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Care Opinion

Shocking behaviour organising outpatient appointment

Posted By Shammy

"Shocking behaviour organising outpatient appointment"

About: Forth Valley Royal Hospital / Gastroenterology Forth Valley Royal Hospital / Outpatients NHS Scotland

(as a service user),

I received a phone call today about a referral for an appointment with the gastroenterologist for my daughter. The experience was so poor that I felt the need to share, so that hopefully others will not be subjected to the same intimidating, abrupt, and quite frankly, uncaring attitude that I experienced.

I picked up the phone and the person on the other end asked to speak to my daughter. No introduction or explanation. I explained that my daughter was at school and asked if I could help. The person on the other end of the phone launched into a spiel about my daughters "gastro appointment" and meeting targets. At this point I asked them to stop and explain who they were and why they were calling. The response was "This is Forth Valley Royal". I thought this was quite an unusual name for a person!

The individual then went on to explain that they had noted we had asked for a postponement of the appointment until June in order to accommodate exam time, but that they had a waiting time target to meet and we needed to make an appointment before then. The individual then went on to say if we did not accept one of the three dates they were going to offer on the phone today, that we would be removed from the waiting list and would have to be referred again.

This felt like some kind of pressure sales tactic - "you need to let me know today on the phone..." or else! This wasn't even done in a nice gentle way, it was pushy and abrupt. It was all about the needs of the system to meet the target, not about our needs as a family. I repeatedly explained that we wished to wait until later in May or early June until exams were over, but this fell on deaf ears. Meeting the target was what mattered.

It didn't end there. A date was offered which was not suitable, and then another which also wasn't convenient. When the second date was declined the person said: "now you have to be careful, because if your refuse this date you are onto your third and final one...". I was shocked by both the motivation for the call (meeting the needs of the government target, not the needs of the person) and the attitude and manner of the individual. Not once did this individual mention their name. Not once did the individual apologise. It was a call with the aim of getting us to comply with the needs of this clinic to meet the waiting time guarantee. Truly shocking.

Do the Scottish Government performance management team realise that this is what is happening?  And possibly not just with this target. I stood up to this person with their demands, but what about someone who is more vulnerable? How many people are being pushed (even intimidated?) into taking appointments which don't suit them just so a box can be ticked and a target met?

I wouldn't be surprised if my experience is just the outcome of a culture that is driven by targets, a performance management culture rather than a person-centred culture.

Please, please reflect on this and ask yourselves (NHS Forth Valley and Scottish Govt) whether a system driven to perverse behaviour by such targets is really the kind of system that will deliver high quality, safe, person-centred care? I think the evidence and my experience is to the contrary.

And please, please, to the person who called me, I appreciate that you have a difficult job and that the system around you is not very person-centred, but please reflect on your manner and think about the basic elements of compassion and courtesy in your interactions with other human beings.

Thank you :-)

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Responses

Response from Elaine Kettings, Chief Nurse, Falkirk Health & Social Care Partnership 5 years ago
Elaine Kettings
Chief Nurse,
Falkirk Health & Social Care Partnership

Submitted on 10/05/2018 at 09:09
Published on Care Opinion at 15:43

Dear Shammy,

Thank you for getting in touch, it is really important to us that we hear from our patients, relatives and carers when the services we provide are not meeting the desired standard. I am really sorry that your experience fell short of this standard

It would be really helpful if you could contact Karyn Gibson Health Records Manager, Karyn is really keen to speak with you to get a bit more information but also to allow her the opportunity to offer a suitable appointment for your daughter.

Karyn's email address is Karyn.gibson@nhs.net

Thanks again for contacting us through Care Opinion.

Elaine Kettings

Head of Person Centred Care, NHS Forth Valley

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by Shammy (a service user)

Thank you for responding to our story – its good to hear from you.

I think we are ok with managing the appointment process thank you. We are savvy enough to be able to get what we need, but its harder than it should be because of the culture in which targets dominate, and then harder again because of the attitude we encountered on the phone call.

I suppose what we are really looking for is to hear about whether the team who make these calls have had the opportunity to reflect on our story, and whether any changes might come as a result?

We just want to try and help you to avoid repeating this experience for others…

Response from Pauline Marland, Medical Director, NHS Forth Valley 5 years ago
Pauline Marland
Medical Director,
NHS Forth Valley

Submitted on 14/05/2018 at 13:30
Published on Care Opinion at 16:29

Dear Shammy

Thank you for your post explaining your experience. Reading it caused me concern and so, in addition to Elaine’s reply, I’ve asked for us to find out more about the team who would have had this conversation with you and for us to share your post with them to allow them to reflect and respond. I’ll ensure that response is posted in the very near future.

Regards

Andrew Murray

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by Shammy (a service user)

Thank you :-)

Response from NHS Forth Valley 5 years ago
NHS Forth Valley

Submitted on 28/05/2018 at 14:26
Published on Care Opinion at 16:03

Dear Sammy

Thank you for taking the time to send us your feedback. I really am sorry that you were left feeling so let down, I can't begin to imagine how frustrating and upsetting this must have been for you.

I would like to reassure you that this is not the behaviour I expect from any member of my team. You will appreciate that the Booking Team do have to work in a challenging environment, adhering to the organisation’s Access Policy, however this is usually managed in a professional, effective way, providing a satisfactory outcome for our Service User, unfortunately that this was not your experience.

I am keen to use your comments as an opportunity to reflect on how we are communicating with Service Users and to consider what learning we can take from this. With that in aim in mind my Service Manager, Karyn Gibson, shared your story with our Booking Team, who were both shocked and disappointed by what they heard.

In an effort to improve the service we provide, Karyn and a small group of our Booking Team have formed a focus group that will work to review our current practice with the intention of making it our aim that every telephone conversation is a positive experience with a satisfactory outcome.

Thanks again for sharing your story.

Kind regards

Lorna Rodger

Head of Health Record Services

NHS Forth Valley

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by Shammy (a service user)

Thank you for taking the time to get back to us and its good to hear that the story about our experience will be of help to your team.

I do appreciate that the context you work in is challenging, targets are a pretty unsophisticated method for improving performance. Hopefully the Scottish Government team responsible for this one might also get the opportunity to reflect? We’ll see if a response is forthcoming... I’m not holding my breath though :-)

Thanks again for taking the time to respond.

Response from Craig White, Divisional Clinical Lead, Directorate of Healthcare Quality and Improvement, Scottish Government 5 years ago
Craig White
Divisional Clinical Lead, Directorate of Healthcare Quality and Improvement,
Scottish Government

Leadership team supporting improvements in quality across health & care services

Submitted on 12/06/2018 at 16:54
Published on Care Opinion on 13/06/2018 at 16:01

picture of Craig White

Dear Shammy

Colleagues at Care Opinion flagged your posting with me on Twitter a few weeks ago, which prompted me to speak and then meet with colleagues who lead Waiting Times policy.

The Scottish Government is committed to ensuring people get access to hospital care. This is why targets have been set. If someone advises a Board that they will be unavailable for a period of time due to say, holidays, work commitments or examines, then the Board should pause the waiting time until the person is again available to accept an appointment.

This means if the person has a waiting time target of 12 weeks and they advise that they will be unavailable for 4 weeks then the Board will have 16 weeks in total to see or admit the person as there will 4 weeks which will not count against the target. (16 weeks minus 4 weeks unavailability equal 12 week target). This ensures that people can delay hospital for personal reasons whilst still being covered by waiting time targets.

As you may be aware the Scottish Government commissioned Professor Sir Harry Burns to review Targets and Indicators in Health and Social Care in Scotland. His report can be read here: http://www.gov.scot/Resource/0052/00527689.pdf and the Official Report of an evidence session attended by the Cabinet Secretary and her officials to discuss some of these issues is available at http://www.parliament.scot/parliamentarybusiness/report.aspx?r=11497&mode=pdf

If you would like any further information on the work referenced in the evidence session then please do get in touch with me at craig.white@gov.scot and I will put you in touch with colleagues who are working on this.

I am pleased to see that NHS Forth Valley staff are using your feedback to support discussion and identify learning and change needed to ensure that no-one else has the sort of unsatisfactory experience you described.

I hope that this is helpful and am sorry for the delay in posting this response.

Best wishes

Craig White, Healthcare Quality and Improvement Directorate

The Scottish Government

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Update posted by Shammy (a service user)

Dear Mr White

Sorry for the delay in thanking you - I missed this response in my inbox. Thank you for the work you have put in to get this information and clarify waiting-times policy for appointments. I really appreciate it!

Allowing the person to take control of the waiting-time clock and press pause is a really sensible approach. One wonders how widespread knowledge of this "pause" process is both for the public and the teams interacting with them? The person that spoke to me seemed to have no knowledge of it. Perhaps in the busy-ness and pressure of the hurly-burly they just forgot about it?

Anyway, thanks again. I really appreciate the additional information and further explanation.

shammy.

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