Memorandum by United Bristol Healthcare
NHS Trust (PST 42)
Following my meeting with PASC on Tuesday 10
December I would like to respond to your request to respond in
detail to the questions in the paper.
Q15: There is a strong sense that NHS targets
are introduced without any attempt at piloting or feedback and
that front line clinicians have not been consulted.
Q27: The waiting time targets for new outpatient
appointments at the Bristol Eye Hospital have been achieved at
the expense of cancellation and delay of follow-up appointments.
At present we cancel over 1,000 appointments per month. Some patients
have waited 20 months longer than the planned date for their appointment.
We have kept clinical incident forms for all
patients, mostly those with glaucoma or diabetes, who have lost
vision as a result of delayed follow-up; there have been 25 in
the past two years. This figure undoubtedly underestimates the
true incidence and of course there is the large backlog of patients
still to be seen. One particularly sad case was that of an elderly
lady who was completely deaf and relied upon signing and lip-reading
for communication. She lives with her disabled husband who like
her is completely deaf. Her follow-up appointment for glaucoma
was delayed several times and during this time her glaucoma deteriorated
and she became totally blind.
In addition to the distressing consequences
for the patients, the staff at the hospital have to deal with
a huge number of phone calls and letters often from patients who
are anxious and upset. Doctors' time is spent responding to 200
letters per week requesting that appointments be re-instated.
This activity is extremely time consuming and demoralising for
The outpatient waiting time target for new patients
has been introduced without sufficient resources and we have already
employed nurse practitioners and optometrists wherever it is possible
to do so and taken all possible measures to improve efficiency;
inevitably there have been adverse consequences for other areas
Q31: Targets in themselves are not bad. However,
it is important to choose the right targets and to monitor their
effects. When hospital trusts are assessed, other factors such
as CHI assessments, research productivity and clinical outcomes
should be taken into account as well as the star-rating targets.
Richard A Harrad
Clinical Director, Bristol Eye Hospital