To think sometimes we need to question NHS efficiency more?

[DayCareCase]

I support the NHS, I’m up for funding it properly even if this affects taxation. I get lots of contracts etc create issues and the NHS has a tough job.

But...

Sometimes it seems there’s a culture of ‘it’s not us, it’s the cut’ that behaviour can be inefficient, service is no just wrong, but simple things could be easily done to make things better. Either at no cost, or even reducing waste. For example our local hospital only sees children for blood tests in the busiest day when all the clinics run. They could change the time, sometimes you wait 2.5 hours with a 3 yr old, when at 3:30 you can be seen in ten min. Or they could run a kids queue, most no cost options.

Today I’m having surgery. The same. Everyone turns up at 7. Even if you’re due in at 4pm. The first load are allocated a cubicle but about half the people sit in the discharge lounge all morning. I cannot see how this is efficient or benefits anyone. Why not give appt times? (Knowing people may still have to wait) or even just the lot you’ve already got marked down as those without a bed until the first case are seen to come in later. No water 6am-4pm is hard!! Surely it makes later finding vines hard, more anxious patients to deal with and a generally more stressful environment?

I’m also sitting next to where the consultant sees male patients. I’m 6 foot from a guy having to discuss his testicles. Makes the whole male/ female division pointless. Moving the desk a bit, closing the door would be cost free.

Small examples, but every time I go there seems to be no real effort to improve. Some individuals work hard. The lower levels of staff are obviously working hard in a crap environment and ready for abuse. So I guess management? Consultants? There needs to be some focus.

Sometimes I think the culture of don’t question the NHS goes too far...

I think we get so west-centric, people can’t imagine anything other than NHS or the US style.

I have a diabetic eye test every year. Up till several years ago, my own optician used to do it at the same time as my normal annual eye test checkup. (It's eye drops to dilute the pupils then a photo of the back of the eye to check for damage).

Then the local NHS trust decided to do it in house. Now I need two appointments per year, one at my normal optician (paid by NHS) and another at a local health centre. So that's the first inefficiency - 2 checks instead of 1.

Then, at the health centre, it takes 3 staff - one to check paperwork and tick boxes on health history etc., another to put the drops in and another to take the photos. There is massive wasted time between patients when these people aren't doing anything as it's one patient every 15 minutes. Then they're only in one place for half a day at a time and have to unload/load their van with the equipment which I've seen them do and it takes about an hour, so that's 3 hours wasted per day just loading/unloading the equipment - when I say half days, they actually only do 2 hours, i.e. 10 to 12 and then 2 to 4, so all that faff for just 16 patients per day (15 mins per patient, 4 hours of actual seeing patient time). Just 16 patients per day, for the costs of a van, and 3 full time staff. Crazy stuff!

But even before then, there's the appointment system! Under the new system, they send a letter with an appointment. This may be for any random health centre in the county! Even though I always go to the same one, they don't use that information from their system to pre-select the same place for the next one. Not even nearby ones - last time, it was to a town 20 miles away when we have 3 different health centres doing it within 5 miles of my home! Also, I work part time, so a pre-fixed appointment would usually need changing anyway. Of course, when you phone up to make changes, it's an answerphone, so someone needs to phone you back to actually discuss a suitable appointment time. I'd love to see the statistics on just how many appointments they send out need to be changed - I expect it's the majority when they can't even make your next appointment at the same location as last time!

I agree with the inefficiency. I went for a minor procedure under ga two years ago. The week before I had to go for a pre-op. Took an hour of nurse’s time taking all my details not to mention all the small stuff - receptionist’s time, someone printing my forms off, etc etc. The next week, turned up at 7 along with about 50 other people and went in around noon - the nurse here had none of the details from the pre-op. Took all the same details all over again and had no idea I’d even been for one. Firstly, what a waste of my time and theirs and secondly, where had all that detail gone if not into my file or records? Worrying.

Technology is another constant battle.

My mum is a medical receptionist and was complaining that they are phasing out faxes. Apparently they are "vital" to urgent information. I pointed out email would be a lot more efficient/cheaper/less wasteful.

But they [some of the recipient pharmacies and suppliers] "don't have email", she argued - like that was a completely insurmountable problem!

And many trusts are still running on Windows 95 and the like - it's such a mammoth task to upgrade; and as we all know about government IT upgrades, rarely go well.

Most people have dealings with the NHS in some form during their lives and I would think experiences are generally mixed - and it is human nature to remember the bad parts, rather than the good parts.

I drove OH to our local UCC last night. He was advised to go to the A @ E at the Big Hospital 20 miles away, after the doctor at UCC had rung someone at the Other Big Hospital in the area. We got there but when DH saw a doctor he was told there was nothing that could be done and he would need to have an appointment at the OBH, where the specialists are. The UCC doctor had said he had to go through BH - er, driving 20 miles in pain, (well, I was actually behind the wheel of course!) in the small hours, in icy conditions for nothing to be done. Now fine, if he had presented at BH in the first place - we’re not doctors so we didnt know nothing could be done, but he only did so because he was told/advised to!

On the other hand, he accompanied me to my routine annual check up with the GP yesterday (after having visited UCC the night before for the same issue as last night). We share a GP and he had already had DH’s notes from the night before. GP discussed the issue with DH and prescribed him some extra tablets then and there (all in my appointment)> We were very impressed. (I assume the GP wouldn’t have done all that if my check up hadn’t been normal - just a case of, yes all your levels are normal. Lose weight, cheerio till next year so I didnt need his time. And GP knows we share all each other’s medical information).

We were waiting 3 hours at BH and we understood that this was not the hospital’s fault - we were walk ins and couldn’t see what activity there was going on in the ambulance admissions bit (and in fact the doctor DH was apparently meant to see was in theatre for at least 2 hours so obviously a lot was going on). But, it would have been nice to have been told in general terms that there were a lot of 999 emergencies (iyswim) hence the wait. Then we could have passed the time composing suitable letters to our MP etc!

Incidentally all the staff we saw were lovely.

On a similar note I was put into a management role where there was already a manager at one level below me. So she manages people below her and I manage her. This is absolutely ridiculous and I made a big thing about what a waste of resource this is and money. I am being moved elsewhere but many managers managing managers don’t say anything to hang on to their cushy banding

You now have so many levels of management and clinical quality leads it’s bonkers

Worse still is the project teams. ‘Transformation’ is out of control with non clinical people making wacky cost saving suggestions

But to those questioning A&E - is it not the case that most hospitals now operate this?
Go to desk and tell them what’s wrong
Clinical navigator sends you to the in house GP, in house minor injuries, in house ambulatory or usual A&E

If you go to GP and they send you in to hospital you go to ambulatory not A&E unless major emergency (like 999 blue light)

So most A&E’s do now have GP’s in them?

On the plus side, lots of Trusts are now starting to operate "while you wait" clinics.

I have used them for blood tests and x-rays. You get your chit from the GP (don't always need a GP appt either, just collect from reception), then go along to the clinic at a time convenient to you and take a number, like at the deli counter. When it's your turn, you go in and get the job done with the HCP. In due course, you get the results via your GP. No waiting for missed appointment holders, no wasted empty slots. Brilliant!

My last blood test, I was (literally) locking my car at minute 1, then unlocking it again by minute 20, all done.

@CallMeSirShotsFired

This is GDPR and faxes are trying to be phased out as some trusts have had HUGE fines for data breaches with fax machines

and you are only supposed send patient info over encrypted email to nhs.net or gov.uk. You can encrypt it easily but people are afraid of doing it or don’t know how. Long list of complicated rules that people don’t understand or are not trained on

I think patients don't always realise the wider work of hospital staff. Many (not all, but many) of the anaesthetists that you see, are also Intensive Care Doctors. They may well have been arranging a bed in intensive care for a patient pre-op, so that they can safely have surgery, or liaising with the ITU team on duty regarding a patient, etc., as well as running their surgery list.

The surgeons will still have rounds to do in the wards before coming to surgery, and there will still be an emergency surgery list to co-ordinate alongside the planned surgeries.

Patients can't go to surgery unless they are fit for surgery, and for every surgery there will be a series of checks and procedures, which all take time.

Surgery isn't routine. It is complex and highly dangerous, even at its most basic form. Everything that the surgical team does to ensure your safety makes it seem routine and run-of-the-mill. You should be glad that it takes time - it means they are doing it properly.

he final straw for me was when consultant dermatologists were lined up to have their skin inspected by a SECRETARY- because she was the management’s “designated skin care person”, and she’d been given one hour’s training to spot industrial dermatitis! And she then had to complete a “skin health” form on every member of staff in the hospital
BabDoc- why bother to post such obvious nonsense?

@KennDodd Still waiting for that link to the report where the UN declares the NHS one of best most efficient healthcare systems in the world. I've been looking exhaustively and still haven't found anything other than those I've already quoted.

I think quite a lot of what the OP is suggesting is inefficient is the opposite - it's probably the most efficient way for the hospital to run things, but it's less convenient for the patient.

And in terms of there being too much management, much of this "management" consists of people ensuring safety and that government target are met. So people in risk management, audit, operational managers etc. Not to mention the non-crime staff doing essential things for the running of a hospital like estates and facilities, HR, admin staff, researchers.

It's so incredibly easy to sit and criticise "inefficiency" when you don't actually have any understanding of what all these people do!

What's really inefficient (and soul-destroying) is spending hours every month hunting for pieces of equipment, because there aren't enough or the ones you've had are broken. But there's no money to pay for more!

Or as a member of staff, hanging around waiting to find out whether your theatre list is going ahead because there are no beds in the hospital because patients can't be discharged, because of a lack of social care funding. And then operations being cancelled as a result. It's an absolute national scandal and nobody seems to be paying any attention!

Ahem. "Non-crime" should read "non-crime all". I hope all NHS staff are non-criminal

OP. The reason it all looks wildly inefficient to you is because you have absolutely no clue what is actually going on “behind the scenes” as it were. You are assuming that what you can see happening is all that is happening.

PPs have tried to explain why things happen as they do. Why surgery in a busy NHS hospital with multiple patients cannot be reliably booked in for a specific time. It is not comparable to a private hospital. Again for reasons PPs have already given. (No emergencies cropping up, less patients to get through, more complex cases often etc.)

I would agree that there are too many managers & not enough actual staff giving care. But that’s about it. Also, a lot of things that may seem inefficient or duplicated to you (and yes I know there is duplication) is down to safeguarding laws etc. and done in the best interests of the patient to try & avoid error.

Errors in healthcare obviously are much harder to put right than pressing the wrong button on a computer in some other workplaces!

Admin is often woeful.
Dh was recently sent to the wrong centre for a minor procedure. There was then no time to make it to the correct centre, so that was one appt. wasted.
Despite several appt. letters being sent to the correct address, my BiL had one sent to a house where he hadn't lived for 17 years! If the residents hadn't bothered to forward it, that would have been another appt wasted.

As for people with dementia, I've heard so many times of relatives in despair, since despite having it explained time and again, the hospital persists in sending appt. letters only to a person who will not only never remember, but will very likely either hide the letter or throw it away.

They complain about missed appts. but I do wonder how many are not the patient's fault.

I agree that some of the staff are horrible too.
As a child I saw a nurse to have stitches removed. I was petrified but kept still and kept quiet.
She jeered and laughed and pointed at me , saying I had 'turned green' .
I could have done with a kind word. I suppose she's made it her career.

I think patients don't always realise the wider work of hospital staff.

This! And people say, "oh, if private hospitals can manage not to keep patients waiting, why can't the NHS?" Because in the private sector the staff aren't trying to do a whole bunch of other stuff at the same time! The surgeons/anaesthetists come in to do their list and that is all!

And the private sector isn't necessarily more efficient either - one of our clinical managers was recently head hunted by a private hospital to improve efficiency, based on his NHS experience.

*You just can't "book" surgery

*But people do if they go private.

That’s what people pay for really ( because the surgeon probably works for the NHS as well ). People pay for a specific day & time, knowing it will actually happen!*

Well of course you can if you go privately. There's only elective surgery. There's no emergencies, no really frail or very sick patients who (the private sector would turn them away) and there are no staff - especially clinical - in training. The two aren't at all comparable.

The biggest issue facing the NHS is turnover of staff, My DP left last year. His outcomes were measured and compared to others in the trust and nationally. His were way above average. And yet he was given more and more work to do, less and less time, which meant he was bringing home his computer every night to do masses of paperwork. He eventually left and most of his colleagues with great outcomes also left. The NHS is so focused on saving money that it treats its staff like shit. So lots of good staff leave.

The NHS wins elections.

No one is therefore allowed to criticise it.

Also when you book surgery in the private sector you are paying more for the surgeon to be available at that time. The NHS is run to do things the cheapest way possible. That is to have all patients turn up at the same time so the theatre is never empty (except for normal turnaround). That does not happen in a private hospital. Cheapest is not always the way the patient wants it to happen.

I have been waiting for an ENT appointment for sinus problems. I received a letter from the hospital asking me to call to make an appointment. On calling, I'm given an appointment date and time. I then receive another letter confirming the appointment.
Why not just send one letter with the appointment? It's a waste of admin. time as well as postage costs.

My family and I have always had good to exceptional clinical care in the NHS for a birth, A&E visits, GP visits, baby related stuff.

But yes, I think procurement is going wrong. A massive organisation should be getting goods at the cheapest market price, not paying quadruple.

And I agree somewhat with the OP anecdotally. I have hypothyroidism. I manage it very proactively. Every 6 months I get a GP letter asking me to come in to discuss my condition. I go in. GP tells me to do a blood test so she has current results to look at. I need her to print out a blood test form. I do a test a week later. Results a week after. Book another appointment. GP assesses results. Because I've been in this circus for years now I have asked the GP for a wad of blood test forms, and I make a note of when I need to go for tests, and book a review appointment at the required time. But if I wasn't managing this properly, that would be an extra GP appointment plus letters etc twice a year to print out a bit of paper.

Or how about, here's a letter with a blood test form, saying go book a test and then book an appointment to discuss results?

getting Admin is often poor because the computer systems are often very poor, and admin staff are expected to do too much. So good staff leave.
Good staff have choices about where they work. But the pressure on the NHS is to do everything as cheaply as possible. That is not always the best way.
Nottingham lost their internationally renowned eye clinic because the Drs walked when it was privatised, they warned they would. Now the eye clinic struggles to do routine stuff and can no longer do the cutting edge work it used to do.
Where my DP works is beginning to develop a reputation as a centre of excellence for the work it does. Staff are treated decently. They are not paid more than the NHS, but treated like human beings rather than machines that can be expected to do ever more work every year.