Thursday, 25 March 2010

Tip of the iceberg

Three pence in every pound spent by the NHS is wasted… and that’s according to official government figures. If that’s what the men from the ministry are owning up to then I think we can assume that the real figure is closer to 30 pence in every pound.

Even if we accept the 3p figure as being true, that still represents a staggering £3billion pounds down the sluice every year. However, from my experience visiting my local hospital yesterday I can imagine that the amount of money wasted is far higher.

The hospital’s showy atrium was positively groaning with smarmy management types, sat at the café tables tapping into their laptops, no doubt wasting a bit more time producing even more pie charts to show how the local Trust is winning the battle against hospital acquired infections. Incidentally, my local hospital only has ten wards closed to visitors due to various viral outbreaks this week.

Not only were there armies of administrators sipping on their cappuccini in the atrium, I also noticed during my clinic visit that the number of receptionists has ballooned alarmingly. I waited for almost five minutes for one of the two receptionists to greet me and book me in for my appointment. One of the two ladies was chatting away on the telephone while the other one was attending to the far more important task of making the tea and sorting out the biscuit situation. Occasionally other members of staff would bustle past with pieces of paper in their hands, carrying chits back and forth to the consulting rooms in what looked like some sort of Dickensian paper trail. Overmanning in parts of the NHS seems absolutely criminal in terms of waste and ineffectiveness. Mind you, I wouldn’t say no to a nice cushy job sitting behind a desk and gossiping while drinking is much NHS tea as I want.

The good news is that when I did get to the consultant after an hour of waiting, I was treated with great respect, courtesy and professional competence. It goes to show that parts of the NHS do function well and if we had fewer managers and paper pushers it could be even better.

This morning I’m off for my hydrotherapy session in a department where there are no receptionists, no one carries around paper and people simply get on with their job. Unfortunately, the hospital is considering closing the hydrotherapy pool on cost grounds.


  1. Completely agree! Too many management bods doing nothing productive.

    In the last week my son has had 2 emergency admissions to hospital. The first, we phoned paediatrics who said they would let A&E know we were coming. We got to A&E and waited, and waited and waited! He collapsed! We waited! We were told that as we had arrived by car he couldn't be an emergency!!!!
    2nd trip, in a 999 ambulance following a collapse at home. Got to A&E, baseline obs done then left. An HOUR later, still nothing. Not even a check on him. His disease means he can deteriorate very rapidly!

    What were the staff doing? Well, the nurses were doing NOTHING! Not quite true. They were gossiping at the desk. Apparently the department was really busy!

    So, all the government targets in the world cannot actually ensure that a potentially critical patient gets the appropriate care.

    I am glad to hear the consultant was good yesterday. I hope all is well with the healing process. We had similar on our admissions. Not great till we got to paediatrics then excellent service!

  2. Sounds very much like one of my local hospitals, not too far from where the Queen lives for part of the year. Gossiping at the desk, focusing on making tea at the peak time of 0830, walking backwards and forwards with pieces of paper.

    Luckily husband and I are old enough now for people to stand up and offer a seat (which took some coming to terms with for me but hey, gratefully accepted) as there are never enough seats for all those waiting.

    Like you, when we did get to see the consultant she was helpful and efficient.


  3. Nurse: I really hope your little one gets better soon. It must be a nightmare for you. I know what you mean about gossiping staff. It makes my blood boil when some NHS workers go on about how they're run ragged with work and then I hear the same ones giggling, gossiping and gorging on boxes of Milk Tray chocolates while patients are left unattended. Time to bring matron back, I think.

  4. Reminds me of several years ago, anticoagulation blood tests at Kingston upon Thames Hospital; 08:45 join queue for reception to open at 09:00; 09:15 still waiting whilst receptionists discuss last night, boyfriends, husbands, kids etc; 09:30 join queue for blood test; 10:30 join queue for results; 11:15 join queue to see doctor; 12:30 catch train to office; 13:00 asked by project manager is this going to happen every day and will I be working that evening to make up my time at the hospital.

    Or Royal Lancaster Infirmary in 2009 when asked back by lab staff because phlebotomist had drawn insufficient blood, then receptionist told me I couldn't have a blood test because I didn't have my yellow book (lab still had it because what was point of posting it to me when they hadn't done test) nor did I have a blood sample form, because lab had asked me to return. Receptionist spoke to me as if I was a child telling me the procedure was I had to go to my GP, get a form from him and then come back later in the week. I went and found a nurse who knew me, told her the receptionist problem and nurse put me in the queue.

    I can go to a UK GP, see his nurse to have blood taken, nurse isn't there every day so might have to go to a different surgery, must be between 08:00 & 11:30 because samples collected before 12:00. Blood with yellow book sent to hospital lab then yellow book with results posted to my home address, might arrive next day, next week, depends on how Royal Mail is this week.

    Contrast that with Cape Town where I called at pathologists outstation on my way to work at 08:00, said what I needed, bloods taken, completed my journey to office arriving 20 minutes later than normal and consultant's nurse rang my office that day with results. Or Zurich; arrange appointment with my house doctor (open 07:00-22:00 every day of the year including holidays). Lab staff on site at all times, an hour at most to be tested, see a doc, be told ongoing dosage and when to return. Do it in my lunch hour, in the evening or at weekends - when convenient for me.

    In Zurich if I didn't have such a complex medical history, only needed anticoagulation, I'd be given a blood test m/c, training and do the tests myself at home, only seeing a doctor if the results were outside the desired range.

    Then think something like the above UK performance gets repeated when I need new compression stockings fittings; moulds for new supports for the bones in my feet; 6 monthly CPAP technician visit; 6 monthly respiratory clinic checkups and all the other checks. Outside UK its a quick trip in my lunch hour, UK spend the morning or the day in a hospital that's usually nowhere easy to get to.

    And how about prescriptions? UK my GP is only allowed to prescribe sufficient for a month. For some medicaments I further have to produce a treatment card at a Chemists and be given a lecture on a substance I might have been taking, in the case of at least one compound, in excess of 23 years. But then I'm a member of the public therefore by definition thick and not to be trusted.

    Outside the UK I am given yearly prescriptions for medicaments, the pharmacy allows me to choose whether I am given everything at once or decide on how much I will collect then - say 3 months worth - and they keep a record of what is outstanding.

    And NHS staff seriously inform me we have a service we (they!) can be proud of, the best in the world - cloud cuckoo land thru' rose-tinted spectacles.


  5. Well said, John. The sooner the NHS is stripped of its sacred cow status, the sooner we can begin to see improvements. There's something odd about the employee culture of the NHS. It's almost as if some of the staff believe that being part of a workforce of 1.4 million people makes them untouchable and unaccountable. Bad managers who are far too accountancy based are to blame for a lot of the poor attitude.

  6. Thanks XTM. My offspring will, hopefully, be stable for a while but it is a life long condition for him which may well result in more 'emergency' admissions. We have become very well aquainted with the paediatric department over the last couple of years and have seen changes there for the better during that time. I am not looking forward to moving in to the adult side of things and having to train them! LOL!

    Well, our letter of complaint went in the post today. The chance of me being employed by this health authority will be zero when it is received! But, would I want to work for a department that thinks the way this one does? No! I would not. So, I will continue to be a highly motivated, experienced A&E nurse who refuses to work for the NHS!

    I used to be really proud to be a part of the NHS and still would be if things were run properly. There are some pockets of really good practice within the NHS which should not be forgotten but if you never experience those then it can seem a very bad organisation.

  7. I have to visit hospital fairly regularly to see the cardiologist. I now just book annual leave. Last time I arrived at 2 for appointment at 2.10pm. Finally got seen at 5.15pm. The clinic started at 2 so how could this have happened? When I was in seeing the cardiologist he took a long phone call on his mobile and then shook his head and said 'no wonder my clinics are always running late!'.

    He barely listened to my answers. I would say he spent less than 2 minutes with me. Is this normal for anyone else?

    I'm sorry to hear what you went through Nurse. It's ok when you're an adult but this should not happen to a child.

    How's progress ExTm? Feeling any better?

  8. Hi Carolyn

    I'm sore today after my hydrotherapy so not feeling on top of the world. Sometimes progress can seem so slooow.


  9. Following on from my earlier post, my husband went to see the same consultant again at 'the hospital close to the Queen' at noon today. He was seen straight away and was in and out in less than half an hour. I went shopping but there were even some parking spaces.

    It looks like a lot of these bottlenecks occur early in the morning, although not always from what Carolyn said.


  10. Just posted my first entry on my brand new blog about my experiences at my local A&E just for some stitches and a shot, and found your blog at the same time. The NHS offers fantastic patient care but I think it would be hard to find a worse run, more wasteful organisation (except for maybe the US healthcare system).

  11. Just discovered your blog - truth through and through - have spent the best part of the last year fighting proposed legislation about home education inroduced on a bunch of lies about abuse which did not exsist and in the meantime plenty of evidence of abuse in the NHS and no hope of change. Currently have a step daughter with cancer and the care is awful - poor communication, incorrect drugs, poor nutrition etc. Would you believe when she stayed at the NHS hospice in the autumn she receied only packets of crisps for 4 days because they were "unable" to cater for her diet (set by her consultant). This is apparentl because the food is cooked 150 miles away and driven here!!!
    The food offered is high in salt and not dried out. Gross. And in her case the lack of nutrition was life-threatening.