How can hospital administration be so bad? Someone please explain it to me.

[HospitalHassler]

I'm waiting for surgery as I have severe endometriosis, a large ovarian cyst and complications due to adhesions. As is common with many endo sufferers, it took me years to get a diagnosis (thanks to my GP and that good old IBS diagnosis), before a trip to A&E finally got me seen by the right people. I had surgery last year, but the cyst has returned and I've been referred to an endo specialist for extensive surgery.

I'm in constant pain, it impacts my life daily, and I'm nearly 40 and have been trying to conceive for years. So it's a shit situation which I'm desperate to sort out.

But I'm being held up and tripped over at every hurdle, seemingly by a combination of incompetent staff and a clunky administration system which has allowed me to fall through the cracks. My experience so far:

Cockup #1 - Secretary panics, delays my referral, and then forgets to send it

I saw the consultant in August, and was told I was being immediately referred. After several months of patiently waiting, I called and asked a couple of questions about my referral. The secretary panicked, and decided that my questions warranted a further appointment with the consultant (they didn't), told me that I had to see the consultant because he needed to talk to me about something (he didn't, she totally lied) and that he wouldn't send my referral until he had seen me (another lie).

I complained to the hospital and spoke to the consultant, who agreed with me and apologised that the secretary was a 'low grade staff member who didn't understand the questions I was asking'. Which begs the question how the fuck was she able to make decisions which directly resulted in further delays to my treatment.

I was then told that the hospital 'forgot' to send my referral to the specialist. The consultant had in fact dictated my letter within days of seeing me, but that secretarial staff never typed it up and it didn't get written or sent until I reminded them to do so.

I finally saw the surgeon in December, and was referred to a second surgeon for investigations (I need multi-disciplinary surgery so both surgeons have to see me). I saw surgeon #2 in February. I was told that all that remained was for surgeon #1 and surgeon #2 to liaise and come up with a date.

Cockup #2 - Fallen to the bottom of the in-tray?

I have been calling regularly to ask for progress, and there has been none. Until a couple of weeks ago. I spoke to yet another secretary who reviewed my notes, put me on hold for a few minutes, then came back with "All I can say is I'm so sorry, we'll be writing to you asap". I took this to mean that there had been a cock up, they had forgotten me and were about to rectify that immediately.

Cockup #3 - You've done WHAT with my file?

I waited for that imminent letter, it didn't arrive. So I called again... spoke to a different secretary who told me that they were trying to get my case reviewed but were having trouble locating my case notes. Yes, my case file was currently missing. They. Had. Lost. My. File.

I immediately contacted the customer complaints department, spoke to a wonderful man who made it his mission to find my file. He found it within a few hours. It was the day of the Jr Doctors strike, and I apologized to him for hassling him on what was surely a busy day. He said that it was a bit bonkers that day, but he couldn't do much about it, so he was happy to be able to focus on the things he could help with and felt that helping me was a job well done. I could have cried.

Cockup #4 - it takes how long to sign a form?

So my file has been located and I spoke to the secretary again this week. She said all that was needed for the consultant to sign my form and then it could go to the team to schedule a date for me. Yes that's right, it has taken 2 months (and counting) for a consultant to sign a form.

Then she launches into this spiel about how there are thousands of other women in the same position as me, and some of them have waited years for diagnosis (you don't say!) so I just need to be patient!

Please could someone come and explain to me how hospital administration works, how files can go missing, how a secretary can make decisions on whether you ought to be referred or not, and how it can possibly take so long to get a man to sign a form? And can someone please explain how the listing system works - is there a queue, and will I go to the bottom of it as of next week when they hopefully, finally, receive the instruction to put me on the list?

I'm exasperated. I am extremely grateful for the NHS and I have no doubt that many of the issues are caused by under-resourcing and clunky systems (I work in civil service, I get it). I think if I could just understand how the system works, it might help me calm down a little.

[GooseberryJam]

That is beyond poor. Ring PALS again and say that if they can't get back to you with some practical help within 24 hours now, your official letter of complaint will be emailed to the chief exec of the trust that same day. They never want you to officially complain and that is often the point to press home. When my elderly mother was being poorly dealt with in hospital, I emailed the chief exec after repeated attempts to address the problem on the ward. The next morning I had a phone call from the head of complaints, desperate to be helpful. Summon up your anger and get tough now. Sadly it tends to be what works.

[TreaterAnita]

That's utterly ridiculous OP. I would complain again and tell them you're going to take legal advice. In reality there's not a lot that a lawyer could do in your situation (though you have certainly experienced additional pain as a result of the cock up, and probably loss of some chance of a successful pregnancy) but generally those are rocket up the arse words, so it might help you. I'm really sorry they've made such a mess of it.

[Turbinaria]

I would contact the trust's chief executive and the CQC with details of your patient experience cc in both Consultants and the PAL manager. It's time to go to the people who have the power to get things moving

[HospitalHassler]

I rang the appointments clerk today. No sign of my file.

She told me that it does take longer to arrange the multi-disciplinary surgery that I need, which I fully understand. But I'm not even on the waiting list for it yet.

My file has been sitting on a desk, waiting to be signed off for over 2 months.

So I rang the patient liaison service again to ask for help, but they said they're dealing with my case and haven't got anything to report yet.

Can someone please tell me whether the secretaries will hate me for ringing them on a weekly basis? Will I be penalised for it, like subtly shoved to the bottom of the pile? Is there anything else I can do?

I'm considering contacting my old consultant to originally referred me, to see if he can follow it up - is there any point in doing that?

I cried all the way to work. I'm at the end of my tether.

[HospitalHassler]

Update - I rang the secretary at the beginning of the week. She said "Didn't I tell you to give it a week?" I said yes, I was just checking whether the Dr had signed off the necessary paperwork yet. He hadn't.

She said "Well it will take at least a week for them to list you once they receive the paperwork". Yup, I know, I was just ringing to put the necessary rocket up your arse to get the dam thing signed love, given that it's only been sitting on your desk for two fucking months.

She told me to ring back in a week. I said I would. And then I lodged a complaint with the complaints dept. I detailed the date of my referral (October!) and all the dates that I have rung since.

And I'm going to ring the appointments clerk tomorrow, because they've now had 2 months and one week to receive the paperwork, so i don't think it's unreasonable to expect it to have been signed by now!!!!

I have been patient, I have been polite. I have apologized for 'hassling' with phonecalls. And I have reached the end of my tether.

Weekly phonecalls from now on until I get my date.

[stopfuckingshoutingatme]

Kudos for mamadoc for their Honesty
Op just keep at it - keep chasing and keep a diary -I do hope you get your treatment soon X

[HospitalHassler]

I think you've hit the nail on the head there, I'm being gas lighted by the secretary into believing that I'm being unreasonable for having to ask where my appointment is 2 months on. The fact that I got the exact same script from her on 2 occasions "well there are 100s of other women in the same boat you know" suggests it's her standard approach.

Thanks to this thread I realise it's not unreasonable for me to expect to have been listed by now, in fact they are in clear breach if the 18 week pathway rule, and I'll be saying exactly that when I call them again tomorrow.

[PerspicaciaTick]

The NHS is very good at gaslighting patients into thinking it is their own fault that their treatment isn't happening as they expected. The implication is always that the patient is too dim, too confused, wasn't listening properly, is panicking, is too demanding etc. etc. and this is why treatments are postponed and referrals delayed. It is never the institution's fault, always the patient's.

[BeauGlacons]

That's exactly the issue it is for me. I'm not a chum, there's therefore no need to use my first name. But when a doctor does I expect to be invited to use theirs - that's what irks me. It's an equality issue.

I think we are on the same page Mamadoc. If I can be vulgar, if someone is going to examine me in intimate places, actually I want to retain maximum dignity and fir me that's being called Mrs last name.

I do appreciate I have a very difficult last name but people only have to ask and write it phonetically. In my case my first name isn't that much better but NHS staff are happy enough to trip over it and comment about its unusualness.

[mamadoc]

Because she's cross with me! It's like my mum she only uses my full name when she's cross.

I dislike patients using my first name and I will dissuade them from doing so but I do accord them the same privilege. It's a boundary issue for me to demarcate a professional not a friendship type scenario.

[BeauGlacons]

I don't think NHS staff are elitist or stuck up. They aren't. I do think there is an embedded culture of disrespect in the NHS though. Why does your secretary address a note to you as "dear Dr" when you are on first name terms.

I have recently been unwell. I have not met one single Dr or health professional who has asked me what I wish to be called or if they may use my first name. Doctors, however, have always introduced themselves ad Dr, Mr or Miss and their staff address them by title whilst always using my first name. I genuinely don't understand why patients are regarded as less than equal. I will happily address a doctor by title but if that is what they prefer I simply don't expect them to use my first name. I don't think it's about elitism or being stuck up. I think it's,about arrogance actually and I don't understand why members of a caring profession don't address or regard other humans as their equals. I am glad you do but in my experience you are the exception. I used my GPs first name recently and was told he preferred Dr Maxwell (not his real name) so why then would he call me Cressida (not mine either but similar genre) without asking. Why then would he get arsy when I say "well I think it's Mrs Prideaux then". Again not real name. Why, just why?

[mamadoc]

In fact we call one another by our first names. I buy her a birthday present and Christmas present and I don't expect one in return as I am very aware of our income disparity. I value my secretary very much and I think she knows that.

I recognise you from previous NHS debates and you always have an agenda that NHS staff are rude, elitist and stick up. Maybe some are but I can assure you that I am not and I don't know anyone who is. When I make a mistake I certainly do apologise and as I've said before I call my patients by their title unless/ until they indicate that they prefer otherwise.

[BeauGlacons]

Human error is normal. It's also normal to apologise when it happens. It's the apology so often missing. The lack of undersTanding that sick people are stressed and can do without it.

I take all the letters I have with me and take a note of what I'm being told and agree it back to the doctor. I also chase appointments and make sure test results have been sent on before appointments. I don't really have time to do the job of NHS admin but neither do I have time to be messed about. It really helps to be able to say Dr x advised y on z date, my appointment was at. Seems to oil the cogs. Doesn't make the system better.

Mamadoc, when your sec writes that note to Dr Mamadoc I hope you ask her to use your first name, or at least call her Miss/Mrs/Mr ir Ms Secretary having found out what he ir she prefers to be called. I think admin staff would be more polite if the people they work for afforded them the level of respect they take for granted. I do suspect Drs treat admin as underlings so admin kick the disrespect down to the patient.

[mamadoc]

I was going to post to be honest as a consultant and say that sometimes it is out fault and admin cover for us but I see Bill Sykes has already got there.

Not all the cock ups all of the time but some are mine. I have, for instance, forgotten to dictate a letter or make a referral or order a test. Not regularly but just occasionally and unfortunately especially where it is out of the ordinary as this sounds because it's out of my regular routine.

On these occasions my secretary always covers for me. I have never asked her to and don't expect her to but she feels it's more important that the patients trust in me is maintained! She will leave a tactful note on my desk eg 'dr x, do you know what's happened here?' For which read 'you cocked it up didn't you?'

Human error isn't going to disappear so in an ideal world systems would save me and eventually they do but usually the patient notices first.

[OllyBJolly]

I'm appalled at the lack of professionalism, organisation and manners within the admin of the NHS. I'm equally impressed with the care and commitment of the clinical staff.

My DSis has long running health issues. She needs quarterly brain scans. It is very rare that the organisation of this goes smoothly. In the early days she would often get an appointment for the PREVIOUS week, or she would turn up not being told she needed blood tests before a contrast MRI. Her notes would rarely be there which would mean sitting in radiology waiting room -once for 2 two hours- while they located notes. Now we know the system, we know what to ask but it was so distressing at the time.

We go to regular epilepsy clinics. The admin staff member is usually eating at her desk (no matter what time of day our appointment, we while away the journey guessing what it will be today) and she does get relief for breaks so it's not that, complaining loudly about consultants taking too long (for one, I'm grateful our consultant takes time to describe reasons for prescribing and potential side effects) . If the consultant has a message for the GP, he scribbles onto scrap paper and DSis takes it to the GP - apparently if he "went through the proper channels" it would take up to 4 weeks.

She had a brain tumour debulked recently. All went superbly well and 7 days later she was well enough for discharge. The doctor told her at 8.45 am she could leave the hospital - as soon as the paperwork was complete. 7.45pm we finally got to leave because the discharge letter had "gone astray". It was eventually found in pharmacy.

There is a lack of real leadership, no ownership, and no team spirit. It was once described to me that the bureaucracy exists to keep the bureaucracy going - it's not an admin support operation. That might be true.

[sashh]

Ex HCP here.

Cockups do happen. And unfortunately sometimes it is the same patient the cockups happen to.

I had a similar time, was booked for an op to remove ovary, registrar opened me, decided I needed to be seen by a specific surgeon, let's call him Mr X. He referred me but the hospital admin changed it to another consultant, I went to the outpatients to be told I need to be seen by Dr X and no one else.

I got a letter a few days later saying I'd been moved from Mr X's list and sent back to the other Dr - that's when I got mad, made a few phone calls, put in a complaint and asked them to reimburse me a day's pay. They did.

[zoobaby]

CQC = Care Quality Commission. You could search it online. Maybe write them a letter. They love to hear about health trusts cocking up.

In fact, Google the name of the primary care trust running the hospital. Write a letter to the CEO of the PCT as well as the boss of the hospital. Let them know you're send a carbon copy to the CQC. The PCT I have [work related] dealings with is always running scared of the CQC, so it might instigate a change somewhere along the line to make them a little more accountable.

[HospitalHassler]

I'm in the North west. What's a CQC rating?

[NoMudNoLotus]

HCP here .... Where in the country are you?

Your hospital sounds particularly bad - what is its CQC rating ?

This isn't something that happens routinely ..... Yes we are under pressure and Iv been a registered HCP 17 yrs now and Iv never heard of such a cock up.

Complain for sure.

[stopfuckingshoutingatme]

Complain and log with PAL and don't patiently wait ever ever again

So sorry OP - my late father learnt how to work the NHS - takes grit

[BeauGlacons]

I hope you are OK now. This is precisely why I always introduce myself as Mrs Glacons !

[BeauGlacons]

treacle. FFS says it all.

[treaclesoda]

Have just remembered something else. A few years back I was ill and had been an inpatient in my local hospital four times inside a year. Was rushed to A&E in agony one night with a flare up of the same condition. I told them what was wrong and the doctor very sarcastically asked if I had diagnosed myself. I was like this and pointed out that I had been diagnosed in the very same hospital and surely it was on my records. He quickly announced there was no record of me having been a patient previously. When I was able to tell him the actual dates, or thereabouts, he disappeared then came back and said that of course I may well have been a patient in the past but I had to understand that my medical notes were confidential and that subsequent doctors weren't allowed to look at them. Which was truly baffling because if that's the case, why keep records at all?

[BeauGlacons]

So, nice file, hole punch, patient holds notes. Yep, some patients might be slapdash but so is the NHS. Job done. The patients who car will have their notes, the patients who don't will be no worse off. I keep a file anyway and put a written note on it after every telecon, consultation, trip to exray, etc.