The Department of Health has today updated Tynwald Members on its work to reduce waiting times, highlighting several areas where progress has been made. Despite reduced waiting times in many clinics, the Minster for Health, David Anderson MHK, made it clear that it was proving increasingly difficult to achieve reductions within the Department’s finite and increasingly stretched resources.
In late 2011 the Minister requested the formation of a working group to fully evaluate the demand and capacity within the Health Service – particularly at Noble’s Hospital – and for the group to make and lead the implementation of recommendations on initiatives to reduce waiting times. Today’s presentation to Tynwald Members is the second update they’ve received on the work of the group, which saw Chief Clinical Information Officer, Dr Iain Kewley, detail a range of specialities in which waiting times have come down for outpatient treatment such as dermatology by 44%, rheumatology by 25%, general surgery by 48% and breast surgery by 56%. Dr Kewley also outlined areas where waiting times for inpatient care had decreased, such as 16% for ophthalmology, 40% for general medicine, 46% for oral surgery and 26% for breast surgery.
Despite lowering waiting times in some areas, waiting lists remain high for certain specialities such as dermatology and ear, nose and throat, and some waiting times have increased, such as pain management and endocrinology.
The Department made clear in its presentation that in order for it to make any further significant impact on waiting times in many areas, capacity would need to be increased, which would require significant investment and resources.
Partnership working and care pathways
In its 2012 update to Tynwald Members the Department emphasised that waiting times were a Health Service problem and not specifically a Noble’s Hospital problem in that the issue needed to be looked at in its totality, from the point of referral by a GP and not simply a patient’s first hospital appointment. It was quickly evident that solutions would need to be found through multidisciplinary working right across the Health Service to include community care such as GP’s and district nurses, through to acute care at Noble’s Hospital.
Work being undertaken to address the dermatology waiting times – which are particularly high – is an example of the multidisciplinary partnership working approach the Department is taking. GPs have been involved in helping to address growing demand for services with the Department planning to provide additional training for three GPs who will become expert GPs in the field of dermatology, allowing them to develop additional skills and clinical knowledge. This will include the use of teledermatology which involves taking photos of skin lesions and passing them on at the point of referral, allowing the consultant to ‘triage’ cases ahead of seeing patients.
Initiatives such as this exemplify moves to make ever better use of existing resources and clinical expertise across the Health Service, not with just within Noble’s Hospital. In addition, it demonstrates the benefits of challenging existing practices and processes, looking for innovative approaches to reduce waiting times and improve outcomes for patients.
Challenges in areas of high demand and low capacity will however persist for the foreseeable future. In the case of dermatology, the Island has two part-time visiting consultants from England, with no additional funding to deliver a comprehensive service on-Island through a full-time Consultant Dermatologist.
As part of its work to streamline care, improve efficiency and promote joined-up working between GPs, community care and hospital care, the Department has increased the roll-out of integrated care pathways. These pathways ensure a single mapped-out patient journey across all fields of health care, providing consistent management and tracking for a variety of conditions.
DNAs down by 3%
Administrative processes have also been reviewed, in particular the verification of waiting time data, the creation of a new Appointments Bureau at Noble’s Hospital for all outpatient clinics, and identifying what can be done to reduce the number of patients failing to attend their appointment, which wastes capacity and increases waiting times for patients.
Those attending Noble’s Hospital for an outpatient clinic now all report to a single reception point, which has freed up several staff to work in a centralised Appointments Bureau. This in turn has led to more effective appointment management, allowing cancelled slots to be quickly reallocated by a single team which has an overview of all appointments at the hospital. Staff are also able to issue additional reminders to patients about their upcoming appointments which has seen outpatient Did Not Attends (DNAs) reduce from 10.5% to 7.5% since the Bureau was established.
£7m a year extra required for Health Services to match investment in England
The work to evaluate waiting times has seen the Department look to the UK and the English NHS in particular given the similarities and also the public’s tendency to compare on-Island health care with that in England. There is a significant funding difference however; between 1997 and 2010 the NHS in England saw its budget double from £55.1 billion to £125.4 billion1. In the Isle of Man, whilst health expenditure has increased significantly during the same period, the Department estimates a minimum of £7 million increase in funding would be required to locally match the investment seen in the English NHS. But it should be borne in mind that waiting times remain an issue across the UK.
Minister for Health, David Anderson MHK, said:
'Our work on waiting times is encouraging, but extremely challenging and it is clear that fundamentally addressing some of the longer waiting times will require significant further investment. The new Department of Health and Social Care is the only Department to see an increase in funding in this year’s Budget at 2%, which equates to £3.91 million. This in itself demonstrates Government’s ongoing commitment to protect the vulnerable.
'In spite of this and as I stated last week following Tynwald’s approval of the Budget – addressing the long term challenges posed by longer life expectancy and the health and social care demands that this brings; meeting public expectation in terms of new treatments; and the impact that lifestyle choices has on the public’s health – particularly the rise in long-term conditions that can only be managed rather than cured, such as diabetes and arthritis; it is clear that a national debate is required on how we fund our Health Service in the years ahead.
'Our work to date on reducing waiting times, bringing down DNAs, increasing efficiency, introducing more integrated care pathways and remodelling care has required a significant amount of detailed work across teams throughout the Department, including Noble’s Hospital, Community Health and GPs. It is encouraging to see such a strong team effort in addressing these challenges and I would like to extend my sincere thanks to clinicians and officers alike who are driving this work forward. We will continue to do our utmost to reduce waiting times wherever possible, but it is increasingly unrealistic to think that these challenges can be addressed within the Department’s existing resources. The Department and the Council of Ministers are ever mindful that despite the desire to invest in health and social care, Government’s ability to increase spending is severely constrained by the need to rebalance the budget as a result of a decrease in revenue from the VAT sharing agreement. As such a ‘third way’ is required if we are to sustain a health service fit for the 21st century.'
1 London School of Economics and Political Science, 2011.
