Thursday, 16 September 2010

NHS Targets... The Loophole

You may recall the blog entry from when I saw the podiatry surgeon, we discussed fusion surgery and I was placed on the waiting list...

With the waiting time-scale being about 3 months and me seeing the surgeon in March, I expected surgery to be around June.  This meant the letter would have arrived around the end of May giving a date for pre-op assessment and surgery.

It was quite a busy time for me so it wasn't until the end of July that I realised I'd not heard anything.  

I contacted Loughborough Hospital and initially was passed around 4 departments.  Eventually I was told to speak to the Day Surgery Manager as this is who would be dealing with my case.  I got the answering machine and left a message explaining my predicament.

Later on that day I had a voice mail from the Day Surgery Manager... The message was very clear and to the point (quite abrupt if I'm honest) and stated that my surgeon had left the hospital and therefore I needed to speak to him at the hospital where he was now based, Derby Nuffield.

As you can imagine, I was pretty peeved at being brushed off and so contacted the one organisation who I knew would get things sorted for me... PALS (Patient Advice Liaison Service)

PALS were first announced in the government’s “NHS Plan” of 2000, with the main aim of offering a support service to patients who often felt they weren't being listened to.  An independent facilitator was needed to handle patient and family concerns, with direct access to the chief executive and the power to negotiate immediate solutions.  After successful pilots, PALS were rolled out countrywide in 2002.  

I spoke to a lovely lady, Annie who took all the dates, details and went off to investigate.... Not so long after, she called back with an update.....

Seems the surgeon was already based at Derby Nuffield but was doing some surgery for Loughborough.  This service was then cut back which meant he could no longer do my type of surgery.  A letter had apparently been sent to my GP asking him to do a re-referral.

I have always had the utmost support from my GP surgery and had he received the letter, I know he would have been on the phone to update me.  I spoke with the practice manager, who confirmed that the only letter that had been received (they're scanned directly onto my notes) was the one in March, confirming that I had been put on waiting list and outlining my surgery.

In the meantime PALS spoke with the 18 week coordinator.  One of the national priorities for the NHS since 2008/09 was "achieving a maximum wait of 18 weeks from GP referral to start of treatment of patients.  As soon as you've exceeded the 18 week wait, the hospital are in breach and its referred to the 18 week coordinator.

I had definitely exceeded the 18 week target.  The question was, how was it going to be solved?

Well it seems where the NHS is concerned, not very easily and not without jumping through a couple of loopholes..... particularly with the waiting time clock....

The waiting time clock starts when you are referred but certain things can freeze the clock, or even stop it.

For me to get my surgery, I either had to see the same original surgeon but at a different hospital (Derby) or a different surgeon at the same hospital (Loughborough)... Now you'd think that because I'd already exceeded the original 18 week target, I would be treated as a priority... Not so! This is classed as a re-referral so the waiting time clock stopped.

Either way, I was going to have to wait so I took the decision to stay at the same hospital.  Its a hospital I like, and although the admin side sucks, its clean and friendly plus parking is free.

I got an appointment with the new surgeon within a week so that was a good start.  He gave me a different perspective on my surgery which I did appreciate and so the type of surgery I've elected for is simpler, and only needing a local anaesthetic (and before you worry, I wasn't pressured into simpler surgery)

It can also be done at a hospital nearer to home, which again is clean, friendly and with free parking so bonus....

What's annoyed me though is the loophole where if you are re-referred because of a hospital cock-up, the wait starts over again...  The surgeon said he aims to get me in for November time and while I appreciate its not his fault there was a cock-up, these loopholes don't help the ones waiting for the surgery.

I've since also discovered that performance management of the 18 week waiting times target by the DoH ceased with immediate effect in June 2010 - source  

I truly hope we aren't going to go back to the days of long waiting lists with no accountability!

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