A&E waiting times
Discussion
I'm struggling to find it now, but there's a slide deck covering all NHS Trusts showing the "achievement" of the 4 hour waiting time when it was introduced, and the behaviours it drove if attainment was prioritised...
Iirc, it was done by Seddon when he was reviewing failure demand and use of metrics within the NHS during the Labour years.
It was not positive. All that happened was that "management to the metric" became key - and pretty much everyone (except the most urgent) waited almost exactly 3hr45, until either being rapidly treated and discharged, or admitted swiftly.
When the Conservatives came in, despite increased funding, suddenly the metric performance started to fall. Difficult to draw any causative conclusion other than the staff prioritisation of attaining the metric had reduced... Can't think why.
One of the biggest issues with the NHS is siloed, useless metrics that scan well with those that don't understand how to effectively measure systemic performance...
Iirc, it was done by Seddon when he was reviewing failure demand and use of metrics within the NHS during the Labour years.
It was not positive. All that happened was that "management to the metric" became key - and pretty much everyone (except the most urgent) waited almost exactly 3hr45, until either being rapidly treated and discharged, or admitted swiftly.
When the Conservatives came in, despite increased funding, suddenly the metric performance started to fall. Difficult to draw any causative conclusion other than the staff prioritisation of attaining the metric had reduced... Can't think why.
One of the biggest issues with the NHS is siloed, useless metrics that scan well with those that don't understand how to effectively measure systemic performance...
waynedear said:
I think the set targets are not achievable, ‘here is your target, you have to make 9 beans 10’
My wife who will not go to hospital for love nor money said she felt unwell one evening last year and though she should go to hospital.
Triage nurse saw her within the hour, then the wait began, 7 hours.
As this particular hospitals senior inspection manager she could have told them who she was or asked to see a senior member of staff and she would have been seen.
She chose to wait her turn, the place was packed with people that did not need to be there, just eat we’re doing a roaring trade at the main door.
I believe the NHS, staff and hospital are doing the best they can, it’s the visitors that cause the problems.
You can get bumped up the queue cos management?My wife who will not go to hospital for love nor money said she felt unwell one evening last year and though she should go to hospital.
Triage nurse saw her within the hour, then the wait began, 7 hours.
As this particular hospitals senior inspection manager she could have told them who she was or asked to see a senior member of staff and she would have been seen.
She chose to wait her turn, the place was packed with people that did not need to be there, just eat we’re doing a roaring trade at the main door.
I believe the NHS, staff and hospital are doing the best they can, it’s the visitors that cause the problems.
Kermit power said:
Esceptico said:
Typical PH. Should have realised it would be the fault of people for getting injured and being sick rather than the government for underfunding the NHS.
I’m sure that the 30% of people waiting more than 4 hours will be relieved by the anecdotal tales of quick visits above. They are obviously injured/sick at the wrong time or wrong place.
It's not "typical PH" at all. Talk to anyone who works in A&E and they'll tell you the place is having with people who not only don't need to be there, they don't need to be at a GP either.I’m sure that the 30% of people waiting more than 4 hours will be relieved by the anecdotal tales of quick visits above. They are obviously injured/sick at the wrong time or wrong place.
SlimJim16v said:
The 4 hours is b
ks. It doesn't mean you're treated, just that someone has seen you. It's just bullst to make the statistics look better.
Same with referral waiting times... ks. It doesn't mean you're treated, just that someone has seen you. It's just bullst to make the statistics look better. So easy to game, if people wish to. Seemingly, from the data, the desire to is linked to which government is in power...
gregs656 said:
I have a few friends who are paramedics and the general consensus seems to be that front line services are under immense pressure because access to non-emergency is patchy. Not just GPs etc either but mental health and social care, leading to people who probably ought not be in hospital blocking up A&E as the duty of care means they can't really go anywhere else.
Seddon calculated using the NHS' own data that "failure demand" for emergency services due to systemic failures elsewhere in the overall system is over 80%...This is the problem with measuring by department for a complex public service system.
Would any commercial company be reporting "critical KPIs" (even though they're not indicators, but lagging metrics) relating to the performance of a single machine/department in a system of delivering a good or service?
No. They measure and report outcomes of the system.
Esceptico said:
Typical PH. Should have realised it would be the fault of people for getting injured and being sick rather than the government for underfunding the NHS.
I’m sure that the 30% of people waiting more than 4 hours will be relieved by the anecdotal tales of quick visits above. They are obviously injured/sick at the wrong time or wrong place.
A huge amount of people don't need to be in A&E. Only the feeble-minded think this is a "simple" underfunding problem.I’m sure that the 30% of people waiting more than 4 hours will be relieved by the anecdotal tales of quick visits above. They are obviously injured/sick at the wrong time or wrong place.
From my wife’s experience, you’ll be seen to immediately if it’s truly A&E worthy. Majority of her day is taken up by people who have no idea what A&E is really for.
Examples of the last few months are
Girl suffering ‘anxiety attack’ (wanted to avoid an exam)
Mom claiming she was suicidal (what A&E could do I don’t know)
Girl scuffed her cuticles while filing
Lady banged her knuckle and tried to get signed off work
Multiple cases of people trying to avoid work (never suffer a serious injury on a Monday)
Multiple instances of people wanting free morphine (come in with an ‘injury’ and claim tablets aren’t working)
Multiple patients coming in with a headache they’ve had for a few hours
People using it as a GP surgery because they don’t want to wait 4 weeks for an appointment
Extra patients created in the waiting area when the underclass start fighting each other and fall down like footballers (not kidding)
Multiple cases of excessive drinking. Rather than sleep off the hangover at home they descend on A&E for a magic pill.
Multiple cases of drug overdoses
Patients who need further care cannot leave A&E until a bed is free elsewhere in the hospital, so they take up the few cubicle spaces or end up waiting in corridors.
However many A&E units are too small. Where she works, several hospitals with A&E/Minor Injuries were closed as they’d become a ‘super hospital’. The hospitals were closed but the surviving hospital was not expanded to cope with increased numbers.
If A&E was used for A&E worthy reasons, there wouldn’t be such a problem. Population education is what’s needed (so they know where they should be going) as well as expanding the size of A&E units and walk-in centres.
Examples of the last few months are
Girl suffering ‘anxiety attack’ (wanted to avoid an exam)
Mom claiming she was suicidal (what A&E could do I don’t know)
Girl scuffed her cuticles while filing
Lady banged her knuckle and tried to get signed off work
Multiple cases of people trying to avoid work (never suffer a serious injury on a Monday)
Multiple instances of people wanting free morphine (come in with an ‘injury’ and claim tablets aren’t working)
Multiple patients coming in with a headache they’ve had for a few hours
People using it as a GP surgery because they don’t want to wait 4 weeks for an appointment
Extra patients created in the waiting area when the underclass start fighting each other and fall down like footballers (not kidding)
Multiple cases of excessive drinking. Rather than sleep off the hangover at home they descend on A&E for a magic pill.
Multiple cases of drug overdoses
Patients who need further care cannot leave A&E until a bed is free elsewhere in the hospital, so they take up the few cubicle spaces or end up waiting in corridors.
However many A&E units are too small. Where she works, several hospitals with A&E/Minor Injuries were closed as they’d become a ‘super hospital’. The hospitals were closed but the surviving hospital was not expanded to cope with increased numbers.
If A&E was used for A&E worthy reasons, there wouldn’t be such a problem. Population education is what’s needed (so they know where they should be going) as well as expanding the size of A&E units and walk-in centres.
ok first thing to clear up, the a&e target is 95% leave A&E within 4 hours, we haven't hit it for years, even when we appeared to be doing it in reality we were running at around 92% and used the figures from minor injury units which are often quieter of have an appointment system to boost the average and hit the target. About 2 years ago we got stopped from using that (quite rightly) and then with everything else we've been so far away and there is always massive cheating, back timing etc
The target has good and bad points, A&E being the only place which is always open and the public have direct access to medical care is hit by any other problem in any other part of the NHS be it GP cover, lack of beds, dumping of the elderly, the complete professional disengagement of psychiatrists, staff shortages in the hospital and that's all before you get to staffing in ED. The bad point with it being a quantum target is it means a patient that leaves at 3:59 good, leaves at 4:01 bad
There has been a lot of talk about using the average (mean although you should really use median) is that on an individual level, as a patient you could be there for 24 hours, but it makes no difference. Its a better measure of the stress in the system but does lead to good care. I work in one of the test sites for the new target and for the last 6 months we've had people spending 12-18 hours in the department waiting for a bed for the last 6 months, I went to work at a friends department to help them out this week, i'd forgotten how much better it was with the target. With the target there is pressure to get the patient out, the hospital actively sucks patients out of the department. Without it it is seen as A&Es problem.
There is no clinical evidence for the 4 hour target, it was dreamt up by the Blair government from a focus group The problem with patients staying in A&E is the department gets smaller with each patient, plus the medical staff have to look after patients the same as on the ward as well as processing their own.
Why is it a mess? well the demand keeps going up, when i started we used to see a member of the public every 5 years, we've passed 4 and approaching 3 and of coarse the population has increased significantly during this time. As well as this the ageing and increasingly medical complexity of the population means each elderly patient is so much more complex so sort out.
Before we even think about solving it, we need to realise ll the problems which are hitting us and really this is just some of them, i've tried to group them together.
Outside the NHS
Social care- This is such a mess and needs to be funded properly, sadly this is knock on from the collapse of the family unit, families are split up, all in smaller houses because housing is so expensive which require two incomes for the mortgage, so families can not look after their relatives so the tax payer pays. The sad thing is the family still want to pass on/inherit the value of the house. Maybe some increased in the inheritance threshold if the recipient looks after their relative may help, but i don't know, something has to give. We are swamped with the elderly failing to cope, or having falls and no one to look after them. In the end it needs to be paid for in tax or in time.
Fear of litigation/ health and safety- We get so many people who have been sent it "just to be checked out" firstly it's not how medicine works, just because we don't find anything wrong with you, doesn't mean there isn't. Secondly it's that private gains vs social losses again, people off loading their responsibility to A&E, my sister was the trained first aider for her college, the thing they stressed over and over again was just call an ambulance they didn't actually teach her any more first aid then that and the lesson being you shouldn't be sending them home, always send them to A&E. Just think of the cost of all these ambulances, all the time in ED to the NHS
The 24/7 culture- we all want to have the ability to go food shopping at 3am even if we don't use it, but have the dichotomy of I want to be able to do everything 24/7 but i only want to work monday to friday 9-5. Most of the time this hits the low paid, so making it attractive to work nights or weekends is relatively easy, medical cover is the first place were this becomes difficult not unsurprisingly people are not keen to be forced to work evenings nights, bank holidays and weekends for time and a third and the viability of doing this until people are 68 is nonsense. The target has further fed the demand for evening and night cover why wait until tomorrow when at 8 you can go and be out before midnight. The problem is the antisocial hours are harder and more expensive to staff. The more other people work 24/7 the more problems happen during this time, people are actually pretty safe tucked up in bed.
Drugs and alcohol- everyones whipping boy when it comes to abuse of A&E, but it's not the ones you think who are the problem, the drunk/intoxciated +/- injury and relatively easy and quick to solve. The killer is the chronic patients, the alcoholics and drug addicts, although small in number they create a huge amount work for their number and are very difficult to solve.
Vulnerable adult and children social services- part of our role is to detect the vulnerable and engage social services, after baby P we have been hugely proactive with this and want to make sure it doesn't happen again, my impression of social services its they have learnt nothing from Saville snd Rotherham, i'm guessing because in the end because they weren't prosecuted but it's still going on, and they're still not picking it up
The NHS
Funding- annoying as it is, the NHS needs to get paid for the work it does, if we are required to do more, we need to be paid more in addition to adding the rate of inflation. Controlling the demand or saying what it is we do is the role of the government.
The private sector- The cherry picking of profitable procedures or patients is akin to what the road haulage industry did to the railways with result that lead to the collapse of rail transport. Taking the quick easy procedures on the easy patients proportionally increases the costs on the NHS. In addition the NHS should not be expected to be the trainer or insurer of the private sector. If the private sector is using NHS training then it needs to contribute towards that training cost or train it's own staff. If a patient has private procedure and it goes wrong, then the patient remains a private patient if it's transferred to the NHS, again private gain socialised losses
The feminisation of the workforce- Don't get me wrong, we do not discriminate but the rate of drop outs, parental leave and part time workers is significantly higher in the female workforce. This has then lead to the men who have started to go part time, so you end up with more and more staff who work less and less. Its not helped with the fact it is easy to replace that time you're not working with work which pays better then working for the NHS and this is without the same stress. It is snow balling, it's going to get worse. In emergency medicine training we actively encourage the trainees to go part time as a way of surviving, rather than fix the problem. Sadly once they go part time people almost never come back to full time.
National pay scales- sadly this hits a common theme, because the pay scales are national you can't use the usual market forces to attract people into the hard to fill roles and locations. We end up stupidly short in roles where there is no private practice and have significant anti social working this then feeds into flexible working.
Student loans- it takes a long time to train a doctor, hence unless you come from a wealthy family the debt is massive. When i qualified I was something like 16k in debt and that was significant enough that if i'd known this going in, i wouldn't have gone to medical school. They are now rolling out 100k in debt and with the higher rate of interest have to payback something like 200k. Personally i think as long as you're working for the NHS the NHS should pay your interest, do the equivalent of 30 years full time work for the NHS, the NHS pays the capital.
Mental health- there is a complete failure of mental health provision which results in the patients ending up back in A&E, this sadly falls at the feet of psychiatry who have no interest in providing the cover needed, as a tax payer you are paying for a consultant psychiatrist to be on call at every NHS site, if you ever need them you can never find and they will never come in, except if someone needs sectioning and the sceptic in me is because they are then paid a significant sum for doing it. All of this has been handed off to non medical staff. Whats even worse is despite being looked after by doctors, these doctors refuse to do anything medical for their inpatients, any problem, ambulance to A&E and use them for the medical cover.
Primary care- yes primary care are not providing the cover they should and this feeds back and send the patients to A&E where they will always been seen and the out of hours cover is a disgrace, but they have the same recruitment and work load problems. Its not helped by the GPs been the big fish in their practices, if they phone us for advice we talk to them immediately, when we call them back its 15-20 minutes to get them to come to the phone, that's 15-20 minutes sat on the phone burning time and money
Hospitals
Beds- we just don't have enough, the problem is that they are only efficient if we are always completely full as they cost money to staff even if empty. Unlike a hotel we can't say those who are leaving must be out of a bed by a certain time and no one can come to A&E until 2 hours later. The number of beds we need is pretty easy to calculate, most number of patients who have ever been kept in overnight - least number of patients sent home in one day + most number of patients admitted in one day. Sadly this gives a bed occupancy rate of 85% or lower, most of us are running in excess of 95% hence there just isn't the room and the patients over flow into A&E
IT- the NHS it is awful, we have multiple different systems all with different passwords which change at different frequencies so i spend maybe 30 minutes a day logging on to system or waiting for the system to respond. Sadly the IT staff are those not good enough to get a better paying job elsewhere. Then there is the desire to collect data, as a result about half my day is spent entering data, i'm not a typist ( a quick read of this should confirm that) you turn up too find yet another form, yet another data set had been added all of this takes time to enter and that's time i'm not seeing people.
5/7 vs 7/7- The reality is most of the hospital shuts down at the weekend, you only have to look at the car parks to realise this, it would mean paying people more and properly for the time, but the hospital needs to be fully running 7/7 outpatients should run at weekends, all the services should run. It would cost more but it's 1/3 more work that could be done on the same infrastructure. Trust me MRI scanners do not need to sleep at night and have the weekends off.
Long term planning- There is almost no planning beyond 5 years and nothing beyond 10, this means the actual hospital is never replaced, its rebuilt over and over again, we need to realise that buildings have a finite life and plan for how we are going to replace them, where they will go next and then write the buildings off over the lifespan of them
ok i'll shut up now, but if there is something specific you want to know just ask, sadly most of this boils down to a lack of funds, yes some people need their butts kicking, but most of this can be fixed with money sadly and most of it is caused by trying to run it on the cheap. Healthcare is expensive but like cars, reliable cheap fast, you can only ever have two of the three.
The target has good and bad points, A&E being the only place which is always open and the public have direct access to medical care is hit by any other problem in any other part of the NHS be it GP cover, lack of beds, dumping of the elderly, the complete professional disengagement of psychiatrists, staff shortages in the hospital and that's all before you get to staffing in ED. The bad point with it being a quantum target is it means a patient that leaves at 3:59 good, leaves at 4:01 bad
There has been a lot of talk about using the average (mean although you should really use median) is that on an individual level, as a patient you could be there for 24 hours, but it makes no difference. Its a better measure of the stress in the system but does lead to good care. I work in one of the test sites for the new target and for the last 6 months we've had people spending 12-18 hours in the department waiting for a bed for the last 6 months, I went to work at a friends department to help them out this week, i'd forgotten how much better it was with the target. With the target there is pressure to get the patient out, the hospital actively sucks patients out of the department. Without it it is seen as A&Es problem.
There is no clinical evidence for the 4 hour target, it was dreamt up by the Blair government from a focus group The problem with patients staying in A&E is the department gets smaller with each patient, plus the medical staff have to look after patients the same as on the ward as well as processing their own.
Why is it a mess? well the demand keeps going up, when i started we used to see a member of the public every 5 years, we've passed 4 and approaching 3 and of coarse the population has increased significantly during this time. As well as this the ageing and increasingly medical complexity of the population means each elderly patient is so much more complex so sort out.
Before we even think about solving it, we need to realise ll the problems which are hitting us and really this is just some of them, i've tried to group them together.
Outside the NHS
Social care- This is such a mess and needs to be funded properly, sadly this is knock on from the collapse of the family unit, families are split up, all in smaller houses because housing is so expensive which require two incomes for the mortgage, so families can not look after their relatives so the tax payer pays. The sad thing is the family still want to pass on/inherit the value of the house. Maybe some increased in the inheritance threshold if the recipient looks after their relative may help, but i don't know, something has to give. We are swamped with the elderly failing to cope, or having falls and no one to look after them. In the end it needs to be paid for in tax or in time.
Fear of litigation/ health and safety- We get so many people who have been sent it "just to be checked out" firstly it's not how medicine works, just because we don't find anything wrong with you, doesn't mean there isn't. Secondly it's that private gains vs social losses again, people off loading their responsibility to A&E, my sister was the trained first aider for her college, the thing they stressed over and over again was just call an ambulance they didn't actually teach her any more first aid then that and the lesson being you shouldn't be sending them home, always send them to A&E. Just think of the cost of all these ambulances, all the time in ED to the NHS
The 24/7 culture- we all want to have the ability to go food shopping at 3am even if we don't use it, but have the dichotomy of I want to be able to do everything 24/7 but i only want to work monday to friday 9-5. Most of the time this hits the low paid, so making it attractive to work nights or weekends is relatively easy, medical cover is the first place were this becomes difficult not unsurprisingly people are not keen to be forced to work evenings nights, bank holidays and weekends for time and a third and the viability of doing this until people are 68 is nonsense. The target has further fed the demand for evening and night cover why wait until tomorrow when at 8 you can go and be out before midnight. The problem is the antisocial hours are harder and more expensive to staff. The more other people work 24/7 the more problems happen during this time, people are actually pretty safe tucked up in bed.
Drugs and alcohol- everyones whipping boy when it comes to abuse of A&E, but it's not the ones you think who are the problem, the drunk/intoxciated +/- injury and relatively easy and quick to solve. The killer is the chronic patients, the alcoholics and drug addicts, although small in number they create a huge amount work for their number and are very difficult to solve.
Vulnerable adult and children social services- part of our role is to detect the vulnerable and engage social services, after baby P we have been hugely proactive with this and want to make sure it doesn't happen again, my impression of social services its they have learnt nothing from Saville snd Rotherham, i'm guessing because in the end because they weren't prosecuted but it's still going on, and they're still not picking it up
The NHS
Funding- annoying as it is, the NHS needs to get paid for the work it does, if we are required to do more, we need to be paid more in addition to adding the rate of inflation. Controlling the demand or saying what it is we do is the role of the government.
The private sector- The cherry picking of profitable procedures or patients is akin to what the road haulage industry did to the railways with result that lead to the collapse of rail transport. Taking the quick easy procedures on the easy patients proportionally increases the costs on the NHS. In addition the NHS should not be expected to be the trainer or insurer of the private sector. If the private sector is using NHS training then it needs to contribute towards that training cost or train it's own staff. If a patient has private procedure and it goes wrong, then the patient remains a private patient if it's transferred to the NHS, again private gain socialised losses
The feminisation of the workforce- Don't get me wrong, we do not discriminate but the rate of drop outs, parental leave and part time workers is significantly higher in the female workforce. This has then lead to the men who have started to go part time, so you end up with more and more staff who work less and less. Its not helped with the fact it is easy to replace that time you're not working with work which pays better then working for the NHS and this is without the same stress. It is snow balling, it's going to get worse. In emergency medicine training we actively encourage the trainees to go part time as a way of surviving, rather than fix the problem. Sadly once they go part time people almost never come back to full time.
National pay scales- sadly this hits a common theme, because the pay scales are national you can't use the usual market forces to attract people into the hard to fill roles and locations. We end up stupidly short in roles where there is no private practice and have significant anti social working this then feeds into flexible working.
Student loans- it takes a long time to train a doctor, hence unless you come from a wealthy family the debt is massive. When i qualified I was something like 16k in debt and that was significant enough that if i'd known this going in, i wouldn't have gone to medical school. They are now rolling out 100k in debt and with the higher rate of interest have to payback something like 200k. Personally i think as long as you're working for the NHS the NHS should pay your interest, do the equivalent of 30 years full time work for the NHS, the NHS pays the capital.
Mental health- there is a complete failure of mental health provision which results in the patients ending up back in A&E, this sadly falls at the feet of psychiatry who have no interest in providing the cover needed, as a tax payer you are paying for a consultant psychiatrist to be on call at every NHS site, if you ever need them you can never find and they will never come in, except if someone needs sectioning and the sceptic in me is because they are then paid a significant sum for doing it. All of this has been handed off to non medical staff. Whats even worse is despite being looked after by doctors, these doctors refuse to do anything medical for their inpatients, any problem, ambulance to A&E and use them for the medical cover.
Primary care- yes primary care are not providing the cover they should and this feeds back and send the patients to A&E where they will always been seen and the out of hours cover is a disgrace, but they have the same recruitment and work load problems. Its not helped by the GPs been the big fish in their practices, if they phone us for advice we talk to them immediately, when we call them back its 15-20 minutes to get them to come to the phone, that's 15-20 minutes sat on the phone burning time and money
Hospitals
Beds- we just don't have enough, the problem is that they are only efficient if we are always completely full as they cost money to staff even if empty. Unlike a hotel we can't say those who are leaving must be out of a bed by a certain time and no one can come to A&E until 2 hours later. The number of beds we need is pretty easy to calculate, most number of patients who have ever been kept in overnight - least number of patients sent home in one day + most number of patients admitted in one day. Sadly this gives a bed occupancy rate of 85% or lower, most of us are running in excess of 95% hence there just isn't the room and the patients over flow into A&E
IT- the NHS it is awful, we have multiple different systems all with different passwords which change at different frequencies so i spend maybe 30 minutes a day logging on to system or waiting for the system to respond. Sadly the IT staff are those not good enough to get a better paying job elsewhere. Then there is the desire to collect data, as a result about half my day is spent entering data, i'm not a typist ( a quick read of this should confirm that) you turn up too find yet another form, yet another data set had been added all of this takes time to enter and that's time i'm not seeing people.
5/7 vs 7/7- The reality is most of the hospital shuts down at the weekend, you only have to look at the car parks to realise this, it would mean paying people more and properly for the time, but the hospital needs to be fully running 7/7 outpatients should run at weekends, all the services should run. It would cost more but it's 1/3 more work that could be done on the same infrastructure. Trust me MRI scanners do not need to sleep at night and have the weekends off.
Long term planning- There is almost no planning beyond 5 years and nothing beyond 10, this means the actual hospital is never replaced, its rebuilt over and over again, we need to realise that buildings have a finite life and plan for how we are going to replace them, where they will go next and then write the buildings off over the lifespan of them
ok i'll shut up now, but if there is something specific you want to know just ask, sadly most of this boils down to a lack of funds, yes some people need their butts kicking, but most of this can be fixed with money sadly and most of it is caused by trying to run it on the cheap. Healthcare is expensive but like cars, reliable cheap fast, you can only ever have two of the three.
Edited by piquet on Thursday 16th January 11:45
Piquet - absolutely outstanding post!
Thank you, both for taking the time and giving it such reasoned consideration clearly over some time.
From my perspective, having a career in developing effective and efficient complex operational systems with suitable measurement and performance improvement structures to underpin continual improvement, a vast amount of your post resonated with me - the context is different, but the principles and solutions are exactly the same.
Thank you, both for taking the time and giving it such reasoned consideration clearly over some time.
From my perspective, having a career in developing effective and efficient complex operational systems with suitable measurement and performance improvement structures to underpin continual improvement, a vast amount of your post resonated with me - the context is different, but the principles and solutions are exactly the same.
Nickgnome said:
What is your solution?
I don't have one mate and I wouldn't pretend to! I think I'd be consulting with the govt for a lot of money if I did....One thing's for sure, simply lobbing cash at the issue won't make it go away - I think there's a lot of re-education to be done with people about what you should and shouldn't be visiting a hospital for but that's just one part of it.
It's a hugely complex issue.
Zirconia said:
You can get bumped up the queue cos management?
She is management of the governing body, specifically hospitals, this one is one of hers, yes she could on this occasion have been given preferential service, she chose not, she is that kind of woman.The specialist that saw her towards the end recognised her and gave out to her for waiting, but wait she did.
Yes very good post Piquet. I really hope the government does finally listen to those that know, the people that work there, and take their advice rather than making up vote winning policies that are completely irrelevant.
For me A&E has just become this dumping ground that people just go to for anything, as Piquet said recently we had to go at 3am due to my young son boiling over and we couldnt get his temperature down. When we arrived it was like some caricature of underworld creatures that disappear when the sun comes up. I had to deal with an addict who was abusing my family whilst we sat in the waiting room, it was pretty much at the point I was going to hit him before a doctor rushed out and pulled us through to be seen.
How anyone makes a living dealing with some of the utter trash that clog up the A&E I really don't know. Total respect for the staff.
For me A&E has just become this dumping ground that people just go to for anything, as Piquet said recently we had to go at 3am due to my young son boiling over and we couldnt get his temperature down. When we arrived it was like some caricature of underworld creatures that disappear when the sun comes up. I had to deal with an addict who was abusing my family whilst we sat in the waiting room, it was pretty much at the point I was going to hit him before a doctor rushed out and pulled us through to be seen.
How anyone makes a living dealing with some of the utter trash that clog up the A&E I really don't know. Total respect for the staff.
Great post - very illuminating
Personally spent 6hours plus at A+E on a wednesday evening after breaking my shoulder last year. Frustrating for sure as I knew what was wrong (Did it skiiing and had an x ray with me)
And I have nothing but empathy for the staff involved but its hard to keep patient when you probably need a few minutes of anyone's time just to get into the system.
I knew it would be referred to the fracture clinic in due course but there's just no way to short cut the system
Personally spent 6hours plus at A+E on a wednesday evening after breaking my shoulder last year. Frustrating for sure as I knew what was wrong (Did it skiiing and had an x ray with me)
And I have nothing but empathy for the staff involved but its hard to keep patient when you probably need a few minutes of anyone's time just to get into the system.
I knew it would be referred to the fracture clinic in due course but there's just no way to short cut the system
borcy said:
Piquet, could you expand on the mental health part of your post. What is the back ground to the Drs not being interested in dealing with their in patients or just sending them to a&e? Is it a culture thing?
short version, yespsychiatry is a branch of medicine and you have to be doctor to be a psychiatrist. This makes complete sense as they need to know about drugs and how they interact with other medication and medical and problems the patient has.
There is then a cultural thing were they go, oh we don't look after the medical problems (despite being doctors). It comes from the fact that being medically unwell can potentially cause most psychiatric symptoms so they turn round and go, we can't see the patient until all the medical problems have been fixed and that leads onto, oh we can't look after medical problems, so we get sent patients with a chest infection, patients who have wounds etc. I understand they do have a limitation of what they can do there, but they are still doctors and haven't had a memory wipe. It's nice and convenient to hand it over to someone else and if woken at night much easier to say, oh just send it to a&e.
I would be ok with it if they decided they were't doctors just therapists and were trained and paid accordingly
Sambucket said:
If part time agency work is so much less stress for equiv money, what is the solution to that? My gut reaction is that unless NHS can somehow ban staff from working privately, then slide into privatised healthcare is inevitable.
sorry just for clarification, i was referring to non clinical work or clinical work outside the NHS, there are a myriad of roles in things that need a medical input or knowledge or just use the experience base. These tend to be monday to friday 9-5 and can be often done at homeyet another great idea of the NHS is the clamp down on locum fees, they have remained static for the last 10 years, the result is it is almost impossible to get a good senior locum any more. It used to be people doing it in their spare time, now it's just not worth it and the everywhere ends up understaffed. Its the result when you try and control a market with supply and demand you never hit the equilibrium.
As i mention above i helped a friend out this week, driving home realised i earns only 25% more then doing my normal job and the same when you took into account the travelling time and costs, i can't seem me locuming ever again, i', one of the hand full of people who used to do it, i just don't have the time and the reward doesn't justify doing it
The pay in the private sector can easily be 5-10x an NHS salary for medics, yes there are some costs to cover but it is massively worth their time, the killer for therm is it's very hard to have a successful private practice without an NHS job to hang it from so they can only do it in their spare time. Hence we're not as short in specialties with a big private practice .
Esceptico said:
Typical PH. Should have realised it would be the fault of people for getting injured and being sick rather than the government for underfunding the NHS.
I’m sure that the 30% of people waiting more than 4 hours will be relieved by the anecdotal tales of quick visits above. They are obviously injured/sick at the wrong time or wrong place.
It's still only January but I doubt we will see a more ill informed post in PH for the rest of 2020.. I’m sure that the 30% of people waiting more than 4 hours will be relieved by the anecdotal tales of quick visits above. They are obviously injured/sick at the wrong time or wrong place.
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