Since starting this blog, those involved with healthcare regularly contact me with tales from the front line – good and bad. One thing I always guarantee is anonymity and the other rule I have is, of course, to check authenticity as much as possible.
A young booking clerk, currently working for a Trust which aspires to Foundation status has told, with some distress, that she is about to hand in her notice. The reason for this is ‘I didn’t join the NHS to do this sort of thing – it’s wrong – I feel so sorry for the poor patients’
And what is ‘this sort of thing’?
And what is ‘this sort of thing’?
The girl was told by her manager to phone up many of the people due for surgery this week and postpone their booking. These patients will all have had their pre-op checks, will have made personal arrangements for their hospital stay and will have been psychologically preparing themselves for the event. What is so unusual about cancelling operations you may ask? In this case – it’s the reason for the shuffle in operating list that caused this clerk some concern.
The patients who were being cancelled have all been on the waiting list for more than 18 weeks (exceeding the current target). The clerk was advised to call up a new group of people offering surgery to be undertaken in the newly vacated slots.
The new group of patients given the advantage of using these new slots have all been on the waiting list just less than the 18 week target. The motive quickly becomes clear. Those who have already exceeded the target will have been noted in the stats – those just about to reach the 18 week cut off will narrowly miss the deadline and avoid worsening the Trust’s waiting list figures.
I’m not sure if this tale is shocking or not, probably even old news, but it is certainly very sad. Presumably the motivation behind this action was to avoid further financial penalty and possibly aid the Foundation Trust application. Anyone involved with targets in any industry will do their best to present the figures in a favourable light but this must not be to the detriment of individual patients. I wonder what sort of pressure whoever made the decision to fudge the figures must have been under, especially as this will have caused considerable distress to some patients and maybe put them at risk.
The actions of this hospital trust in disadvantaging some patients to expediate targets shows that in the red mist of pressure, cuts and politics, hospital and healthcare providers may be losing sight of the core values of the NHS. Outcomes, targets, performance measures – call them what you will – these benchmarks will always be associated with healthcare. But we must not let the desire or need to hit targets distort the very heart of what we are here to do - help people to get better and keep them well.
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7 comments:
It is these sorts of situations that might prompt people to consider cross-border healthcare (the EU Directive I'm working on).
The origins of the Directive lie in numerous rulings delivered by the European Court of Justice (ECJ) over the last decade or so on different aspects of patient mobility, freedom of movement principles and the availability of services within the European Community. These rulings have established that EU citizens enjoy the fundamental right to access healthcare in another Member State. This right derives from the Treaty itself.
At its most basic level the Directive allows patients to access and pay for treatment in another EU state and then claim a reimbursement of eligible costs from their home health system. The very act of reimbursing individual patients and/or paying a foreign provider direct (if that is in the patient’s best interests) means that this money moves out of the system and is effectively lost to the NHS.
One of the main drivers for patients seeking cross-border healthcare is the opportunity to receive treatment more quickly – in effect, bypassing NHS waiting lists. Therefore, in the event that waiting times were to increase for certain treatments under the NHS, we might expect a larger number of patients seeking cross-border healthcare going forward - especially so if the concept of “undue delay” applies in an individual’s case.
The European Court of Justice has defined undue delay as a waiting time that "exceeds the period which is acceptable in the light of an objective medical assessment". This means that such judgments should be based on individual medical assessments, not merely on arbitrary time-based targets. Evidence of undue delay may be provided by a home clinician, or, under the rules on mutual recognition of professional qualifications, by a clinician registered in another EU Member State.
The NHS hasn't really woken up to the implications of this Directive....yet....
Thanks Rob - It's interesting to note that the NHS hasn't woken upi to this yet - I wonder how long it will be before patients wake up to it? And how easy would it be to get reimbursment? Maybe that would be the birth of a new patient waiting list - waiting for reimbursement for overseas treatment...
That's easy - we introduced interim regulations last year (in lieu of an agreed Directive) which require PCTs to determine reimbursement applications within 20 working days, unless further information is required (and they must determine whether they need more information within 10 working days).
The European Commission is very clear that national authorities must be responsive to their citizens and put in place efficient procedures to enable them to exercise their fundamental rights....
Wow - that's impressive! If oinly other PCT services operated to such tight deadlines...
It doesn't mean they hit them....!
One has to wonder if the surgeons involved have complained to the CQC?
And if not, would the GMC think their behaviour complies with the GMC Good Practice standards???
It's highly likely that the surgeons don't know about this. The lists for cold surgery tend to be controlled by the trusts as far as I understand
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