Tuesday, June 05, 2007

Blogging in an NHS Waiting Room

If you want to know why the NHS is in an administrative mess read THIS post on the 2020health.org site. It is a live 'waiting room' blog. Here is the most relevant extract...

It seems that in order not to breach the waiting time target, clinics like these are quadruple booked. 200 patients were booked in this afternoon with no increase in the four doctors usually on duty as when there are 50 patients. I've been handed a copy of the complaint form to fill in - they have a ready supply. Yet most people around me declined the form, preferring to moan rather than write. The receptionists were shaking their heads even as we arrived; “its mad this clinic - just look at it - well if you want to wait...”. The concerned mother in me felt we should - how otherwise will we know if Jem's finger bone is back in one piece? ... So the patients get seen, after 2 -3 hour waits, by doctors who are exhausted and the hospital gets to tick its box for no breach of waiting times. Discretion and discernment have gone for the doctor and clinic manager, replaced with frustration and anger from patients.

After 2 hrs & 35 minutes we get to see the Doc. He is very apologetic. “It’s not your fault,” I say & he almost keels over with surprise. I reassured him that I understood the impact of the waiting time targets, and in between thanking me [“did you hear, he thanked you three times mummy…...why?” said Jem] for being ‘so patient and kind’, he relates tales of the abuse he has had during the afternoon from other patients. That’s why the most prominent posters now in this clinic are the ones saying that the staff have a right to work free from abuse and agro from patients. Ultimately, until managers and clinicians can work together with patients, and have their focus on efficiency and healing, scenes like this will continue. With the Department of Health dictating and imposing successive, inflexible, indiscriminate targets on the health service there will always be unintended consequences. They are too remote, never have the day-to-day experience that frontline professionals can bring and don’t appreciate the freedoms required for good working relationships. The medical and clerical professionals on whom we rely, who are the NHS, deserve the freedom and respect to do their jobs based on their experience and knowledge. They [we – I am a health professional too] do want to deliver a high standard of work and we go to work each day precisely to enable healing and restoration. Facilitating this needs to be the aim of a national health service, and to do this it doesn’t have to be nationalized.


Anonymous said...

It's called a triage system. The case obviously wasn't that urgent so they had to wait. What's the problem?

Straws, cluching, as usual.

Iain Dale said...

Read the post, idiot. If you can'tr see what the problem is your real name is presumably Patricia Hewitt.

Anonymous said...
This comment has been removed by a blog administrator.
barry monk said...

At last, Iain, at last, you have woken up to the story that is the NHS. A wonderful system has been wrecked by Nu labour - money squandered on IT systems that will never work, management consultants who don't know anything except how to charge large bills, and politically directed target which disadvantage the illest and weakest.

Check out any of the medical web sites, like Doctor Rant, or my site

Anonymous said...

If you're one of UK's hard working smokers - who pay around £10 billion in extra tax - the NHS may not even agree to treat you. My advice under such circumstances would be to commit a serious crime and turn yourself in.

Then, in common with all of the imprisoned murderers, paedophiles, rapists, other serious criminals living at her majesty's pleasure, you'll have free snout and the smoking rooms denied to other smokers, excellent health care, free accommodation and care and free class 'A' drugs if you want these - plus large sums in compensation if you're inhumanly denied your drugs.

Anonymous said...

Alternatively, smokers denied NHS treatment could become MPS, in which case they would be chauffeured to a private room in an NHS hospital.

And of course, on recovery, there would be all of the, taxpayer subsidised and duty free fags and booze on offer to politicians in the Palace of Westminster and (some MPs claim, apparently) exemption from many of the laws of the land inclusing the prohibition on smoking in enclosed spaces which will soon apply to everyone else.

Rich Tee said...

This targets culture is inherited from the private sector. What is the saying? Accountants know the price of everything and the value of nothing.

In call centres (like I work in) customer service is measured in the number of calls you deal with per hour, so the faster you get rid of someone the more you get rewarded! That is why the service is so bad. The fact is that wellbeing cannot be measured by statistics. This was touched on in the documentary The Trap.

I know that the Conservatives are due to report on wellbeing this summer but I must admit to being a bit pessimistic - I think they will recommend continuing with the targets culture because there is no real alternative at the moment.

Anonymous said...

Sounds like the medics decided to run a big follow-up clinic (badgered by the managers, no doubt)so that they could use the slots in their other main clinics to see newly GP-referred patients which are subject to target waiting times.

It's a tactic that's used from time-to-time to clear a backlog. However, they do bank on anything between 10% and 20% DNA'ing (ie Did Not Attend). Sometimes this backfires because everyone turns up!

On the point of abuse of NHS staff, most people are usually very patient (no pun intended) but if they are given frequent information why things are running late they are more understanding.

It's true that private organisations would not run things like this but then they don't deal with anything like the volume of patients which the NHS handles.

And yes, I am an NHS manager but I'm thoroughly disillusioned by the shambles and great waste that NuLabour has created. Roll on retirement!

(Iain - I'm going anonymous on this for obvious reasons. TF)

Anonymous said...

Am I missing something, or do some NHS managers lack the bottle to stand up to Whitehall bullying?

I have this depressing vision of a hospital where everyone, from top to bottom, knows that they are not working in the best interests of their patients, yet no-one has the courage to stand up and say so.

Anonymous said...

If you look at a hospital as a production-flow Iain as I did after several tediously long waits for a 10 minute consultation you can see the problem is TOO FEW DOCTORS.

The factor that is in abundance is Patients.

The factor that is in deficit is Doctors

The waiting is merely cycling a pool of work-in-process inventory rather like boards on a conveyor waiting for a drilling-station. If the drilling station is the bottleneck, the conveyor has to spool to get access and backogs build up.

Labour decided to tackle this by cutting doctors training and getting more into hospitals earlier and took training away from the Royal Colleges.

Then they shoved these Truncated Training Doctors into job applications against those still on the traditional training route ie SHOs at the same time imposing spending cuts across the system

As a consequence we have 34000 doctors applying for 18000 training posts to become qualified doctors.....they can only apply for 1 job every 12 months so if they don't get interviewed they must spool for 12 months before getting back onto training.

So you can see the current abundance of patients will be matched by even fewer doctors in future as the Hog Cycle shows that Medicine is not a job with guaranteed employment but does carry guaranteed debt

The problem in hospitals is simply too little of the key resource and too many people trying to use it.

The Government pretends it is the Patient who is king, but logic shows that rationing on doctors posts is the cause of all delays and that Britain has a very poor ratio of doctors to patients so the regime is trying to substitute Nurses for Doctors though who pays their malpractice insurance is moot

Anonymous said...

Trumpeter: it is well-known that if NHS management tell it like it is, they are sacked - as one Director of Nursing put it to me, if you've got a mortgage and family, or are nearing your pension, would you risk it?

By the way, our big new hospital, opened just 6 months ago, doesn't have enough bed linen or bedpans, but it does have a GRAND PIANO AND A PIANIST in the lobby! Well, if you had to choose, that's the obvious one to go for, isn't it?

Anonymous said...

But Judith [8.52. AM], Our employment protection laws make it very difficult to sack people nowadays, especially for whistle blowing; and almost impossible if the whistle-blower is a top manager.

I have some sympathy for the middle-managers with 2.5 kids and a mortgage, but what about the people at the top? Surely they could speak out, instead of meekly kowtowing to the ghastly Hewitt and her minions?

Anonymous said...

But Judith [8.52. AM], Our employment protection laws make it very difficult to sack people nowadays, especially for whistle blowing;

Get real - how will you fund the tribunal if you are non-union ?

How will you handle the poor telephone references when you look for another job ?

How many jobs are available for NHs Administrators outside the NHS ?