Capitalism

Jez, Surely you weren't kept waiting for ages in pain with such a shoulder ? if yes, that's an absolute scandal².

Fritz Von Wouldn't suprise me though unfortunately

quote:

A surgeon who has waits of 9 months spends his time seeing private patients with skills paid for by the NHS, and cared for by nurses also trained at tax payers expense. Could there be a connection? Could some of the cancellations be because the surgeon is dashing off to see his BUPA patients?

Jez here's a couple of snippets from a previous thread which might explain the above.


Consultants are contracted to work a certain number of hours for the NHS - and in fact most of them work many more hours than their contract. Any private work is done in their OWN time, and does not detract from their NHS work.


If the private queue didn't exist, the surgeon would not have been operating on his NHS patients instead, he would have been off work. Even if his extra time was paid for by the NHS, it would not create extra operating theatres, nursing staff or beds that could have been used for NHS patients.

Regards
Clive

True recent story

Orthopaedic consultant A is employed by NHS Trust A. Trust A is struggling to meet outpatient wait list targets. Consultant B is employed by NHS Trust B. Trust B is struggling to meet wait list targets too.

Trust B employs consultant A to do some sessions, at private hospital C, seeing 'long waiters' in order to ensure it does not miss the targets and incur a penalty. A is doing one of these sessions when Consultant B appears from another room opposite. 'Funny thing' says A, 'I was just seeing some patients from your waiting list who were going to be waiting too long'. Really?' says B. 'I was just seeing some of yours!'

These consultants were seeing patients in their 'own' time but being paid private rates for doing the work. They are not alllowed to be paid to see their 'own' long waiters in a PP session in case they are accused of deliberately lengthening wait lists to increase private practice.

Target penalties have created all sorts of bizarre scenarios like this.
Bruce

Bring back those good old Matron is in charge Days:
http://www.private-eye.co.uk/covers/1128/1128pe.jpg

Fritz Von Nurse My bedpan is overflowing

A HEALTHY CORPORATION

Just like your neighbours you have millions of cows.
You both have hundreds of vets.
Your neighbour's cows must insure themselves so that the insurance companies can pay for their vet bills.
But your neighbours have hundreds of lawyers which means that their vets are frightened of lawsuits so the cost of vetcare is high because every sick cow is investigated for mastitis and footrot even though they went in about their lumbago. And many of their very thin cows can't afford the vet insurance.
Your vetcare system has its own problems though, because it has, like your legal system, evolved through successive governments and many many years.
Many of your cows are worried by the problems in your vetcare system because health is an issue close to every cow's hearts but;
Cow attitudes to government have been, through the years, in the process of changing from a belief in the lord-cows and house-of-commons cows as benificent patriarchs to believing that each cow is responsible for itself and is its own lord and master...

This may possibly be of interest to some folk; innit ?

Surgical accountability

Just 13 years after M.D. exposed the Bristol heart scandal and suggested that heart surgeons should put their names to their results, those in north-west England have done just that. The 25 trail-blazers published three years of data on coronary artery bypass graft and aortic valve replacement in the British Medical Journal (5 March). The figures are adjusted for risk so as not to discriminate against those who take on harder sugery in sicker patients. All of the results compared well with the national average. Contrast this spirit of openness and proven competence from heart surgeons with the audit of endocrine surgeons carried out by the Royal College of Surgeons on behalf of the British Association of Endocrine surgeons (BAES). Contributing to this audit is an obligation of membership of BAES and information on three procedures, surgical removal of the thyroid, parathyroid and adrenal glands, is collected. So far, so good. Alas, this is done on anonymised returns (surgeons are allocated a numder) and when the audit is published only the individual surgeon can identify himself or herself and decide if any action is appropiate. The absurdity of this is apparent when the results of the 2000-2002 audit are analysed. This has thus far only been circulated to BAES members; but M.D. has seen the results for thyroid and parathyroid surgery and there an alarming number of unidentifiable surgeons dabbling with this highly complex neck surgery. Some are averaging one operation (or fewer) a year. When M.D. asked a BAES executive commitee member if he would allow such a surgeon
to operate on him, or a member of his family, the answer was an obvious "no". Yet he seemed powerless to do anything about it. A start would be to kick the dabblers out of BAES. The National Institute of Clinical Excellence has recently published guidelines for the head and neck cancer services, stressing the need for a specialist approach; and the BAES has its own
guidelines for thyroid surgery which stipulate "all thyroid surgery should be performed by surgeons with a special interest
and training in thyroid surgery and whose volume of work is sufficient to maintain their relevant skills." And yet some BAES members clearly flout this advice.
The climate in which surgeons now operate is tough: while physicians and GP's regularly get away with mixing the blue pill up with he purple one, surgical errors are much harder to to hide. Reductions in junior doctors'hours have meant that surgeons are far less experienced than before, and new consultants don't have the competence
to take on the full range of operations expected of them. Half of the surgeons currently suspended are those within six months of taking up their consultant posts, and although the process of investigation is supposed to be "blame neutral", many careers are being ended before they begin.The tragedy is that in many cases surgeons are competent across a range of common procedures but muck up on the harder or rarer ones. What's needed is for surgeons to regulate themselves and swiftly
prevent their colleagues from attempting the complex procedures they aren't able to do. The alternative is a knee jerk suspension by management, or a retrospective inquiry that causes huge professional damage.

M.D.

Margaret's shoulder (A current UK election case for those not in the know innit)

What anaesthetist in his or her right mind would want to put Maragaret Dixon to sleep ? Patients don't come much higher risk (she is obese, diabetic, bronchitic and with both heart and ranal failure) and shoulder surgery is seldom very successful. Her case says nothing about the state of the NHS other than that doctors choose who has surgery on the basis
of how necessary it is and how likely the patient is to survive. For some people, a two-year wait for sugery can increase your life expectancy by, er, two years.

Taken You'll not be suprised to learn from the latest steam-powered issue ('1128' 18.05.2005) of Lord Gnome's Tasty Pamphlet:

P.S. The above mentioned lady is 69 years old I believe !

Fritz Von Well It made some sense to me at least, innit !

quote:

If the private queue didn't exist, the surgeon would not have been operating on his NHS patients instead, he would have been off work. Even if his extra time was paid for by the NHS, it would not create extra operating theatres, nursing staff or beds that could have been used for NHS patients.

Regards
Clive

Waits in processes are caused by a mismatch in the variation in demand and capacity. By carving out their capacity (in this case between private and NHS patients, but there are many other manifestations - sub-specialisation, urgent/soon/routine) they create waits. Tampering as a result of the target culture makes it worse.Take a look at Kate Sylvester's work here: http://www.modern.nhs.uk/improvementguides/capacity/

Jez

My mother in law has just come out out hospital and has been told she needs a by pass and she can expect to wait several months. She may be lucky and get the operation this year. She is on the NHS.

My brother in law, who thank goodness for his sake is in BUPA, waited just over one week.

Need I say more.

Regards

Mick

My father-in-law had his in Leeds General Infirmary in 3 days on the NHS. Fantastic care he had too, and so did we as concerned relatives. So what does this trading anecdotes mean? Nowt really Mick.

Mick,
NHS waiting times for non-urgent Cardio-Thoracic surgery:
First figure=Shortest wait (days). Second figure=longest wait

Bradford 0 41
Hull and East Yorks 2 163
Royal Devon and Exeter 6 6
Birmingham Children's 7 21
Hammersmith 8 32
Leeds 12 169
Liverpool 12 263
Barts 14 121
Brompton and Harefield 14 150
Blackpool 19 181
South Manchester 21 81
St Mary's 26 119
Guy's and St Thomas' 28 224
Papworth 30 152
Sheffield 31 194
Bristol Healthcare 34 156
University College London 39 122
King's College 45 163
St George's 50 96
Oxford Radcliffe 51 65
North Staffordshire 53 112
Leicester 57 153
Plymouth 60 212
South Tees 63 204
Wolverhampton 74 163
Birmingham 84 252
Great Ormond Street 88 172
Central Manchester 91 335
Coventry and Warwickshire 94 154
Newcastle 107 181
Brighton 148 194

Might be worth your mother-in-law asking her GP to refer her to Devon & Exeter, or she could spend a few days with us in Yorkshire and take her pick. The hospitals in your area do seem to have longer waits than most though don't they?

quote:

My father-in-law had his in Leeds General Infirmary in 3 days on the NHS. Fantastic care he had too, and so did we as concerned relatives. So what does this trading anecdotes mean

What it means Jez is that the NHS works for the majority of people, and works well. I wish your father in law a speedy recovery, it's always a pleasure to see praise for the hard working staff, I know from experience it means a lot to them.

Regards
Clive

quote:

I wish your father in law a speedy recovery

Thank you Clive. He was a new man 2 days post-op and continues to be on top form. In a private health care system he would be dead.

Jez

My Mother in Law seemed to go into hospital to be laid in a bed, to be examined by a doctor, to be sent home and told that she may be coming back at a later date for surgery. She came out with the same problem she went in with but now knows that she has to live with the condition a lot longer.

She should have gone in with a problem and come out with it sorted out.

I expect her condition to deteriorate to the point where an operation would be unwise. Then the inevitable will happen.

This episode has made me bloody determined never to have to reply on the NHS. There is no way on earth I will gamble my wifes health with that lot.

Sad but true.

Regards

Mick

quote:

Thank you Clive.

You're welcome Jez, and Mick I also wish your mother in law well and hope she gets her bypass operation as soon as possible.

Mick we may have our differences on the NHS, but I certainly do not wish you, our your family any discomfort or suffering. When your mum in law gets her operation, I hope you'll report back with the standard of care that she receives... which should be exemplary.

Regards
Clive

Clive

Somehow I do not expect this to have a happy ending. I hope I am wrong but I doubt it.

Regards

Mick

Mick
Please have some faith, I know from experince in these situations that people look on the dark side of things which is understandable. I think you may well be, and hopefully on my part pleasantly surprised at the outcome.
I'm no Cardio Thoracic Surgeon, and don't know the details of you mum in laws condition. This forum certainly is no place to discuss them, but please try and keep up the hope and expectations that things will turn out for the better.

Regards
Clive

Clive

Only time will tell.

Regards

Mick

Mick
Keep us informed and that is out of genuine concern, I suppose the same concern I would extend to other members on this forum.

Regards
Clive

quote:

She should have gone in with a problem and come out with it sorted out

I absolutely agree with this Mick. Not only would it be better for patients (the most important thing of course), but it would be more efficient and less work for the organisation, meaning that the NHS could treat more patients, more quickly, at less cost. Some NHS services have already adopted this way of working, unfortunately they are still in the minority.

Jez / Clive

In an ideal world, she would have gone in and had the op but it never happened.

Possibly I am being too cynical but it did cross my mind, that having a patient in overnight is one way of reducing waiting times on paper at least.

Take an extreme case to illustrate the point, if they call her back in once a month, the longest waiting time is one month.

Some one somewhere gets a pat on the head and possibly avoids penalties which I believe hospitals have to pay if certain performance criteria is not met.

Regards

Mick

Mick,

I think most people are very pleased with the standard of care they receive from the NHS... once they actually receive it. A friend of mine, who is a GP, once told me that an NHS hospital is quite the best place to be (over and above a private equivalent) if you've actually got something seriously wrong with you.

I hope your ma-in-law makes a full recovery, and I'm touched and refreshed to see a man who actually loves his in-law!!! Even I am not yet too old to be surprised!!

Best wishes,

Earwicker

Mick,

First of all let me add my voice to those wishing your mother-in-law the very best. Waiting for an operation of this nature is, of course, extremely distressing and hardly helps the original condition.

There was an interesting article on the cover of The Spectator comparing health treatment in the US with that in the UK, particularly with regard to cancers and heart conditions. Unfortunately, you need to subscribe to see archived articles and I'm not a subscriber. However, I have found a copy of the article on James Bartholomew's web site. It's entitled : Which is better, American or British medical care? and I've added the link here for anyone interested.

Regards
Steve M

Earwicker

You said.."I think most people are very pleased with the standard of care they receive from the NHS... once they actually receive it.

That is very true, the caveat being once they actually receive it.

Also, I have no wish to appear an hypocrite. I am not very fond of my mother in law, she has always looked upon me as the pig who defiled her daughter, but I think she should get better treatment than this.

From what I can gather, treatment by drugs is an option and this may be a better bet than operating on a 75 yr old woman who is in reatively unhealthy condition. Her arteries are in a bad state.

Once I know a few more facts and also what the time scales are likely to be, I shall make a few enquiries about funding the op myself.

I think the main problem is that it is less safe to operate on her as each day passes.

Regards

Mick

Mick, I too obviously wish your Mum in Law a full & speedy recovery as is possible, but I do really question your airing of it all on this forum if you get my drift ?


Fritz Von Barbour Jackets are cool

Fritz

It all stems from the difference one receives between the NHS and the private sector.

I was using it as a live example.

Possibly it is best dropped.

Regards

Mick