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.

[BeauGlacons]

Phone every day southdowns. Ask, when you get your appointment if they would expect better for their wife, mother, child, sister, etc.

I had a lively apt last week "rheumatology". Referred mid Feb, the lo ely Dr said the Wai for the apt for the lV infusion was 12 weeks. I said awfully nicely "your website says 17 weeks, does that mean from first referral or from today. She said there wasn't much she could do. Apt cam through for 24 May. Funny that!

Go with info and stats and quote it nicely and non confrontationally. It is so very, very wrong. I need my treatment to keep funding the NHS until I'm 67. It needs a reality rocket up its backside. Contemplates in ite to become a non exec - shame I've got a full time job and family.

[BeauGlacons]

Apols for typos. Cooking dinner with wine in hand.

[summerdreams]

I have no experience with your condition it sounds dreadfull though, I do have experience with ds hospital admin he's under 3 diffrent consultants so 3 diffrent departments due to complex medical problems, at one point it was 6! Every week without fail I have to at the least be chasing one thing up and he's 20 months old with a dangerous blood condition and immuno defiecsey.

We have important preventative antibiotics that the consultant will change give us a months supply and then doesn't send the letter to the gp so they can't continue perscribing them and it also took till december for them to send the letter requesting my son has an adult flue jab after about 15 phone calls from me its a nightmare and sometimes I feel like it's a full time job keeping track of diffrent referrals.

[JCDenton]

I worked in a medical records department for three years. Notes usually went missing for a few reasons. Big one is that it goes to a ward, secretary, doctor or what ever, it's booked in, not booked out and they swear they don't have it. Not a lot you can do if you're the records clark in that situation except hope it turns up on file in time.

There wasn't enough proper storage so files could be improperly stored and go missing that way. Of course we got the blame even though you physically could not fit all the files on the proper storage shelves.

Misfiles. Someone in the filing room might file 300+ files in a day, sometimes they'll read 3943 as 3493 or something. Usually they'll be caught fairly quickly but if your notes are coming through the department frequently, they could be missing because of that.

[BeauGlacons]

There's a great deal to be said for the French system where patients keep and are responsible for their file.

[Scholes34]

I work in admin (not NHS), but still with large database systems and seem to spend too much time forensically checking why the system has thrown out the information it has - just because I can be bothered to.

Have also had bad experiences with the NHS. I once sat in ENT over one hour after my appointment time, listening to the receptionists arguing over my lost notes. I did point out to them eventually that it was me there were talking about and that it would be nice to know when I'd get to see the cosultant. ENT and Audiology have reception desks next to each other, but can only co-ordinate appointments if the consultant walks out with my notes and asks them to do so. My mum had to wait two weeks for one department to get her notes from another department in the same hospital.

The maternity services seem to work well with mothers to be holding on to their own notes.

[Turbinaria]

NHS trusts are starting to do away with paper records but the problem with this is the no one can agree on using one IT system and so the acute hospital setting could be on a different system to the community health setting and the GPs are using something else which is a PITA. Some departments within the same hospital Only use electronic records whereas others hold to paper records for dear life.

[CigarsofthePharoahs]

I used to know someone who worked in admin at my local hospital.
The problem was essentially that there weren't enough of them to do the job. She also told me many a tale about having to type out badly dictated notes.

[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.

[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]

treacle. FFS says it all.

[BeauGlacons]

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

[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

[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.

[HospitalHassler]

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

[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.

[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.

[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.

[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.

[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]

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]

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]

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]

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.