Be Excellent To Each Other

What's with the news at the moment? Trying to whip up a storm about how awful the NHS is?

As far as I can see, it's presenters telling us how bad it is, and cutting to interviews in the street where everyone interviewed says it was totally fine for them.
They then go to a relative interviewed in the studio to ask them about their mum's 15 hour wait to be seen in a corridor after she had a stroke. Which turned out to not be a stroke, and she had an ambulance out immediately who confirmed it wasn't a stroke, and she had to wait 12 hours in a cubicle, not the corridor, before a bed on a ward opened up.

My favourite this morning was the on street interview with a guy who had been in and out of A&E in 25 minutes, and said that he went today as it would be less busy that going on the weekend If you can wait for a day that isn't busy, it's hardly an A&E issue, now is it...

Our local hospital has a 24hr walk-in centre to deal with the non-emergency cases, is that a rare thing? It seems like a good idea to have them.

Is there a way to not see a particular thread? No offence to you Trooper but I really can't be arsed reading some of the inevitable half-baked, fuck-witted ranting that this one is sure to attract.

Not unless you put Trooper on ignore. Or don't click on the link, I guess.

Oh, you know the solution to that one, Mark.

I for one have never had any issues with the NHS. Anecdotal I know, but there it is.

Yes, put Trooper on your ignore list.

I've dealt with it slightly differently and put everyone with history of half-baked, fuck-witted ranting about public services on my ignore list.

Except me because you can't ner ner.

I have a post-it note which I move around the screen for you.

When I was writing the post, I did wonder when you and Cavey would turn up for an argument

Well, he won't any more (unless he access the link through active topics, or something).

The service I've had at hospitals has without exception been superb. GPs are a different matter entirely. I'd exclusively use walk-in centres if it wasn't for the fact that they can't ever prescribe anything because they don't have access to your records because ACTUALLY I DON'T KNOW WHY NOT.

And Trooper

I'm lucky enough to have hardly ever been to hospital (I last went to A&E because I couldn't see out of one eye (due to Nerf gun issues) and was seen almost immediately - it was Christmas morning, though). The Grimlet was seen with his broken elbow in about 30 minutes at 6pm on a week night, and Mrs Grim... is always treated superbly (although that's not A&E).

Fuck me it must be quiet

I received a letter from my GP yesterday (dated 29th Dec) saying I couldn't be prescribed any more medication on repeat (the letter didn't say which one) without a review. I am low on one thing so thought I'd better ring this morning. I waited on hold for 30 mins - finally got through and they didn't have any emergency appointments left that day and I'd have to book in for two weeks' time. It turned out to be a medicine I've got loads of anyway. Useless tossers.

There's an election coming up.

I used to moan about my GP surgery, was there a lot when our son was younger used to be waiting for 30 minutes to be seen etc

After reading what others put up with I'm grateful! You have to ring from 8am on the day you want to been seen and I have always been seen

My sons GP always calls us back when needed as well. I called 111 on Xmas day was seen by one of the GP's who was running the out patients clinic in 2 hours.

For the hospital the only time I've used NHS recently is when my son was born, it was brilliant service, we are lucky that our postcode allows us access to a very good hospital.

I have BUPA so use that for anything that's wrong with the family.

Which is great except that BUPA don't have an A&E service and require you to get a GP referral before you can see a consultant. I'd quite happily do it the other way around! Have private cover pay for quality GP services and then get referred to the NHS for hospital treatment

Amusingly, all my treatment for the last 10 years has been NHS after my private consultant referred me to himself, but on the NHS on the basis that the NHS clinic has a much better quality of care.

It's wonderful.

I went to the GP last year and they were running around 10 minutes late, but the first thing the doctor (a 50-ish Indian lady) said to me was "What's the problem, Big Unit?" so everything was great

The 95% target is bollocks anyway. Everyone visiting A&E has to be seen within 4 hours whether they should actually be going to A&E or not. You're interested whether the guy having a massive heart attack was seen within 4 hours (ideally, a little sooner, and there is no suggestion that this isn't happening*) and are fairly indifferent as to whether the old dear with a bruised pinkie was seen in time.

Notwitstanding this, the target isn't being met now and was before, so something has deteriorated. A non-partisan 'expert' yesterday on the Daily Politics attributed this to a significant degree to people going to A&E for non A&E things, and blamed the GPs for not being available. However, he also said that the way the christmas and new year bank holidays landed this year led to surgeries being closed for longer leading to this effect being magnified and implied that you can see that cycle recur in previous years where Xmas Day was on a Thursday.

* Yes, stories of A&E units 'closed' and ambulances queueing outside. These aren't closed to blue light emergencies and the ambulances waiting outside don't have people suffering heart attacks in them, but its less emotive to confirm this fact in your news report.

The A&E service I have received has generally been excellent, and I say that as someone who has been whisked to hospital in an ambulance twice in the past few years.

The main issue they have (other than underfunding) is people using it for non-emergencies.

And Trooper

I think the diabetes care I have had has been brilliant over all, a few teething troubles to start with ok.

My GP is good and what seems quite rare, is I can book appointment, rather than having to ring up on the day.

Why is everything always my fault.

For whatever an anecdote is worth, here's a different one: I recently took MrsDoc to A&E. We arrived at 18:45. We saw a nurse for triage at 21:25. We went through to "major treatment" at 22:55, saw a doctor at 23:00, waited for test results, and were finally discharged at 00:10, five hours and twenty five minutes after arriving. We were not unusual; I was watching the progress of people through the waiting room and our experience was typical that night.

And now after the anecdote, some data:



(Source: http://www.bbc.co.uk/news/health-30679949)

These are the goverment's own figures; there is no spin in that graph. I can't read that as anything other than "the coalition softened the target, and is now failing to meet the new, softer target." It's all well and good to dismiss the noise about A&E wait times as electioneering but that doesn't mean things aren't actually worse than they were under the previous government.

It's because of the immigrants, obv.

And Trooper

This is my contribution to this discussion:

http://thepatientfactor.com/canadian-he ... h-systems/

This ranking is weird: Italy in second, while norway is in 11th, Switzerland in 20th, Sweden in 23rd and Australia in 32nd? There goes all my preconceptions

I've spent four days and nights in hospital over the last month and the service has been absolutely superb. A&E were really good as well.

This is also a good chart to show how hospitals manipulate their performance of the 4 hour target. See how the number of people seen spikes just before the threshold.

'Other outcomes' sounds a bit ominous.

Well, yeah. Any form of management by metric is going to produce edge effects by this. I don't think that's particularly sinister.

It'll mostly be "discharged", although I guess "died in A&E" must be a factor.

A&E really should be split up into A and E. Because A doesn't necessarily mean E, so the time to treatment shouldn't necessarily be the same.

The problem is that all problems aren't equal. Waiting 5 hours for something that wasn't critical and has no lasting effects? Sure it sucks for the specific people involved, but it isn't that important as a whole. The key measure i'm interested in is how quickly do they see people who are critical and where time is of the essence. Are there figures for that?

I guess the figures for that are "how many people died before being admitted".

[edit]Or had lasting issues due to how long it took to be seen, I guess.

Agreed - my point being that the metric is bollocks - as the key outcome there is whether the manipulation of performance, to see someone at 3 hrs 50 to meet the target, is at the expense of a critical case. I'd hope it is unlikely.

No, but similarly you may have an A, which isn't an E, but can only be dealt with at A&E at that time.

The worst bit of waiting 4 hours in A&E for a non emergency case is waiting in A&E. Ali and the boy waited there for three hours to have a 5 minute blood test back in October, with scant entertainment and no 4G reception. A virtual queuing system would help here - E.g. I've hurt my ankle but the wait time is four hours, I'll quite happily book a slot then sit at home watching TV for 3 hours and then trot off to A&E to be seen half an hour beforehand, rather than sat in the waiting room for that whole time.

Going back to the original post, the thing that stuck me was that they were saying "worst performance for..."

I thought they were going to say something like "...50 years" or something, but they actually said "...10 years".

10 years? 2005. I don't recall there being a big hoohah then about waiting times being really bad or anything. It seemed to me like they had an agenda the way they were presenting it. So much so I even mentioned it to my wife. Then I got distracted by something and got on with my life. :/

Malc

Isn't there a bit of a difference between "being seen within 4 hours" and "being discharged/admitted within 4 hours"...? I've been in A&E loads and loads of times with both of the kids and for myself, and I don't really have any horror stories, sorry. Waiting any amount of time when you're in pain or dealing with something you feel your body shouldn't be doing can be distressing but from my own experience of sitting amongst people in A&E, the biggest issue is the inconvenience of waiting.

Yeah, why is the reception always shit in these places!?

Modern building regulations and the growth of steel infrastructure. (Which I know I don't need to tell you about!)

Drab colours and old magazines

not enough staff

Too many sick people.

Trooper

Most people have already got pissed at the ceremony.

[edit]Wait - I need to start going to different wedding ceremonies.

Sure. But again: what's shown in that graph is a significant degradation in response times in A&E; it's certainly a service that is performing worse for the average user.

Furthermore, unless A&E is handling significantly more non-urgent cases in the last five years than it did in the five years before it, then it seems reasonable to assume that there are critical cases taking longer too, simply by the law of averages. Now one hypothesis is that A&E *is* handling significantly more non-urgent cases, mostly because the coalition has cut funding for things like non-urgent walk-in centres and GP offices, forcing more people into the (much more expensive) A&E channel. But that's hardly a robust defence of the sitting government's ability to manage healthcare either.

Two things. Firstly, I don't think that metric is any more fallacious than a number of others I've worked under myself. I only see two options in process management: apply flawed metrics or don't measure anything. I'd much rather apply flawed metrics, cautiously and with one eye on their shortcomings, than rely on gut feel alone.

Secondly, this is one of the government's chosen headline metric, so judging it by its performance against it doesn't feel unreasonable to me.

My understanding was that these figures have only been tracked this way since 2005, so that's all the data they have. So another way of putting it is "the worst performance since records began."

The reason the metric focusses on discharge or admission, to my understanding, is because until that happens you're still consuming A&E resource: nurse time, doctor time, tests being run, and so on. And A&E is really expensive to run so it's in everyone's interests to get people shunted on to the correct destination as quickly as possible.

Our work BUPA is odd, you need a referral but half the time they never check or ask for it. What they do is make sure the people you are seeing are on their list of approved people. As long as they are they just give me a number which I then give to the specialist.

With my son who is on the same scheme, its all up to me I can choose anybody I like, they don't have a list of preferred people for kids.

Quite expensive, £370 for my son a year although I could have 6 kids for this price! Just about to add my wife as she is leaving work and that's costing me £730. Both have a £150 excess as well.