IOM DHSC & MANX CARE

[wrighty]

Missed appointments save money, just to completely spell it out. Not that I’m arguing it’s a good thing - it is inefficient. If I have 3 hip replacements scheduled on a day’s operating list, and one doesn’t show up, we don’t spend the £1500 or whatever it is on the implant. 

[Newbie]

12 minutes ago, wrighty said:

Missed appointments save money, just to completely spell it out. Not that I’m arguing it’s a good thing - it is inefficient. If I have 3 hip replacements scheduled on a day’s operating list, and one doesn’t show up, we don’t spend the £1500 or whatever it is on the implant. 

That's assuming that the person who doesn't turn up doesn't go on to have a hip replacement at some point in the future. If they do, missing the initial appointment ends up costing money. In that case the £1500 on the implant will get spent at a later date anyway, and many of the other costs (staff etc) will be the same whether you do 2 or 3 hip replacements on 1 list. If you only do 2 it is less efficient (as you say) and therefore more costly in the long run.

If they don't turn up because they no longer require one (for any reason) that is a different matter. If that is the case there should be a system that stops them being sent for and their spot could be offered to someone else on the waiting list. Either way, running lists at two thirds capacity is less efficient/more costly in the long run.

Edited September 22, 2022 by Newbie

[John Wright]

39 minutes ago, wrighty said:

Missed appointments save money, just to completely spell it out. Not that I’m arguing it’s a good thing - it is inefficient. If I have 3 hip replacements scheduled on a day’s operating list, and one doesn’t show up, we don’t spend the £1500 or whatever it is on the implant. 

I’m sure that’s tongue in cheek, at least I hope it is. Presumably they still need the hip replacement, so the expenditure is delayed, rather than saved, and another patient has been deprived of the opportunity, etc.

[Gladys]

It's the opportunity cost that is the issue, surely?  Ie the cost to patients in terms of delays in getting appointments. 

[Andy Onchan]

2 minutes ago, Gladys said:

It's the opportunity cost that is the issue, surely?  Ie the cost to patients in terms of delays in getting appointments. 

Beat me to it..... opportunity costs are basic economic theory.

[Apple]

51 minutes ago, John Wright said:

I’m sure that’s tongue in cheek, at least I hope it is. Presumably they still need the hip replacement, so the expenditure is delayed, rather than saved, and another patient has been deprived of the opportunity, etc.

I think you are right. Any changes to an arranged clinical intervention on that basis would create all sorts of costs further down the line potentially if still required.

Having an in built system of ongoing waiting list validation and appointment confirmation would seem to be at least helpful, but the system doesn't seem to work like that. It also does not take into account the numerous reasons caused by the current administration process.

[Zulu]

4 minutes ago, Apple said:

I think you are right. Any changes to an arranged clinical intervention on that basis would create all sorts of costs further down the line potentially if still required.

Having an in built system of ongoing waiting list validation and appointment confirmation would seem to be at least helpful, but the system doesn't seem to work like that. It also does not take into account the numerous reasons caused by the current administration process.

One of the administration problems is you get a letter stating you have missed your appointment - Sorry what appointment as you never received an appointment so how can you have missed it??

[wrighty]

1 hour ago, John Wright said:

I’m sure that’s tongue in cheek, at least I hope it is. Presumably they still need the hip replacement, so the expenditure is delayed, rather than saved, and another patient has been deprived of the opportunity, etc.

Of course, but budgets are thought of as quarterly, or annually, or by parliamentary term. So by those criteria a DNA gives a saving on that time period’s budget. It might cost more down the track, but by then there’ll be a different health minister, probably. 

[Apple]

2 minutes ago, Zulu said:

One of the administration problems is you get a letter stating you have missed your appointment - Sorry what appointment as you never received an appointment so how can you have missed it??

I have never experienced that but I know friends who have. And more than once.

They didn't complain as they did not want any form of delay as the person was desperate to be seen. Good outcome eventually but added more time in pain that could have been avoided.

On a positive note the appointment of the new Breast Care Consultant is a positive step forward and hopefully indicated there are ways to attract people to the island.

[John Wright]

2 hours ago, wrighty said:

Of course, but budgets are thought of as quarterly, or annually, or by parliamentary term. So by those criteria a DNA gives a saving on that time period’s budget. It might cost more down the track, but by then there’ll be a different health minister, probably. 

The sad thing is that type shortsightedness is common across publicly funded health care. There’s no concept of service delivery, value for money or customer convenience. And, from my experience of private medicine it’s not much better there.

Ive just had experience of Clatterbridge and it’s systems. 

An anomalous blood test result ( taken at Nobles but sent to Clatterbridge for analysis ) resulted in me being asked to attend to see the consultant in Liverpool.

Off I trotted. I contacted the specialist nurse, suggested we go straight to Biopsy rather than repeat the bloods. Consultant overruled.
 

So early August I had bloods taken in Liverpool. I’d not seen this consultant before. He clearly hadn’t read my records, didn’t realise I’d come from/lived in IoM. Criticised me for not having full blood screen every 8 weeks in last year ( I had, but Nobles and Clatterbridge systems don’t talk - so results have to be entered manually and are in the “wrong” place ). Suggested if the second results were anomalous I could “pop in” for a biopsy. I pointed out that popping in was not straightforward, or cheap.

I reminded him, and the specialist nurse, I would be away in Spain for 6 weeks from 8 August. 20 August, a letter, dated 15 August, arrived at home with a phone appointment for 31 August. 

Obviously I knew that meant second anomalous test result. Contacted specialist nurse, tried to organise date/time for biopsy. Not possible until I’d spoken with consultant. The earliest date they could offer was 12/9. I suggested that as I was in Liverpool on 19/9 that would be better than me flying back from Spain for 24 hours. Took a lot of persuading.

All consultant did was try and tell me that the two consecutive anomalous results didn’t mean anything had returned and not to worry. Well, I knew that and wasn’t, and am not, worried.

19/9 the specialist nurse practitioner had three attempts to perform the biopsy, but couldn’t get any aspirate. Suggestion was they would give me an appointment for a CT guided procedure, in three weeks to a month.

My suggestion they tried again, the next day, on the other side was dismissed. I persisted. Turned up on Tuesday morning anyway. And on 20/9 they, eventually, got a viable sample.

Now it’s a wait for results.

Biopsy is more uncomfortable than a blood sample, and takes longer to perform. But after that the path lab costs are identical. But we’ve wasted a couple of hours in unnecessary consultations and they were willing to waste a day of my time and £350 of Manx Care funding to fly me back. As it is I’ve paid my own travel costs both for August and September and claimed nothing from Patient Transfers.

They know from my records that my pelvis bones are hard and there’s a history of inability to get in and extract aspirate. To the extent, over 5 years, success at first attempt has been less than 50% and at diagnosis they had to perform the procedure on my sternum.

[Andy Onchan]

49 minutes ago, Zulu said:

One of the administration problems is you get a letter stating you have missed your appointment - Sorry what appointment as you never received an appointment so how can you have missed it??

I received one of those not so long ago, two weeks after I had attended the consultation in question!

[quilp]

Me too. Twice. 

[wrighty]

I think we, as in society, need a massive shift in focus with regard to health. Our health service is anything but - it’s a sickness service (apart from a few screening programmes and vaccinations). Society needs to get healthier. Perhaps if we could do that, we could afford a sickness service that works. I’m sure it’s been worked out somewhere (cue @Roger Mexico to google it for me) but the following conditions probably cost or contribute to a large portion of health spending  

• Smoking
• Excessive alcohol
• Drugs
• Obesity/type II diabetes
• Frailty/osteoporosis/sarcopaenia
• Dementia

I don’t know how to do it, but if everyone could be persuaded not to smoke, not drink excessively, don’t take drugs, eat a good diet and get outside and exercise, we’d be a whole lot better off.

[Jarndyce]

24 minutes ago, wrighty said:

if everyone could be persuaded not to smoke, not drink excessively, don’t take drugs, eat a good diet and get outside and exercise, we’d be a whole lot better off.

Wrighty for Health Minister?

[Lilly]

12 hours ago, Zulu said:

One of the administration problems is you get a letter stating you have missed your appointment - Sorry what appointment as you never received an appointment so how can you have missed it??

I was recently at Nobles and witnessed a patient whose appointment had been rescheduled but she hadn't received the new appointment in time in the post and was promptly sent home.  Could it actually be the post at fault l've noticed that local and UK post appears to be delayed sometimes.