Manx Care

[finlo]

4 minutes ago, snowman said:

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

 

 

 

Maybe they're working from home or the UK even!

[Apple]

7 minutes ago, snowman said:

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

I am loathe to point this out but the DHSC over the years has not been the most attractive to work for. Certainly not worth uprooting your work and family for any more.

Our reputation has been sorely damaged by our ineptitude at attracting the numbers and types of the people we would have benefitted from. 

[wrighty]

30 minutes ago, Apple said:

 

 

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

 

Regarding the longest waits, at least in my specialty the longest wait can’t be used as a sensible marker of performance.  There’s always a reason for the longest waiter to be waiting so long - their own choice, they spend 6 months a year off island, they need a heart operation first, some other medical condition takes priority...  It’s never that they’ve just been forgotten about at the bottom of the list. 

[Beelzebub3]

9 hours ago, snowman said:

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

Not in management terms, must be as many managers as nursing staff at Nobles, it would be interesting to find out how many people are hands on, face to face with patients and the comparison to management and back office staff without patient  contact, I know we require admin, but how many? is Nobles overstaffed with the wrong people?

 

 

 

[Apple]

10 hours ago, wrighty said:

It’s never that they’ve just been forgotten about at the bottom of the list. 

That is not what I posted. I did not use the term forgotten.

I actually posted this;

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

Referrals being lost or delayed, requests for further investigations being lost, and records going missing. It happens but it shouldn't.

Validating waiting lists should be a constant process, not an ad hoc one when someone wakes up and sees the length of them, and then asks a question on the HoK. We should have the technology and the staff to do it continuously. We don't.

Consultant waiting lists should be published monthly with reasons for any long term waiting, why people are waiting so long and what is being done about it.

Let's hope this new open, transparent and publicly accessible Manx Care Board can start there. We are paying enough for it.

Edited May 5, 2021 by Apple
corrections

[code99]

10 hours ago, wrighty said:

Regarding the longest waits, at least in my specialty the longest wait can’t be used as a sensible marker of performance.  There’s always a reason for the longest waiter to be waiting so long - their own choice, they spend 6 months a year off island, they need a heart operation first, some other medical condition takes priority...  It’s never that they’ve just been forgotten about at the bottom of the list. 

I agree with your comments about the longest waiting times. My questions are, a) what are the average waiting times for someone to have an initial consultation with an orthopaedic surgeon, and b) what are the average waiting times after the initial consultation for that person to have an actual operation? 

In addition to these waiting times, I know from first hand experience that some GPs are reluctant to refer patients to specialists, even for an initial consultation, unless a patient is in great pain. Instead of doing this, the GP will prefer to prescribe painkillers and suggest (temporary) things like private physiotherapy, until the patient is in more serious agony. GPs are basically saying to patients, 'because the waiting lists to see specialists are so long, I am reluctant to put more patients on them'.

Clearly, Covid has exacerbated the waiting list situation, but it seems to me that the mentality of continually 'saving NHS' has actually undermined the NHS and has worsened the health of many patients. 

Of course, rather than investing money into what people actually want and need (e.g. improved health services), the IOMG is happily wasting taxpayers money on pointless indulgences like festooning the Douglas Prom with completely unnecessary image-obsessed granite ''tombstones''.    

Edited May 5, 2021 by code99

[wrighty]

@code99 some GPs do the opposite - “you don’t need surgery now, but the waiting list is so long by the time you get seen you probably will” hence refer early, thereby compounding the problem. 
 

I can’t answer your question with single numbers. How long you wait depends on who you’re seeing, what the condition is, and how bad it is. I’d like to see an average clinic wait of about 3 months to be seen. Much shorter than that and the threshold for referral decreases as it seems that we’ve not got enough to do. For me, right now, for a routine hip replacement consultation I’m at about 3 months. 
 

My surgical wait is longer. Before covid, I was able to maintain about 6-8 months wait. It’s now over a year. I may catch up a bit over this year, but we’ve accumulated a backlog through having two lengthy periods without elective operating (except minor stuff) while still seeing patients and adding to the lists. 
 

So at a guess, if referred to me today for consideration for hip replacement, you’ll likely be seen in August, and get your operation in the latter half of 2022. Is that good enough? I don’t think so personally and would be happy to do more operating to improve those access times. But I’m just one cog in the whole machine. 

[Newbie]

5 minutes ago, wrighty said:

some GPs do the opposite - “you don’t need surgery now, but the waiting list is so long by the time you get seen you probably will” hence refer early, thereby compounding the problem.

It doesn't generally work like that. The decision to refer a patient is taken in conjunction with the patient after discussing the various aspects of it, no doubt including the likely waiting time. Not all people want surgery, and are prepared to accept some pain/limitation of function, and wait to see how things go. On the other hand some people want surgery at an earlier stage for a variety of personal and lifestyle reasons. There is no one 'standard patient' and they are all individuals.

For those people that do feel they would like surgery for say a hip problem, you can understand the reluctance to wait until they are desperate for it, knowing that when they are referred they will likely face a wait of around 18 months until they are pain free and mobile again

[Apple]

1 hour ago, Newbie said:

For those people that do feel they would like surgery for say a hip problem, you can understand the reluctance to wait until they are desperate for it, knowing that when they are referred they will likely face a wait of around 18 months until they are pain free and mobile again

And God forbid they need both hips doing. Or knees.

 

1 hour ago, code99 said:

Of course, rather than investing money into what people actually want and need (e.g. improved health services), the IOMG is happily wasting taxpayers money on pointless indulgences like festooning the Douglas Prom with completely unnecessary image-obsessed granite ''tombstones''.    

Agreed

1 hour ago, wrighty said:

But I’m just one cog in the whole machine. 

Agreed.

There are both internal and external reasons for where we have been. We now have to make up ground from behind a reasonable starting line. But we keep doing things the same way and in some cases. And we buy the wrong kit.

And we keep 'escorting people' out of the building, or whatever the terminology is nowadays. How many is that now over the last 5 years ? Who's next ?

 

[Roger Mexico]

50 minutes ago, Apple said:

Referrals being lost or delayed, requests for further investigations being lost, and records going missing. It happens but it shouldn't.

Validating waiting lists should be a constant process, not an ad hoc one when someone wakes up and sees the length of them, and then asks a question on the HoK. We should have the technology and the staff to do it continuously. We don't.

Consultant waiting lists should be published monthly with reasons for any long term waiting, why people are waiting so long and what is being done about it.

Let's hope this new open, transparent and publicly accessible Manx Care Board can start there. We are paying enough for it.

That's all true but it wasn't what I (or I think wrighty) was talking about.  The person with the maximum time to be seen will almost certainly be low priority and not in pain and difficult to get hold of to boot.  Their referral won't be lost because then they wouldn't be there at all.  It may even be a mistake with a date being entered wrongly.

Extreme values are by definition atypical and a truer picture of the real situation can be got by looking at averages and other measures such as percentiles.  So Manx Radio were looking at the wrong thing.

These are just waiting times to be seen at first appointment of course.  The biggest waiting list for that is for wrighty's own area of Trauma & Orthopaedics with 1563  waiting to be seen as at 31 March[1], only 134 of whom had been given a date.  The average wait was 265 days, so more like 9 months than 3, though presumably wrighty was thinking only of one particular procedure.

 

[1]  As often with Manx Radio news stories this is several weeks old - the figures were from April's Tynwald.

[Apple]

Statistics eh. Who can trust them. 

5 hours ago, Roger Mexico said:

Their referral won't be lost because then they wouldn't be there at all.  It may even be a mistake with a date being entered wrongly.

I accept that. Initial referrals get put on the system when they arrive in the hospital. Internal referrals for further assessments and investigations can go missing, as I have experienced. I have also noted the use of long waiting lists being used to encourage patients to think about going private. As I said, more use of PPU using Manx Care staff will further deplete staff for non private patient care. But David Ashford is determined to plough on.

Appointments can be 'dropped' or 'missed' if letters are not sent out in time or to the wrong place etc.- we had a scutch of those last year.

Some people at the end of waiting lists are there by their own choice or preference, but not all.

Maybe we should bring in a penalty system for those with long waiting lists like they are doing for Manx Care and their budget.

It really isn't going well is it.

 

[asitis]

21 hours ago, wrighty said:

@code99 some GPs do the opposite - “you don’t need surgery now, but the waiting list is so long by the time you get seen you probably will” hence refer early, thereby compounding the problem. 
 

I can’t answer your question with single numbers. How long you wait depends on who you’re seeing, what the condition is, and how bad it is. I’d like to see an average clinic wait of about 3 months to be seen. Much shorter than that and the threshold for referral decreases as it seems that we’ve not got enough to do. For me, right now, for a routine hip replacement consultation I’m at about 3 months. 
 

My surgical wait is longer. Before covid, I was able to maintain about 6-8 months wait. It’s now over a year. I may catch up a bit over this year, but we’ve accumulated a backlog through having two lengthy periods without elective operating (except minor stuff) while still seeing patients and adding to the lists. 
 

So at a guess, if referred to me today for consideration for hip replacement, you’ll likely be seen in August, and get your operation in the latter half of 2022. Is that good enough? I don’t think so personally and would be happy to do more operating to improve those access times. But I’m just one cog in the whole machine. 

My wife waited just over two years for a procedure, the consultant told her theatre availability and lack of resources were to blame and that only one day a week could be allocated to that procedure. My wife, an NHS sister, said that when she eventually got to Nobles for something meaningful to happen she was impressed, but the interminable wait to actually see someone was dispiriting. In reality, money is the root of most issues in health care and as I often post the dispiriting bit is to sit and watch the incompetents in Government pour taxpayers money away and achieve little!

[John Wright]

Sometimes shit happens in a human run and operated system, if only for the reason that if you have hundreds of thousands of interactions with the public in a year then a few will get lost or go wrong. Obviously we should be working to minimise and to explain and apologise when it does.

My 30 month wait for my urgent neurology appointment ended pleasantly. An apology from the visiting consultant, an admission I should have been seen in 2018, acceptance he couldn’t explain why I wasn’t, a discussion about the merits of various drug regimes to kill the constant pain, and a mutually agreed conclusion that rather than take opiates, gabapentin or anti convulsants, all of which mask the pins and needles but probably slow down thought processes, it better suited me to live with it, and carry on working.

Invite at end to self refer if things got worse and details of his secretaries at Nobles and Walton.

I was impressed that this visiting consultant had been coming over throughout the pandemic, two days at a time, twice a month, and tried to keep things running. It’s not all bad news

[Apple]

You are right John. A lot of what happens in our health and social care services does go well. People's needs are met and public / patient satisfaction remains high in most areas.

There are from time to time blips and in a very few cases there have been some serious outcomes over the years. For me complaints are too high. And now, even longer waiting lists.

I think it is becoming clearer that Manx Care was rushed in and the lack of preparation is now being felt. One of the key issues in the mandate was the scrutiny from CQSW, an important argument for implementation. That so far has not been announced so presumably is not taking place, an essential activity for setting and monitoring standards.

Review after review often highlights areas the DHSC can and must do better such as the Dickenson reports and the KMT to name just two. Managers and clinical staff come and go sometimes under dubious circumstances. 

On the other hand if everything was good news then the tendency I suspect may be not to strive so energetically or passionately for the highest available realistic standards taking into account the island's locations and circumstances.

I remember attending a presentation by the Manager Mr Brian Presley of RDCH about the creation and development of health care on the IoM. The philanthropy, the generosity, the work of people to aid and develop services, volunteers and charities combined, the work of many, many people quietly devoting their time and effort to the developments of where we are now.

A phenomenal achievement when you take stock and think about it. And the work goes on.

[wrighty]

3 hours ago, asitis said:

 ...when she eventually got to Nobles for something meaningful to happen she was impressed, but the interminable wait to actually see someone was dispiriting. 

 

2 hours ago, John Wright said:

My 30 month wait for my urgent neurology appointment ended pleasantly...

I was impressed that this visiting consultant had been coming over throughout the pandemic, two days at a time, twice a month, and tried to keep things running. It’s not all bad news

I was discussing with medical colleagues this morning what we feel are the main problems with healthcare on the island.  The word that cropped up, independently, on many occasions was 'access'.  The other problem in my view is administration.  Most of the staff are good people, trying to do their best, and going the extra mile to do a good job.  It's often said, as above, that once you get seen the care is very good.  Most complaints tend to be about waiting to be seen or communication issues.

The access problem is a difficult one to solve.  We were starting from a bad position, made worse by the pandemic.  Even if money were no object we lack the staff, and in some cases the space, to be able to upscale operations (in the general, rather than surgical, meaning of the word).  Getting more staff is nigh on impossible too, for reasons that have been discussed before.  Several services here are undermanned - in my own specialty, we've not expanded the department since I was appointed 15 years ago.  The British Orthopaedic Association say we should have 6 consultant teams, we have 4.

By administration I refer to the several different systems we have to navigate.  If a GP sends me an email asking me to check an XR but it only has the patient's hospital number I have to access one system to search for the number before going to the XR system to search on the name.  It's very frustrating that patients don't have numbers that apply to all systems, and it's inefficient.  Medway is somewhat inflexible too when it comes to booking clinics.

I don't know what the solution to all this is.  It's a bit like the chap asking for directions, to be told 'I wouldn't start from here'.  I'd quite like to design a system from the ground up, starting with our demographic, determining what services they'll need, and building clinical teams and services up from there.  The conclusions would likely be unpalatable though, so we'll just continue bumbling along doing what we can with what we have.  Like the UK NHS does, which (as Churchill said about democracy) is not a great system of healthcare, but probably better than all the alternatives.