"Poor management of the eye clinic"

About: St Thomas' Hospital / Ophthalmology

(as the patient),

This is rather a long story written in the hope of improving the management of the eye clinic and admissions system at Guy's and St Thomas' NHS Foundation Trust.

I’ve been prompted to place my story here because the trust has not responded to my complaint after 90 days, telling me that it would aim to respond n 45 days, and by a friend, a patient advocate, telling me that trusts are much more likely to respond to complaints posted here than to complaints sent through their systems.

My story begins with the complaint I sent to the trust in January.

This is then followed by a follow-up complaint I sent today. 

Dear Colleague,

I write this with something of a heavy heart in the hope that it will give you an opportunity to improve the organisation of the Eye Clinic. Please treat this as a complaint.

I have no complaints about my care, but I'm reminded of the common assertion that the NHS delivers 21st century care within a 19th century administrative system.

In late December I had an epiretinal membrane removed and a lens inserted. While waiting for the operation in the day unit I received a text telling me that I had an appointment at 9am in December.

I arrived with my wife just before my appointment and went to reception in Eye Clinic 2 where I was last seen. The receptionist didn't seem to know about my appointment and sent me to the reception in Eye Clinic 2.

I think that you'll agree that it's confusing to have two receptions. You should surely have one. At the very least the appointment letters and texts should make clear which one you should attend. At the moment they do not.

The receptionist in the other clinic, who seemed very unsure in their job, was surprised that I was there. They told my wife and me to sit down. We sat there for some 25 minutes, and I then asked the receptionist what was happening. They told me that I had to see the nurse, but he or she would not be in until 10. Many staff came and went, and eventually somebody took pity on us. She said that she had seen a nurse who might be able to help.

Nobody had told me what the appointment was for, although I suspected that it was a routine appointment after the operation to have the dressing removed and the wound checked. This check was, of course, redundant since I had on the instructions of the nurse removed my dressing and put in eye drops the morning after the operation. It was now three days since the operation.

Eventually, after 10am, I was seen by a nurse. She was not expecting to see me but said that she had arranged for a doctor to see me. She tested my eyes and inserted dilating drops. We then went outside again and waited to see a doctor.

We were then called into see the doctor, who was seeing me as a favour and didn't know why be was seeing me. He examined my eyes and said that I needed a scan of my retina. We went outside again and then went through to the other clinic for a scan. We then went back to other clinic and waited to see the doctor.

While waiting a volunteer with a tea trolley asked if we wanted a cup of tea or coffee. My wife asked for coffee and was given a boiling hot cup in a thin paper cup. It was almost too hot to hold. There seemed something farcical and unsafe about offering people with visual problems such a hot cup.

We saw the doctor at about 11. By this time I was losing patience and said to the doctor that I thought that this was a routine postoperative visit to remove my dressing and look at my eye. Unfortunately the routine postoperative clinic was not operating, and I didn't need it anyway. He agreed, and we left.

This was a tremendous waste of everybody's time.

I guess that what had happened was that your automatic system had sent me an appointment without anybody recognising that the postoperative clinic would not be operating.

It wouldn't have been such a waste of time if the receptionist had told me at the beginning that there was no clinic and I'd been called back by mistake. They never looked me in the eye, never helped me, and seemed wholly unsuitable for the role. I fear that they may have had no training at all.

I might add that I'm surprised that the clinic still uses paper records. My records are not that thick, but several times staff could not find relevant documents in my file. Indeed, the doctor who saw me in December could not find the notes written by the nurse who tested my eyes and had to go and find her to see where the test results were recorded.

I'm writing this email in the eye clinic in January. When I arrived the receptionist was not there, and I joined a queue. They returned and without saying anything to anybody in the queue worked on their computer for several minutes.

Thirty-five minutes after my appointment time I was seen by a nurse who tested my eyes and was, I think, anxious that something terrible had happened to my left eye because I could see none of the letters on the screen. I explained that I had had a lens inserted and could see better without my glasses. they asked if I'd had cataract surgery. I explained that I didn't have a cataract but that the consultant had said I would develop one within a year because of the operation and that he recommended doing one operation rather than two, inserting a lens when he did the first operation. The nurse seemed to know none of this. The records did not seem to make it clear.

I've been many times now to the clinic, and of course I observe how the clinic is always crowded. It's sometimes impossible to find a seat. I also observe that most people, including me, seem to wait a long time to be seen. Clearly if you had a more efficient appointment system people would not wait so long, the clinic would not be so crowded, and you could use the space more effectively.

Indeed, I spent two hours in the clinic. I spent perhaps three minutes with the nurse, two minutes having a scan, and four minutes with the doctor who told me to come back in six weeks’ time. The doctor did not show the scan to me, as has happened before, and I hadn’t any evidence that the scan had been looked at at all.

A ratio of nine minutes being seen to 111 minutes waiting explains why the clinic is so crowded and suggests enormous room for improvement.

While I pointing out deficiencies, I might add that when it was recommended that I have an operation I needed to go through preoperative assessment, which meant blood tests an ECG. Although I’d arrived at 2pm I didn’t get to the ECG department until nearly 5, and it had closed, I had to return on another day. Luckily I live close to the hospital, but I know that many people travel from outside London.

By coincidence a day after my miserable Thursday I visited another department with my wife, who had an appointment. Here everything worked smoothly and quickly, and we left the hospital satisfied some 30 minutes after the time of the appointment.

This experience shows that you can do better and that you have lots of room for improvement within the Eye Clinic. Everybody, not least your staff, would feel better if you could make those improvements.

I thank you again for my care.

Complaint sent today

This is a follow up to a previous complaint.

There are three parts to my complaint:

1.I was told that I should expect to hear a response to my complaint in 45 days, which itself seems excessively long, but I have heard nothing after 90 days apart from an initial acknowledgement.

2.My complaint is about the poor organisation of the eye clinic. I have been back twice since my complaint. Both times the appointment was postponed and both times I waited two hours for about to be seen for perhaps 10 minutes—and most of the eight minutes I saw the doctor was taken up not with examining or talking to me but in completing online forms. Indeed, the doctor needed to call help to complete the form.

3.I was told at my appointment in March that my operation to insert a lens would be done urgently—as I have one eye that is long-sighted and one eye that is short-sighted. I heard nothing, but I finally rang today and was told by the first person that I spoke to that something had gone wrong. I was then transferred and given an appointment for late April. I asked the second person what had one wrong. They said that they had no record of my operation being urgent and that if it was urgent I would have been give an appointment on the day. The implication was that I must have got it wrong—so the delay was my fault—but the doctor told me that the appointment was urgent and that an appointment would be sent to me.

All of my complaints fit together in showing the poor organisation of the eye clinic and admissions system. I suggest that a review and overhaul is needed.

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