We depend on the WHO to give us a steer, on PHE to give us guidance and the politicians to get the stuff, in bulk.

When the guidance changes, is where the trouble starts.  Why has it changed, can we trust it?  Are standards being lowered?  The inevitable suspicion is, standards are changed to suit the supply chain.

The PPE guidance has to be something that people trust.  In the same way the abseiling-window-cleaners, dangle off a tall building, knowing whatever British Standard, EN 892:2012+A1:2016 for mountaineering kit means, the rope will hold. 

To be safe, we have to feel safe.

Guidance writers must understand the weight placed on guidance, by the people doing the job.  ‘Wear this kit, don it properly, doff it safely and you’ll be OK’.  Absolute, trust.

We assume somebody who knows what they are doing, having done the job, knows what’s what, has looked at the science, made the judgement call and has a cast iron desire to keep us safe.

When somebody in Whitehall messes with PPE guidance, alarm bells start to ring.

It leads us to have to confront the question; are staff obliged to work with modified or recycled PPE, if it reduces their safety.  The answer is no.  

NHS staff are protected by health and safety at work legislation and come under the purview of the HSE, like every one else.  

They have the option to talk to their line manager and be assigned elsewhere, or walk away, if their fears are well grounded.

Understand the fears; working at the front-line of care, right now, is dangerous.  When a care worker leaves home, to go to work amongst CV-19, the ‘kiss and see-you-later’, so casually given, could be the kiss that says, goodbye.  Not for now, but forever

Will staff refuse to work?  I doubt it.  The sense of vocation that runs through the NHS, galvanises attitudes to suffering and that redefines common-cause.  People may not trust guidance, or politicians, but they trust each other.  They will find a way.

Yesterday, the No10 press conference, blatantly, levered guidance against the supply chain and slipped off questions about masks for the public.  

Chris Hopson, of NHS Providers, tells us not to buy masks because he’s studied the evidence and pronounced, they don’t work.  He sets his members against the public, who pay the wages.  

He is wrong.  Perhaps he’d be better using his time to get more masks into the system.  

He looks like he speaks for the DH.  Where is the the organisation that speaks for the public? 

The public are wearing masks and making them. They’ve made their minds up.  I can’t blame them.  They instinctively understand the precautionary principle.

Taking risk is a personal choice, in the workplace or on the way there, because the consequences of risk are closer than personal.

News and Comment from Roy Lilley

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Reproduced at by kind permission of Roy Lilley.