New Eye Hospital

[John R]

Seems those of us living in Yorkshire, in main between Leeds & Bradford. Are to get a new £2m hospital, which is claimed to be the first specialist eye hospital in the country to be funded, developed and run by eye specialists. It is to open at the end of the year.
To be called "The Yorkshire Eye Hospital" and located at Apperley Bridge. It is being established by 18 ophthalmologists and will provide services for corneal diseases and glaucoma treatments for GPs and optometrists in the area.
This should lead to a speedy diagnosis and treatment of eye related problems.
Lets hope that they will work with the local hospitals to give us the best eye care in the UK.
I will have to have a look just where its situated as its very close to me.

[chip anderson]

Hope they don't dispense and work with local opticians.

[John R]

Chip, We work in a diffrent way over here. All, well just about all opticians dispense glasses/contacts. As they say its what keeps them in buissness. If you get refered to a eye hospital it will be either by your local doctor (GP) or optician who has found a problem. The only dispensing done via the hospital will be for people who have very bad eyes, not your everyday run of the mill person.
So in the UK Hospitals need to have a good relationship with the local opticians and GP's to ensure proper treatment.

[Tim Hunter]

John R said:
Lets hope that they will work with the local hospitals to give us the best eye care in the UK.

John I think what you'll find is that these ophthalmologists work in those local hospitals and that they are bidding for NHS contract work in their private hospital. As they are also the ones who control through put in the NHS (waiting times)many of us have great concerns about a major conflict of interest here.

The local Trusts do not regard this as a positive step forward but are worried that it moves some of their ophthalmologists focus from sorting out problems in the NHS to maximising their private income.

[John R]

Ah i see your point. As the saying goes You can't be in diffrent places at the same time. So we could end up worse off unless we have priviate health cover then....
As details are a bit thin on the ground on this project, i had never taught of this angle. It was my wife who noticed the sign up on the building (She reminded me last night after reading this) many weeks ago and had asked who, what and when.
I think that any consultant who is engaged in working for the NHS should be contracted to do a certain amount of hours monthly before they can think about doing any priviate work. Or even make the choice of either NHS or priviate to stop any conflict of interest.

[John Tickner]

I suspect the impetus for change amongst the consultants concerned is theit new NHS Consultants Contract, that many are opposed to.

In that respect I must admit I have a great deal of sympathy for them. The amount of NHS bureaucracy that I have to put up with in order to contract to the Health Authority is bad enough, and my understanding is that the objection to the new Consultant contract is along similar lines- that there is too much influence held by managers over clinical staff.

I think that it could well be for the better to have arrangements such as this, or medical "chambers" type practices as barristers have ( see recent BMJ for discussion). Certainly, it would make life a lot easier for me and my patients to be able to make use of these services, rather than the cumbersome GP gatekeeper model that we have now for NHS patients.

Lets not forget that the NHS has been described as a fantastic model of health care - but it has never been copied...WHY ? Moreover, all the old Eastern Block countires are now dismantling their state monopolised Health Care systems.

Its not only the sight test that is out of date, but quite possibly the whole NHS structure.

[John R]

John Tickner said:
, but quite possibly the whole NHS structure.

Totally off track but, i do agree that the health service needs to take a step backward. Clear out a lot of the managers and let the health proffesionals run the show. Far too much money is wasted on needless people pushing bits of paper round instead of bums on beds....

[John Tickner]

My reason for mentioning restructuring of the NHS is that I think without radical change, there will be more and more initiatives such as the one you described at the start of the thread.

This initiative is likely to become more commonplace as dissatisfaction within the NHS grows, it is a symptom of a wider problem, not just an isolated incident, or novel idea.

[John R]

John Tickner said:
there will be more and more initiatives such as the one you described

So what you are saying is that more and more of the consultants are likly to decide that private is the way to go. Instead of staying in the NHS and trying to reform from the inside.
Would be a sad day when we lose the NHS.

[sarahr]

So if I understand this, we have to trust the Ophthalmologists to bust a gut to clear the waiting list or else they'll be in danger of earning big bucks for the remainder? That sounds cynical, i know, but i'm sure the vast majority are commited to giving their patients the best service possible but it must introduce temptation to a human being with bills to pay...

[John Tickner]

The idea is not that medicine is private, but that consultants are able to opt out of the NHS bureaucracy.

They can then work from chambers/independent hospitals and contract back in to the NHS by offering clinical services WITHOUT having to accept the bureaucracy.

There is a short waiting list for purely private surgery, and a long one for NHS surgery. Why ? No other country has this problem - why do we accept it and at the same time claim to have a fabulous health care service ? We don't, we have a gigantic lumbering bureaucracy that copes very well with acute conditions, and appallingly with chronic conditions.

If certain groups of specialists eg ophthalmologists/urologists/anaesthetists etc continue to opt out, and then contract back in, expect to see dramatically reduced waiting times and better services.

For further discussion go to www.bmj.com and search for "Doctors' chambers pipe dream or blueprint for the future?" and related articles.

I believe it will be a great day when the NHS is replaced with a more effective system that will still operate without charge to the patient, but for this to happen we have to "ditch the dinosaur".

[Tim Hunter]

John Tickner said:
There is a short waiting list for purely private surgery, and a long one for NHS surgery. Why ? No other country has this problem - why do we accept it and at the same time claim to have a fabulous health care service ? We don't, we have a gigantic lumbering bureaucracy that copes very well with acute conditions, and appallingly with chronic conditions.

John I have to say that it's somewhat disingeneous to suggest that private healthcare is more efficient than NHS health care on the basis of waiting times. I could certainly see patients more quickly for private LVAs if I wished to because I have maybe 1-2 per week, However I have a waiting list for NHS LVAs because I see 30 a week. It's not only about bureaucracy it's also about volume.
The other interesting point is that I'll bet you the waiting lists do not go down too far in the NHS even with this private work being done as if there are no waiting lists there is no incentive to go privately or for the PCTs to contract NHS work out. It's like the joke about the talking pig (you don't eat it all at once or you kill the pig! or in this case cash cow)

I have nothing against private healthcare, I do have significant problems with the control of waiting lists being influenced by those who have a financial stake in a "private solution".

[John R]

Tim Hunter said:
It's not only about bureaucracy it's also about volume.

Well i guess that so few of us in the Uk have
Private Healthcare, that waiting is not yet a problem. If you were to take away the NHS then i could see waiting times shooting to even longer than now with the NHS...Why because there are only so many bodies to see you.. You could also argue that in a privite healthcare service there is even more Red tape to over come.
If i wish to use my BUPA i have to get it cleared by calling them just to find out if they can sort me out...and that after seeing a doctor.. No longer can you lie on the strecher shouting BUPA as your wheeled into hospital....

[John Tickner]

Sorry Tim, we seem to have found a point that we disagree on at last !

I don't accept that it is disingenuous to say that waiting times would fall because there would be a significant drop. Private appointments and consultations take up far more consultant time than NHS ones.

If we can find a way of removing the inequity of private medicine it is better for all. Philosophically, I don't approve of "purchasing" a routine op. just because you can afford to, and therefore someone less well off has to wait. However, I refer at least 30% of my patients privately (their choice) in order to get the problem solved now, not in a years time!

I have yet to be given an acceptable reason for our waiting lists compared to the rest of the Western world, isn't the major reason the NHS itself ?

[chip anderson]

I don't have a dog in this fight, but over here most doctors see at least 25 or more patients a day whether priviate or public. Don't see why any doctor would see only 2-3 patients a day unless he was doing something much more time consumeing an involved thant an eye exam.

Even those doctors that do their own exams and refractions (as opposed to having techs do it) see a lot more patients than this.

Chip

[John R]

chip anderson said:
Don't see why any doctor would see only 2-3 patients a day

Chip. This is due to the fact that they are working both camps so to speek, and only have limited time to deal with private cases.
This is one of the problems with the service in this country. The NHS trains the doctors up and employs them. Once they reach consultant level (God of Gods over here) they (I will add most as some dont) want to milk the sacred cow and rather than repay all the training they have got for free. Slip off and see all the money comming into their bank accounts..
Over here most people see an optician in their own shop to have their eyes tested and will only ever get to go to hospital for eye problems. Stuff like squints etc.

[Tim Hunter]

John Tickner said:
Sorry Tim, we seem to have found a point that we disagree on at last !

I don't accept that it is disingenuous to say that waiting times would fall because there would be a significant drop. Private appointments and consultations take up far more consultant time than NHS ones.

If we can find a way of removing the inequity of private medicine it is better for all. Philosophically, I don't approve of "purchasing" a routine op. just because you can afford to, and therefore someone less well off has to wait. However, I refer at least 30% of my patients privately (their choice) in order to get the problem solved now, not in a years time!

I have yet to be given an acceptable reason for our waiting lists compared to the rest of the Western world, isn't the major reason the NHS itself ?

John I'm sorry that first paragraph doesn't make much sense to me, I'm probably not reading it correctly, could you clarify your point.

My point was that private medicine will always have smaller waiting lists than the NHS because there is less volume going through that sector. If the private sector had to cope with the volume of present NHS work it would probably struggle to beat the present waiting times of the NHS.

From my perspective the reasons why we have a lenghty waiting list in Leeds for Ophthalmology is twofold.

1. Too many patients for too few staff. Insufficient capacity basically due to poor resourcing over the last ten years plus.

2. Complex cases referred from other local units

I suspect there are cases where the NHS has been(and may still be) run inefficiently and there is always room for improvement but until the system is better resourced (present Labour funds are only designed to bring us up to European average on health spending it doesn't take acccount of the massive underfunding that has gone on for decades) don't expect massive improvement.

[John Tickner]

My understanding of a typical 3-4hr NHS clinic is that 15-20 patients will be seen.

That is certainly the number seen in my local satellite clinics- I don 't know about hospital based clinics, but my (limited) experience is that it is of the same order.

Private clinic appointments, however are booked at 30 minute intervals- i.e 9-8 patients per clinic.

If a consultant works 1 week private, and 1 week NHS, as my local consultants do; and the waiting list for NHS is six months and one month for private, then I fail to see why the combined waiting time (if the difference were removed) would not be the average of the two i.e 3.5 months.

This calculation assumes the same length of consultation which is manifestly not the case, and factoring in this figure reduces waiting time further.

There are other problems associated with the NHS. Because there is no "cost" to the patient; there is no perceived value. I have recently been informed of a patient who has returned to the same surgeon for a 20th operation for what is usually a routine single procedure. Unfortunately the surgeon is not very good, but the patient does not perceive this and continues to return out of a sense of loyalty.

If the system is amended, doctors and surgeons would stand or fall according to their results which is how it should be. It is totally unacceptable that every GP, and hopefully every optometrist, knows that there are people out there that you would not dream of allowing to operate on members of your family. And yet we still refer patients to them.

The system needs a complete overhall - Bristol heart surgery and Dr Shipman are the tip of the iceberg.

[John R]

John Tickner said:
I have recently been informed of a patient who has returned to the same surgeon for a 20th operation for what is usually a routine single procedure. Unfortunately the surgeon is not very good, but the patient does not perceive this and continues to return out of a sense of loyalty.

If he is such a poor surgen and has so many re ops why has this not been picked up the the managment at his/her hospital and action taken..Or is this just one of them cases that happens from time to time.

[Tim Hunter]

John T your figures are about right, the RCOphth guidelines recommend 15 patients per clinic. Our Consultants usually have 12 new per clinic and their support team see 15 follow ups each, as well as all the walk ins.

The advantage of having a consultant seeing all patients is that they are much more likely to discharge patients, which juniors are less likely to.

I suspect that root and branch reform of the NHS will take a lot longer than everyone would like and will require more resources than the Government would like. I'm not holding my breath.

[John Tickner]

If he is such a poor surgen and has so many re ops why has this not been picked up the the managment at his/her hospital and action taken..Or is this just one of them cases that happens from time to time.

Harold Shipman... YES, the Harold Shipman, said in an interview in the 1980's that one would be long retired before being struck off by the GMC !

[John R]

In passing the other day i noticed that they had a sign with contact details including email...
Also from this i have discovered their web site

I have also emailed them asking if they would like to join in this dissuusion. I wait with baited breath.

[chip anderson]

As to the patient who saw the surgeon 20 times, bad surgeons need stupid patients. I would say that in this case they are well matched.


Now as to the waiting time. Ever since ophthalmolgy became the highest paying specialty in U.S. medicine, we have been turning too many of them out. This has been delt with by forming super subspecialties. Now a clinic can have the same patient seen by 5 or more sub-specialist with a different fee for each one. Low is the ophthamologist who does ennucleations, catraracs, retinal work, opthalmic neurology, lid repair, examinations and actual treatment of disease. Now you need a whole fleet of ophthalmologist to do what one used to be capable of. Perhaps in the United Kingdom you might want to import some from the U.S. and relieve our over abundance of ophthalmologist and your backlog of patients.

Chip

[Tim Hunter]

Chip

I doubt they'd be happy with the money working for the NHS over here and certainly other Ophthalmologists wouldn't want the private competition.