IOM DHSC & MANX CARE

[cissolt]

1 hour ago, Omobono said:

they send all this stuff out in advance so they can claim there is no one on the waiting list ,  then over the months you are bombarded with new appointment  changed  times and dates ,   the appointments come out from a secretarial pool  ,and often without input from the particular department or consultant , not the best way to run an appointments section , and no wonder the patients get confused , 

The constant changing of appointments and resending of letter is a large part of the problem.

Zero acknowledgement from Manx care that they might be able to do things better.  The problem has definitely worsened since they took over.

[Cinderella]

2 hours ago, Gladys said:

Penalties should only be considered once all other issues, including those of their own making, are solved.  Even then, I am not sure it would do much to deal with the behavioural aspects and would be a nightmare to administer including having some sort of appeal process.  It may also unfairly penalise the more vulnerable.

Let them get their own house in order before flinging fines around. 

Entirely agree about the management issues (and solutions should include digital options like sms as well as paper) but an alternative to financial penalties (costly to administer) would be a ‘demerit’ style approach where, if you miss appointment, you then join the back of the queue. Particularly for high demand appointments (including GP) 

[Cinderella]

59 minutes ago, mad_manx said:

Spoke to my consultant ..Things used to be better in the old days when each consultant had their own secretary and the department  handled the appointments. 

Then for "cost savings" they made it all in in some central appointments section and things have all been berserk since then..

Centralisation can dumb things down. The old fashioned consultants secretary knew exactly how to fill every appointment, and bring in last minute  waitlisted patients to fill short notice cancellations.

In the available data, do they also measure how many slots are never filled (either appointments not made, or cancellations refilled) 

[wrighty]

34 minutes ago, WTF said:

you forgot 'died whilst waiting for numerous years' from your list

Never yet had a DNA due to patient being dead. I think the system cancels future appointments automatically as soon as a death is registered. 

[wrighty]

1 hour ago, Omobono said:

they send all this stuff out in advance so they can claim there is no one on the waiting list ,  then over the months you are bombarded with new appointment  changed  times and dates ,   the appointments come out from a secretarial pool  ,and often without input from the particular department or consultant , not the best way to run an appointments section , and no wonder the patients get confused , 

I don’t think so. People with an appointment still appear on waiting lists. 
 

I have suggested, many times over the years, that sending out appointments for clinics a year in advance is stupid, and there are many reasons why this is the case:

• staff take holidays resulting in clinic cancellations. We have to give 6 weeks notice, not 12 months. 
• There is nothing special, medically, about 52 weeks. If we want to review in a year’s time (why? That is another good question) it doesn’t matter if it’s actually a few weeks either side. 
• If clinics get booked up ages in advance there is no flexibility to see more clinically urgent cases without cancelling someone else. 

My solution is to only send appointments out about 4 weeks in advance. At that stage there should be no need to cancel a clinic for predictable operational reasons, patients are less likely to forget, and we’d have more flexibility. It’s fine to tell a patient in clinic that they’ll be reviewed in a year, and they’ll get an appointment letter nearer the time. All that needs to happen is that instead of being allocated a firm appointment they’re put on a “pencilled in list” on the system, with appointments only verified 4 weeks before. Should a clinic get cancelled 6 weeks in advance nobody would ever know, and the pencilled in appointments get shifted a week or two back.

[Gladys]

8 minutes ago, wrighty said:

I don’t think so. People with an appointment still appear on waiting lists. 
 

I have suggested, many times over the years, that sending out appointments for clinics a year in advance is stupid, and there are many reasons why this is the case:

• staff take holidays resulting in clinic cancellations. We have to give 6 weeks notice, not 12 months. 
• There is nothing special, medically, about 52 weeks. If we want to review in a year’s time (why? That is another good question) it doesn’t matter if it’s actually a few weeks either side. 
• If clinics get booked up ages in advance there is no flexibility to see more clinically urgent cases without cancelling someone else. 

My solution is to only send appointments out about 4 weeks in advance. At that stage there should be no need to cancel a clinic for predictable operational reasons, patients are less likely to forget, and we’d have more flexibility. It’s fine to tell a patient in clinic that they’ll be reviewed in a year, and they’ll get an appointment letter nearer the time. All that needs to happen is that instead of being allocated a firm appointment they’re put on a “pencilled in list” on the system, with appointments only verified 4 weeks before. Should a clinic get cancelled 6 weeks in advance nobody would ever know, and the pencilled in appointments get shifted a week or two back.

Exactly, and not hard.  I get that they may want to 'forward cast' appointments, but as you say keep it internal. 

How is it that 'Joe Bloggs' can see the issue and possible solutions, but management can't?

[Gladys]

1 hour ago, Cinderella said:

Entirely agree about the management issues (and solutions should include digital options like sms as well as paper) but an alternative to financial penalties (costly to administer) would be a ‘demerit’ style approach where, if you miss appointment, you then join the back of the queue. Particularly for high demand appointments (including GP) 

I think GP appointments are outside of this, and whilst a demerit system seems attractive,  it probably has even more unintended consequences and administrative burden.  Once the system is sorted out, then look at how to dissuade people from missing appointments. 

[Gladys]

1 hour ago, wrighty said:

Never yet had a DNA due to patient being dead. I think the system cancels future appointments automatically as soon as a death is registered. 

Well, at least something works!

[Two-lane]

If an organisation has a single problem, there is if course only one problem to analyse. If an organisation has many problems the first step is to go up a level or two to determine if here is a common factor. If there is a common factor, analysing each problem in isolation is a waste of time.

I think that discussing whether or not to put a first class stamp on letters is a waste of time.

[cissolt]

19 minutes ago, Two-lane said:

If an organisation has a single problem, there is if course only one problem to analyse. If an organisation has many problems the first step is to go up a level or two to determine if here is a common factor. If there is a common factor, analysing each problem in isolation is a waste of time.

I think that discussing whether or not to put a first class stamp on letters is a waste of time.

But in this instance, the organisation is blaming the customer rather than looking internally.  Is the minister just reading from the hymn sheet given to him by Manxcare? I assumed he wasn't a complete moron.

[Gladys]

11 minutes ago, cissolt said:

But in this instance, the organisation is blaming the customer rather than looking internally.  Is the minister just reading from the hymn sheet given to him by Manxcare? I assumed he wasn't a complete moron.

Self-examination doesn't seem to be a strong point, even though we are all encouraged to do it!

[asitis]

12 minutes ago, cissolt said:

I assumed he wasn't a complete moron.

You remember what they say about assumptions ! In Hoopers case especially.

[wrighty]

Another issue lies on the referrer side. I see some patients with no idea why they’re being seen - not that they’ve forgotten, but never knew their GP had sent them in. Often they’ve seen the GP about one problem, and GP fires off two or three different referrals for minor non-problems. A proportion of these turn up, because the hospital sent for them and thought they had to, some will not attend as assumed the appointment letter was a mistake. 
 

And another is multiple referrals. Patient may get sent simultaneously to physiotherapy, orthopaedics and pain management in a ‘scattergun’ approach. And then go private across. And then turn up to clinic despite the issue being solved. Or not turn up. 

[Gladys]

1 minute ago, wrighty said:

Another issue lies on the referrer side. I see some patients with no idea why they’re being seen - not that they’ve forgotten, but never knew their GP had sent them in. Often they’ve seen the GP about one problem, and GP fires off two or three different referrals for minor non-problems. A proportion of these turn up, because the hospital sent for them and thought they had to, some will not attend as assumed the appointment letter was a mistake. 
 

And another is multiple referrals. Patient may get sent simultaneously to physiotherapy, orthopaedics and pain management in a ‘scattergun’ approach. And then go private across. And then turn up to clinic despite the issue being solved. Or not turn up. 

But isn't that all about joined up systems? 

[Jarndyce]

34 minutes ago, Gladys said:

But isn't that all about joined up systems?

Isn’t it all?   Fundamentally?