Manx Care

[GD4ELI]

52 minutes ago, wrighty said:

 

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.

"Even if money were no object we lack the staff".

That's the biggest problem.

[Max Power]

2 hours ago, wrighty said:

 

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.

It sounds very very similar to organising a large car dealership to give the best levels of service, in fact surprisingly similar, including the problems with recruitment and facilities! I imagine the difficulty is in being able to make the changes which you all know would make a difference when you are tied to industry standard systems and procedures for dealing with your customers? It sounds like the NHS could do worse than adopt motor industry practices, let me know if I can help?   

[Apple]

I noted that there were adverts for there Independent Review Body fo Social Services recently (this after a long period of not being. able to appoint to one despite legislation that said we need to have one in place).

Hope full this will be wrapped up in there new complaints and scrutiny systems being developed by Manx Care, presumably as some sort of urgency as they have all agreed in Tynwald what is in place is not fir for purpose.

Does anyone know though how members of the public  can actually complain bout social services and who it goes to as any complaints will not be looked at in Nobles?

Presumably LegCo will need to look at and get involved in looking at what the DHSC is going to need throughout the summer ?

[Annoymouse]

On 5/5/2021 at 9:19 AM, 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. 

 

Unfortunately he won’t be the only one, I’ve personally been a pinball between between my GP, hospital and physio for the last year. Communication is absolutely dire, you can’t just speak to one person who can deal with everything, you have to do all the chasing yourself and liaise with each separate department because they don’t/won’t work as a collective.

[2112]

13 hours ago, Annoymouse said:

 

Unfortunately he won’t be the only one, I’ve personally been a pinball between between my GP, hospital and physio for the last year. Communication is absolutely dire, you can’t just speak to one person who can deal with everything, you have to do all the chasing yourself and liaise with each separate department because they don’t/won’t work as a collective.

Very sad story but won’t be last. The Health Service was failing before March 2020 otherwise there wouldn’t be a need for the West Midlands Review. If it was a little old granny or gentleman in a social housing setting, watch the action being taken. 
 

Whether he gets anywhere remains to be seen as I feel these Manx Care bureaucrats won’t like being bounced into action. 
 

Serious money and political will, will need to be spent, what concerns me now is 2 sets of bureaucrats - Manx Care and DHSC fighting and squabbling. Ashie will be point scoring and electioneering. 

[asitis]

I think many factors have played into the situation we find ourselves, Eddie Teare and the pensions tinkering, the knowledge that there was a very poisonous cabal at the top of the management tree, an upside down triangle in terms of service delivery personnel , and the usual unaccountability of the CS and others. Its a bit like being an alcoholic I guess, nothing can change until there is acceptance of the problem. Those at the sharp end have my admiration .

[The Dog's Dangly Bits]

On 5/6/2021 at 10:39 AM, wrighty said:

 

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.

The reality now is that if you want to get an operation in a sensible time frame you have to go private if you can afford it.

The alarming part is that you can't even do that on island anymore.

Everything here seems to have stopped due to covid.

 

[Banker]

20 minutes ago, The Dog's Dangly Bits said:

The reality now is that if you want to get an operation in a sensible time frame you have to go private if you can afford it.

The alarming part is that you can't even do that on island anymore.

Everything here seems to have stopped due to covid.

 

Yes , you would need to go to a private hospital in UK for anything like hip, knee surgery 

[2112]

21 minutes ago, The Dog's Dangly Bits said:

The reality now is that if you want to get an operation in a sensible time frame you have to go private if you can afford it.

The alarming part is that you can't even do that on island anymore.

Everything here seems to have stopped due to covid.

 

Partly true, COVID did prevent things from happening. However, HRH The Chief Minister. Ashie and the other morons which purports to be the Council of Minister, relentlessly were spouting how well the island was doing, earlier this year. Basking in the adulation of its adoring public. I’m surprised they didn’t sit on a float going up and down the promenade. 
If they were on the ball, they should have planned, planned and planned to address this issue. Zero planning and execution have happened, people at their wits end.

In all reality Paul Moulton could have 24/7 material relating to medical backlogs, medical operations waiting lists and medical fcuk ups - crap consultants, botched surgical procedures - sadly the good surgeons and consultants are overshadowed by the bad. 
 

As for private medical - forget it, it will be years before that ward actually comes into fruition. If you want private go to Manchester, Liverpool or London. 

[Annoymouse]

44 minutes ago, 2112 said:

medical fcuk ups - crap consultants, botched surgical procedures - sadly the good surgeons and consultants are overshadowed by the bad. 
 

As for private medical - forget it, it will be years before that ward actually comes into fruition. If you want private go to Manchester, Liverpool or London. 

I think some of the medical fuck ups you mention are actually caused by the delay in being seen, a relatively simple operation becomes more complex in time as people are effectively being left to deteriorate until they no quality of life, you shouldn’t have to wait until your bed bound before you can have an operation.

You would think in the case of the gentleman in Paul’s video he would be on some sort of high priority emergency/cancellation list, but if it’s anything like I’ve experienced he’ll probably be expected to ring everyday  asking if any cancellations are available, rather than be contacted directly when a cancellation comes up. 

As for the private medical situation, if the delay in being seen let alone actually operated on was more widely known, then I expect many more people would opt for private care, If I’d have known what it’s like I would have tried to go down the private health insurance route.

The days of relying on the NHS is over, the only way to be seen quickly/efficiently is if you find yourself in an emergency setting.

[Mistercee]

In my opinion Manx Care needs to start by addressing some of the very basic problems at both hospitals and GP surgeries. I have regular issues with:

1. Getting a GP appointment. I know things are a bit difficult at the moment but if you need to talk to or see a GP should you have to ring at 8:30 am to book an appointment?

2. Non-adherence to review dates. I have seen consultants, been told we will review in 6 months and some time later get a letter with an appointment 12 months hence. 

3. Time taken to type letters.   I have received many letters which boldly state "Letter dictated on ......" followed by "Letter typed on ...." In some cases these dates have been 3 weeks apart. Private enterprise would simply not tolerate this but the consultants I have spoken to about this simply shrug their shoulders and say "it is the system".

4. Out of date records. I recently saw a letter a consultant sent to my GP practice earlier this year which was addressed to a doctor who retired from that practice some 20 years ago. Two weeks ago I received a copy of a letter addressed to doctor who left that practice 2 years ago. Do the people typing these letters not have an up to date list of GP's at each practice. 

5. Incompatible systems. It appears that there are difficulties for the GP's to access hospital records and for the hospital to access GP records. Surely there must be a way to make the 2 (or possibly more??) systems talk to each other.

 

If we can get the basics right a good health care system can evolve - without the basics it ain't gonna happen!!         

[2112]

3 hours ago, Mistercee said:

In my opinion Manx Care needs to start by addressing some of the very basic problems at both hospitals and GP surgeries. I have regular issues with:

1. Getting a GP appointment. I know things are a bit difficult at the moment but if you need to talk to or see a GP should you have to ring at 8:30 am to book an appointment?

2. Non-adherence to review dates. I have seen consultants, been told we will review in 6 months and some time later get a letter with an appointment 12 months hence. 

3. Time taken to type letters.   I have received many letters which boldly state "Letter dictated on ......" followed by "Letter typed on ...." In some cases these dates have been 3 weeks apart. Private enterprise would simply not tolerate this but the consultants I have spoken to about this simply shrug their shoulders and say "it is the system".

4. Out of date records. I recently saw a letter a consultant sent to my GP practice earlier this year which was addressed to a doctor who retired from that practice some 20 years ago. Two weeks ago I received a copy of a letter addressed to doctor who left that practice 2 years ago. Do the people typing these letters not have an up to date list of GP's at each practice. 

5. Incompatible systems. It appears that there are difficulties for the GP's to access hospital records and for the hospital to access GP records. Surely there must be a way to make the 2 (or possibly more??) systems talk to each other.

 

If we can get the basics right a good health care system can evolve - without the basics it ain't gonna happen!!         

So it’s taking a minimum of £4.5 million for the big cheeses salaries and that’s before any other money spent.

You have to ring at 8..30am to see if there are any cancellations of appointments. From experience if you need an appointment the appointment list is fully booked at other times. However if you tell your GP that you are suffering from for example ………….’chest pains’, then an emergency appointment is created. 

[2112]

The Nations Propaganda Mouthpiece this morning in its state press release written and created by Manx Care. It is about services being moved into the community, in Douglas etc. We have a Community Health Centre based at the old Nobles Hospital, home to the Dental and Podiatry service.
In case it has escaped these dimwits and fuckwits both in the Civil Service and in Manx Care, this island is slowly coming out of a pandemic. Services are already overstretched and if there is a waiting list, I dread to think of how long patients have to wait for such simple things like -

Podiatry

Physiotherapy

Dental Services

Audiology 

etc, etc, etc …………

We can’t manage, I would rather that instead of getting the islands media outlet to do its bidding, it actually gets pulls it finger out, and creates a plan to address the waiting lists. If Nobles has to work 24/7, 365 day so be it. 

[Banker]

1 hour ago, 2112 said:

The Nations Propaganda Mouthpiece this morning in its state press release written and created by Manx Care. It is about services being moved into the community, in Douglas etc. We have a Community Health Centre based at the old Nobles Hospital, home to the Dental and Podiatry service.
In case it has escaped these dimwits and fuckwits both in the Civil Service and in Manx Care, this island is slowly coming out of a pandemic. Services are already overstretched and if there is a waiting list, I dread to think of how long patients have to wait for such simple things like -

Podiatry

Physiotherapy

Dental Services

Audiology 

etc, etc, etc …………

We can’t manage, I would rather that instead of getting the islands media outlet to do its bidding, it actually gets pulls it finger out, and creates a plan to address the waiting lists. If Nobles has to work 24/7, 365 day so be it. 

I don’t think there’s enough medical staff to work 24:7 etc, however some priority lists need drawing up & consultants doing extra clinics if possible 

[Apple]

https://www.manxradio.com/news/isle-of-man-news/more-medical-services-could-move-to-community-settings/

Wouldn't more medical services in the community require more medical staff to work there ? Wonder how they will manage that then.

Will the same apply for psychiatric medical services ?

The needs are there but the mechanisms are not. Enticing medical staff to work outside their comfort zones is a herculean task. 

Any news yet on the Care Quality Commission starting ?