Thursday, 19 February 2015

NHS Waiting times.

Its not often I get to blog from actual experience and while I cannot claim to work for the NHS department responsible for dishing out statistics, its fair to say - from my desk situated at the throbbing heart of Scotland's National Health Service - I can offer something of an insight into How Things Really Work.

This post might be a bit dull, so I'm including The Seven Wonders of the World to keep you interested. The Great Pyramid of Giza is first. Impress friends at dinner parties by referring to it by its lesser known names; The Pyramid of Khufu or Cheops.
First of all, I and the people who sit around me are the NHS staff most folk want to see the back of. It's in this building (among one or two others) where all the managers and bureaucrats so reviled by the taxpaying public work. However, people who work here do things like make sure lead gonad shields and aprons in x-ray departments aren't riddled with holes, negotiate contracts to make savings worth millions, plan new hospitals & health centres so they are fit for purpose - like checking doors are wide enough to allow ordinary or bariatric hospital beds (that we buy) to pass through or that new over-bed tables will actually go over the beds or (somewhat more critically) making sure women's bits aren't overly irradiated during mammography scans plus a heck of a lot more besides.

The bit that I work in concerns itself with hospital equipping; its where the people who know about things like electro-medical or lab equipment sit. You can't just go out and buy a blood analyzer, pharmacy robot or a PACS imaging system for medical imaging (be that x-ray, CT or CAT scanning.) These things are often part of the fabric of the building so require a fair bit of forward planning.

The Hanging Gardens of Babylon. Babylonian Priest Berossus attributed their existence to Neo-Babylonian king Nebuchadnezer II - he was so cool; in The Matrix, Morpheus named his ship after him.
The next time you're in a hospital or health centre, look out for bins - why? because bins are a pain in the arse. Every room must have at least one and it needs to be the right kind. If its a treatment area it'll need to have a domestic bin and a clinical waste bin - they'll also need to be the right size. I haven't even mentioned user preference - I mean to say - you'd think a bin was a fucking bin, but its not. You get solid walled bins, bins without walls, plastic bins, metal bins, bins of different colours (white for domestic waste yellow for clinical waste and red for body parts (joking) the entire bin can be coloured or just the lid.) You get soft closing bins (the standard these days) and waste paper bins also of different colours and capacities. Where I work, we make sure every room that needs a bin gets a damn bin. Take a project like Aberdeen's Emergency Care Centre; across seven floors we distributed 693 sack holders, 329 small pedal bins and 429 sanitary disposal bins. And its not just that, its everything from plug sockets to bog roll holders and paper towel dispensers, laboratory equipment to gamma cameras and CT scanners.

Zeus at Olympia; made famous by Laurence Olivier in the original (and much better) film Clash of the Titans.
Over and above all of this, for clinical areas we also have HAI compliance - which stands for Healthcare Associated Infection - this is the reason nurses get all frowny when you sit on hospital beds or patient chairs, its why there are bottles of hand wash every five metres and its why buying hospital equipment isn't straight forward. For example, in examination areas you won't see any fabric covered furniture, it'll be vinyl; there will be blinds instead of curtains and there shouldn't be any untreated wood visible - even floors in new builds curve as they join walls so germs can't congregate in hard-to-clean corners.

But I digress.

This is also where the people who punt out all those statistics on waiting times, cancellations and attendances sit - its called Information Services Division. I say that, the name might have changed, we've just been through a reorganisation and if I'm being honest, I'm no longer sure what division I work in, never mind ISD.

Temple of Artemis at Ephesus. Sometimes (although less accurately) known as the Temple of Diana - what ever you do, don't let The Daily Express know. 
In the 'news,' you'll never guess; we have Jenny Marra from Scottish Labour claiming credit for an SNP government U turn which didn't happen on a policy which up until that point Labour MSP's didn't give a shit about.

Its been a while since 'Scottish' Labour had the reins of government in their grubby little mitts, but when they did - they didn't report NHS statistics with any regularity - which leads us to my point.

As you would imagine, its a lot more complicated than you might think - to go from quarterly to weekly reporting is no mean feat, in fact, I imagine it'll present significant challenges. There are fourteen NHS boards in Scotland who collect & own the data required. Sitting to one side is National Services Scotland which is essentially thought of as another board but is mostly not patient facing - its where all those pesky managers and bureaucrats are - all that data coming from the boards needs to be shared with ISD (which is a division of NSS) then crunched.

The Mausoleum at Halicarnassus. Well this is awkward, A.K.A The Tomb of Mausolus, who was interred there with his wife Artemisia II of Caria... Who was also his sister... (As you do...)
Except the word 'crunched' doesn't do it justice - its massive undertaking in terms of computing time. Also some of the data is patient identifiable - a huge no-no - so needs to be anonymised. After that it needs to be checked and checked again.

Take Orkney, home to the smallest NHS board serving just under 20,000 people. In Dec 2014, 419 A&E attendances were recorded. Hospital in-patient activity to September 2014 saw 1457 (Quarterly figure) patients treated across all specialties. At the other end of the spectrum you have Greater Glasgow & Clyde who's A&E departments saw 36,118 patients in December 2014 and saw 423,926 in-patients treated to the end of September 2014.

The Colossus of Rhodes. Accounts differ, I like to think he stood astride the entrance to Mandraki harbour as drawn above. It was a statue of Helios; the Greek Titan-God of the sun. Some say Colossus referred to its height (some 30m.) There are scholars who believe it is what seafarers thought when they looked up and saw his 'package' as they entered the harbour. (I made that up.)
I know I'm being a bore, even finding the information in the previous paragraph took monumental patience and while I didn't contemplate suicide as such, I never ruled out self harm.

Suffice to say, those figures represent the two boards at either end of the range in terms of population and represent a fraction of the patient facing activity all boards take part in. We haven't even mentioned the number of GP appointments or home visits, or talked about referral waiting times across all the various services the NHS in Scotland provide - not limited to cancer care, child health, drugs & alcohol misuse, dental care, health & social community care, heart disease, maternity & child birth, mental health (adult and child), sexual health, strokes and a good bit more besides.

The Lighthouse at Alexandria.Finished in 247 BC, it was finally abandoned in 1323 AD after earthquake damage. During that time, it was the tallest structure (120 to 137m tall) in the ancient world - which is impressive, but not as impressive as Helios' balls as you entered Mandraki harbour.
To get stats in all, or even some of those areas published on a weekly basis is going to be tough. I'm told the relevant departments are enthusiastically recruiting statisticians and analysts - bearing in mind, a large number saw their jobs evaporate during a previously severe workforce contraction - to get the figures out on a monthly basis. 

No doubt the clueless (and slopey shouldered) Jenny Marra will be on hand to bemoan the number of so-called backroom staff employed by the NHS in Scotland.


  1. Yes, I’m sure Labour were pouring out figures and being totally transparent all the time that they were in coalition.

    Of course, you are right to point out that we (and I’ve done it too) moan about all these manager and accountants and what have you, when there’s not enough nurses to cope with patients’ needs. People (me included0 just don’t stop to think what a massive job it is to run even one small clinic, never mind massive hospitals and that you can have all the nurses and doctors in the world, but if the place is filthy, and the bins don’t work and the curtains are infested with gems, folk will just die…

    Thanks for explaining it. I guess I knew there was a lot to do, but it’s not toil you see it written down that you are aware of it.

    Jenny Marra is a daft wee lassie, like the rest of the third raters in Labour’s Scottish branch office accounting unit.

    As Nicola said today… we all know what Kazia didn’t say anything about the health service at FMQs.

  2. I like that lighthouse. I'm amazed that anyone would have balls more impressive than that!

    1. Thanks Tris.

      I never knew myself what a lot of the poeple who sit round me at work. To be sure, some are treading water, but the deadwood got the heave after the crunch five years ago, its only now that staffing is beginning to rise again.

      'Scottish' Labour motormouths like to make all sorts of claims and demands, but have no idea what it takes to deliver.

      Jim, Kez and Jenny have deployed a political policy blender, loaded it up with crap and turned it on with out securing the lid. Now, we're all being spattered with shit policy ideas, unfounded criticisms and nonsense complaints.

      The lighthouse is impressive, but there is a certain je ne sais pas about Mr Rhodes...


  3. Well Paw I read your article and as someone who for a very short time worked in the NHS I know how hard people work there and how there are good people working there sometimes for a pittance. As for waiting times, as someone who fell foul of them way back before the day of the Scottish Parliament and their control of things NHS. I am lucky to be here, because in 1998 I had the misfortune to discover that a previous diagnosed wart had gone bad, I went to my GP in early January in fact the first day after the reopened after New Year and my appointment was the 18th October. I say lucky to be here, because I was then diagnosed with a Malignant Melanoma.
    Now my memory serves me very well and something about the NHS being under the control of Westminster and a Labour Government as well. Since then I have had one or two scares, fortunately nothing like another Melanoma and I have been seen as I was told I would be within two weeks.
    One of my jobs in the NHS was to produce stats for my Department, it originally took ages to do with the out of date system they used but fortunately by the time I left it was easier I certainly would not want to be producing them weekly.
    I loved the pictures, had the good fortune to have been to Ephesus twice about 20 years apart, The new Houses were very impressive, they are still excavating and many more things to find there. Never been to Rhodes or Egypt though. I have been to Bodrum where the tomb of Halicarnassus was and I am sure that was another of the seven wonders of the Ancient World,
    Let us hope we make Labour a defunct ex wonder.

  4. More like Plunder of the World than a Wonder Helena..

  5. Hi Helena.

    The NHS in Scotland isn't prefect, when I joined ten years ago it was rather bloated. People would leave their job in the NHS and come back as a contractor tripling their salary doing the same thing.

    That all stopped and a great many people got the heave ho, our department is only now coming back up to what it was before staff-wise - we're quite busy. Since we equip hospitals and health centres it must bode well.

    I don't think I've seen any of the wonders of the world, ancient or otherwise. Perhaps I'll get to it at some point.

    Thanks as always for reading.


  6. I worked in the NHS warehouse at Canderside, for a few months, when the building trade was on it's knees (it's still a bit iffy on it's feet), so I know how much stuff hospitals go through on a daily basis, a shit load (technical term).

    As for Marra and the rest of NAUtiLuS (northern accounting unit Labour Scotland), soon to be sinking below waves, they must have huge brass ones like the colossus, to come out with the shite they do, day after day.

    1. I'll be through at Canderside next month for a meeting. I've managed to avoid going there up till now.

      Mmm, is Murphy a modern day Cptn Nimmo minus the gravitas of course?


    2. If he is, hopefully he will be left on the Mysterious Island, of political oblivion.

  7. Pa

    I must admit I don't know much about the inner working of the NHS but there are things that I don't like. I don't like that politicians as soon as they get into power take it through yet another re-organisation which usually means can we save money while not allerting the public who can't afford private health care. I don't get public targets, we all have targets in our jobs but I feel that public targets like waiting times on a service that is a responsive service is pointless. Yes they should have targets and possibly clinical ones but that is something that I feel should remain within house and between government etc. If they don't meet them and there is no good reason hammer the Chief Exec but don't pit hospital against hospital but overall I wish they would just leave the f alone. I am less sympathetic towards education as I believe we are in the dark ages when it comes to them, 15 weeks paid holidays and in service training outwith those holidays is a joke and very costly on the country.

    Rant over.


    1. We've just been through a pretty costly and overly complicated restructuring. Its not so much driven by politicians, its just management fuckwittery mostly.

      That said, I don't exist at a level where ministers etc even know I exist. Its just typical office stuff, a bit Dilbert at times.

      Looks like Jim Murphy so by extension the Scottish press have got a boner for waiting times. Its a a bit false as you say, also, they always dip over winter.

      Murphy was on the telly gurning about it in that breathy way he does - I cannot stand him, he's just so shallow and transparent; the only thing worse than someone who doesn't give a fuck is someone who pretends they do.*

      That's Murphy and 'Scottish' Labour to a tee.

      * A quotable quote - get me.


Thanks for comment as always and I apologise if you have to jump through any hoops to do so. Its just that, I'm still being spammed by organisations who are certain I can't get it up or when it is up its not big enough or that I don't have anyone to get it up for.

Who knew blogging could be so bad for ones self-confidence?