Manx Care

[Newbie]

1 hour ago, Roger Mexico said:

Actually it can happen for two reasons. It could be decreased capacity - they can do fewer procedures in a period from now on because of Covid restrictions, UK specialists less able to come over and treat, difficulty obtaining off-Island appointments and so on. 

Or it could be increased demand - more people wanting treatment on Island.  This isn't necessarily because more are ill, but because people who may have had private treatment elsewhere no longer have that option.  As usual it's probably a bit of both.

Either of those could be the case, but as far as demand is concerned, a bigger concern seems to be that people have found it much harder to access routine healthcare during the pandemic, which you would have thought would result in fewer referrals. The number of referrals should be known, so it should be easy to determine whether demand has increased. As for capacity, I guess Wrighty would now whether that is likely to be reduced as a result of precautionary Covid measures that might need to be taken, but I can't really see why it should have a significant impact. Surely, it is mainly a matter of testing people pre-admission. Once in hospital, the treatments shouldn't take any longer (unless Wrighty knows better).

If you are right, since the waiting time has gone up by nearly 3 years in just over 12 months, it means that they must be getting at nearly three times the number of referrals that they are able to cope with. If that is the case, unless something changes, in another 12 months, the waiting time will have gone up to 7 years! However, as Wrighty says, maximum waiting time might not be the best measure of the hospital's ability to cope with the demand - in which case it shouldn't be the measure used to determine whether extra money is required. There needs to be a better measure of the balance between demand and capacity.

[Andy Onchan]

2 hours ago, wrighty said:

I've never thought that waiting times were a good indicator, particularly if quoting the longest waiter.  Much better to say how many are waiting, and give an indication of throughput.  It's what I do if asked by a particular patient how long they might have to wait for a procedure - I'll say 'there are x in front of you on the list, and I average about y a year of this operation, so it'll probably be..."

Total numbers waiting is not a bad indicator in itself, but the question then has to be whether the referrals in to that service are appropriate, and if so, are there enough people in post to cope with that number and are they working to a reasonable capacity.  If that information is known, then the issue can be managed appropriately by setting referral criteria, clinic templates, staffing levels and performance etc.  

In normal times are the theatres in use 5 days a week 7.5 hours a day? Or are we looking at a Gerry Robinson type process where the theatres aren't open on Fridays because it's the last day before the weekend?  

[Andy Onchan]

2 hours ago, Banker said:

Family member tried to book a blood test today after referral, next available appointments 28/05 . Apparently busy as GPs won’t take blood anymore and just send everyone up to hospital.

GPs don’t seem to want to do anything at present and blame Covid restrictions 

Why don't we have private labs to cover blood tests as well as 'in-house'? 

[Rhumsaa]

13 minutes ago, Gladys said:

And vax hubs. 

Was that from DHSC budget?

I mean it's all from the same pot originally I guess but it feels kind of wrong

[John Wright]

1 minute ago, Andy Onchan said:

Why don't we have private labs to cover blood tests as well as 'in-house'? 

Not enough throughput. Even Nobles don’t test for everything. All sorts get sent away.

[Andy Onchan]

Just now, John Wright said:

Not enough throughput. Even Nobles don’t test for everything. All sorts get sent away.

But the bog standard testing such as lipids etc should be the easiest to farm out at a fixed price. The more complicated stuff could be done on-Island by Nobles Lab. It all seems a bit arse-about-face to me.

[Roger Mexico]

16 minutes ago, Newbie said:

However, as Wrighty says, maximum waiting time might not be the best measure of the hospital's ability to cope with the demand - in which case it shouldn't be the measure used to determine whether extra money is required. There needs to be a better measure of the balance between demand and capacity.

The maximum waiting time is always a silly measure to take.  All that has happened is that Manx Radio have looked at the tables and picked the biggest number they could see, so as to be dramatic.

As it happens the speciality with longest time waiting for a first appointment [1] in days (1751) is Endocrinology, which also has the highest average (755) but in other departments the discrepancy is more marked.  Diabetic medicine has a maximum of  1673, but an average of only 224.

 

[1]  Manx Radio internet people: make you links more helpful by using "#page=" to stop your readers having to scroll through long documents.

[John Wright]

6 minutes ago, Andy Onchan said:

But the bog standard testing such as lipids etc should be the easiest to farm out at a fixed price. The more complicated stuff could be done on-Island by Nobles Lab. It all seems a bit arse-about-face to me.

Not really. 

First. Are the current delays down to taking samples or actually running the tests? I suspect former rather than the latter. A surge of appointments due to end of lockdown crossed with one person down ( illness, holidays, notice ) can easily create a bottleneck.

Second. I’m not sure how many surgeries are doing sampling now. Mine won’t. So I have to phone and wait. Generally I see that as better use of GP/surgery nurse time. Phlebotomists are likely to be faster, and cheaper, and better use of Human Resources.

Third. The type of test where samples go off island wouldn’t be done in most local hospitals in the UK. They go to specialised testing centres. That’s to justify the testing set up costs and staff training and ensure throughput. Best use of resources.

[wrighty]

4 hours ago, Andy Onchan said:

In normal times are the theatres in use 5 days a week 7.5 hours a day? Or are we looking at a Gerry Robinson type process where the theatres aren't open on Fridays because it's the last day before the weekend?  

We don’t have the staff to run all 6 theatres 5 days a week for 9 hours a day. There are lists on Fridays - my trauma list on a Friday afternoon for one - but you’re right, Friday afternoon has less activity than a Tuesday morning, for example. 

[wrighty]

4 hours ago, Newbie said:

As for capacity, I guess Wrighty would now whether that is likely to be reduced as a result of precautionary Covid measures that might need to be taken, but I can't really see why it should have a significant impact. Surely, it is mainly a matter of testing people pre-admission. Once in hospital, the treatments shouldn't take any longer (unless Wrighty knows better).

Not much. We’re less flexible, so filling a cancellation slot is all but impossible due to covid test requirements, so that means that covid measures mean the system is less efficient, hence a lower throughput. Treatments won’t take any longer once we get going, but there are sometimes delays in starting while waiting for the covid result. Particularly in semi-emergency surgery (in real emergencies you just get on with it, covid test or not, but for stuff that needs doing now, but not NOW now, we wait for the test)

[Gladys]

5 hours ago, Rhumsaa said:

Was that from DHSC budget?

I mean it's all from the same pot originally I guess but it feels kind of wrong

It may feel wrong, but it still cost.

[Gladys]

Well,  here we go, the real cost of covid. 

[Apple]

 

22 minutes ago, wrighty said:

We don’t have the staff to run all 6 theatres 5 days a week for 9 hours a day.

And if we start the Private Patient Ward will this suck more theatre and nursing staff out of the NHS system and cause the lists to grow even longer. 

 

4 hours ago, Roger Mexico said:

The maximum waiting time is always a silly measure to take.

 Except for the luckless person in pain or God forbid the one scared witless worrying that their family members may be being overlooked.

 

[finlo]

8 hours ago, Albert Tatlock said:

Heart/Gastro waits of 5 years? - 50% of them could likely be dead before 5 years.

Someone had to rumble that little ruse!

[snowman]

More staff would help. There's a shortage in the hundreds