NHS waiting times - the flip side

[PashaandMe]

Just reading how massive the NHS backlog is, how long people are waiting etc etc

I manage a waiting list of over 2000 patients for my service. I have 2 booking clerks under me and a team of admin staff. Any one of them will tell you the hardest part of treating a patient is getting them in in the first place.

We call patients and offer surgery dates and around 50% of the time they are turned down. The best one I’ve heard so far is that someone was “going out to lunch” that day. We have people phone up the day before surgery to say they’re going on holiday or to ask if they can come in the next week instead. We have at least 3 people just not turn up for surgery every week.

We can’t just call the next patient because they have to be swabbed and isolate for 3 days before surgery.

We can’t discharge because they DNA - once a consultant has said they need treatment it is very difficult to discharge without it.

We can discharge if they turn down 2 consecutive dates. But they will accept them and then just cancel the day before which doesn’t count as turning a date down.

It’s an absolute shit show

This is so frustrating, I’m waiting to see a surgeon, after fighting to be referred I now have been and they can’t offer me an appointment in the next 6 months (already 6 months since referral) I’d quite cheerfully cut out my gallbladder with a kitchen knife myself if I knew whereabouts it was it really should be put to the bottom of the list for no shows with no good reason.

When we phone and offer surgery dates they are all 6 weeks in advance. Urgent patients are 2 weeks or already inpatients.

If they turn down the first we offer another. If they turn down that one we can discharge. At which point they say no I’ll take that date and then they just cancel the week beforehand

I recently had an operation. Quite major but not life threatening at all. I only waited less than 2 months. I asked my consultant why I got the operation so quickly when there is so much in the news about very long waiting lists etc. He said the reason I got it done this quickly was because I said yes to the date offered whereas so many people say no. I couldn't believe it, but from your post OP, this really is true!

This is my alt account, my main has details of where I live and wouldn’t be too hard to work out my hospital. As frustrating as my job is I don’t fancy being unemployed

Is it relatively minor surgery? I work in a surgical specialty where the operations are literally life-saving and hugely improve quality of life. I can only remember a patient cancelling at short notice on one occasion in the last 9 years. It is essentially unheard of.

Specialty runs the gauntlet from very serious to minor. It is usually the minor patients who DNA or cancel.

Urgent will die without out or have very life limiting conditions and they do turn up. Unfortunately even our minors is 2-3 hrs theatre time not utilised

@PashaandMe

When we phone and offer surgery dates they are all 6 weeks in advance. Urgent patients are 2 weeks or already inpatients.

If they turn down the first we offer another. If they turn down that one we can discharge. At which point they say no I’ll take that date and then they just cancel the week beforehand

Well there's the reason then. Not enough flexibility.

I don't know what The answer is, but it sounds hugely frustrating.

Different hospitals operate differently, though, so it's not an NHS problem so much as a trust/hospital problem.

I get seen at two different hospitals. Hospital A is very punctual, appointments run approximately on time (+/-15 minutes). Treatments never been cancelled, in and out as per schedule. Hospital B is appalling. Appointments regularly hours late, even telephone/video appointments. I won't organized any treatment or test there any more because of persistent cancelled appointments and lost results.

Both run by the NHS, both in the same city but under different NHS trusts and they are a world apart.

I was told I would wait at least 18 months for cataract surgery. They called me after 4 months. I was really surprised as the chief consultant had told me they were struggling with the waiting list before COVID, never mind about after.

I heard yesterday I’m having surgery in 2 weeks - I had to postpone it for a week as my son is graduating this weekend and I needed to isolate. I’m afraid I’m not missing it, I know it’s only gown photos but we’re having a lunch afterwards to celebrate, it’s been booked for ages.

To get this surgery I had to get through to gynae. This took hours - literally - after phones kept ringing out. Finally got a secretary who wasn’t my consultant’s but said she would pass the message on.

Got a phone call back - my consultant’s secretary knew nothing about me. Explained I’d seen the consultant over a week ago and had agreed that I’d have surgery under GA. My notes hadn’t been updated to show this and she’d have to email the consultant - she’d phone me back. That was the Thursday, I phoned her again on the Tuesday. Oh yes, she remembered speaking to me, I’d be getting a letter about my surgery soon. Got a phone call instead.

This is for unexplained bleeding. Imagine if I was not confident enough to keep following this up. Everyone is very lovely but it seems quite chaotic.

I had an appt for a scan but I had to change the date as was in hosp having major surgery. I asked them to give me a date that was more than 4 weeks later due to recovery/ability to get there and certainly didn't want any further prodding until fully healed. They sent me a date for 3 weeks instead so had to turn it down. Because that was the second appt, I was discharged and told to get re-referred from my consultant. Thankfully my consultant agreed I did the right thing. To be fair, the lady who said I would have to be re-referred was extremely apologetic but had to follow the rules.

We have a cancellation in 2 days and admin have spent a lot of time today phoning to try and fill it. No one can make it which is frustrating. Such a lot of wasted admin time. I can understand people having plans but it does make you wonder what their priorities are.

We have 5 available clinic days (am and pm) but cannot book at any other time/day due to numbers of staff needed. One patient today can’t make it until September due to childcare, then can only do a certain day at a certain time because of lack of transport. We offered the next available appointment at the time they asked for but that was not suitable as it clashed with another appointment in a different place! Not a lot we can do about that but then she was complaining we were not flexible. This is a frequent occurrence.

The clinic was cancelled last week due to lack of adequate staffing available (beyond anyone’s control) due to sickness and staff already being on holiday, which was frustrating. Everything is frustrating!

Staff are leaving in large numbers due to the relentless workload and paperwork. We have a few on long term sick leave and many on multiple periods of isolation. It’s seems unlikely these staff will be replaced in the short term, so everything is stretched more thinly. Ward work takes priority, so outpatient clinics suffer. Patients are generally understanding but frustrated and believe me staff feel exactly the same but there is nothing we can do!

@Fleurty

Well it is very difficult managing to get to appointments too. The NHS give no options on appointment times, 2 days a week I have to be at my office 1.5 hours away from the hospital and almost always get sent appointments in the middle of the day for those days.

How do you know the lunch wasn't with a friend who was visiting from Australia and they had a 1 day window to see them?

Totally agree people not turning up is unacceptable but people turning down appointment times because they can't make it is surely just a product of randomly assigning them a date/time without giving them any options? In this day and age people should be able to book appointments online from a selection so they can pick a date/time.

That’s just not possible with a service like the nhs. With the greatest respect if you need an op and are waiting for it your friend from Australia just needs to suck it up!

I had a new patient clinic today. 5 out of the 20 patients didn’t turn up. Yet we are constantly bombarded by expedite requests because people are waiting too long. It’s so frustrating.

I had a consultant appointment a few weeks ago and the consultant didn’t turn up. Which I was only told after two hours of waiting. It does make you wonder what their priorities are.

DS2 has 2 appointments, one for October and one for January. That's plenty of notice.

@ Fleurty in an ideal world a perfect appointment time would be amazing, but how on earth do you think the NHS would be able to do this with the sheer volume of patients they look after?? There are reasons lots of people would prefer specific appointment times. Do we therefore expect them to only allow school-age children school holiday appointments? Or only allow people who would an evening appointment? Or except those with children do get an op scheduled around their childcare? I've come to realisation that the public simply do not understand the realities. No sits there saying be grateful because its free. They are thinking Christ....how do we meet thousands of peoples expectations as quickly as possible? Honestly if I have needed an appointment or op to improve my quality of life I've been relieved that I won't need.more sick leave or need someone to grab my kids from school at last. Instead what people.do is complain that it doesn't fit around them enough with no thought to the fact that thousands are waiting. It's not as simple as we think.

The benefit of telephone appointments are that if someone doesn’t answer you can move onto your next patient immediately with no wasted time. You can then try the patient that didn’t answer again later.

If they are coming into the hospital, the whole appointment slot is wasted and the next patient will not be there.

We can also contact patients from an “ad hoc” list by telephone if we have a few non answerers, so it can be more time efficient.

@welshweasel

I had a new patient clinic today. 5 out of the 20 patients didn’t turn up. Yet we are constantly bombarded by expedite requests because people are waiting too long. It’s so frustrating.

Yet when you overbook to try to mitigate for this scenario, they all bloody turn up. Thank goodness I’m not in the game any more!

I actually think NHS should be tougher, as many say your given your appointment weeks to months in advance. Noone has a diary booked up that far in advance unless its a family do or event.

You miss your surgery then back to the end of the queue. If you need surgery it must be fairly important so prioritise your health.

Then the NHS should have a better standby system if the queues are ao long no harm in canvassing those people at the time they are seen to see if they can be on standby within reasonable notice like a few hours or a few days. Not everyone on that list will be in a full time job or working.

End of the day its your health if you can't put that first for something as serious as surgery than well continue to suffer and do it in silence please since its self inflicted

“I actually think NHS should be tougher”

Most of the staff agree with this and want managers to take a tougher stance for those serial time wasters who have no good reason to not turn up.

The problem is that if you are strict and discharge them they will give their gp or
Consultant or pals a sob story or make a complaint and they end up reinstated as it’s always the path of least resistance….

Standby lists are fine for timely cancellations but no good for those who don’t turn up or cancel on the day or 10 mins before the appointment.

@PashaandMe

Ah I love the “I didn’t get my appt letter” patients. They ALWAYS get the “we’re discharging you because you didn’t turn up” letter though

Do you check that they definitely didn't receive the letter?

Because I genuinely didn't get a letter. My Gp who normally gets copies of the letters also didn't. Luckily I listened to a voicemail left on the house number (which I'd already told them not to use and given them both mine and DH's mobile numbers) 2 days before one hospital appointment - fortunately I heard it. I had to make quick arrangements re work etc and luckily don't have much prep needed beforehand. I'd have been mightily annoyed if I'd been been discharged due to a letter not being received.

I've only ever had 3 ops as an adult - everyone has been cancelled and postponed. First one was delayed by almost a year in the end after 3 postponed dates. Second one was luckily only postponed once for a week. Last one was postponed a week before, after the pre op, and moved to a month later. On the morning after I'd fasted overnight, etc they called to warn me it might be cancelled again that day. Luckily they were able to see me - I did tell them I'd already been in A&E twice in the previous fortnight with the issue.

@Dreamstate

I actually think NHS should be tougher, as many say your given your appointment weeks to months in advance. Noone has a diary booked up that far in advance unless its a family do or event.

You miss your surgery then back to the end of the queue. If you need surgery it must be fairly important so prioritise your health.

Then the NHS should have a better standby system if the queues are ao long no harm in canvassing those people at the time they are seen to see if they can be on standby within reasonable notice like a few hours or a few days. Not everyone on that list will be in a full time job or working.

End of the day its your health if you can't put that first for something as serious as surgery than well continue to suffer and do it in silence please since its self inflicted

Many people have diaries with things beyond 6 weeks. Holidays are often booked and paid for weeks in advance. Training courses for work are often booked and paid for weeks in advance. Lots of fairly immovable (at least without loss of money) things are booked well beyond 6 weeks!

Luckily our hospital when adding you to their waiting list for something will let you block out some dates if you know you can't make them.

Yup there is no slack in the system. I don't have time to deal politely with patients who can only come on a Thursday afternoon. I don't care if you have to cancel your holiday. Come or don't come. I can fill my slots 20x over. I'm a clinician who scrapes 20 mins every other week to book in patients for the next fortnight. I have no admin staff at all. If you answer the phone you'll get an appointment. If I go to voicemail I won't leave a message as I won't ever be available to deal with you if you phone back. Yes the system is shot. It's a numbers game and I make it work for as many as I can