"I would rather wait for quality care"

Wednesday 12 February 2020

The quality of care provided by the MSG cannot be compromised in the pursuit of shorter waiting times, the Group's Chairman has said.

Dr Gary Yarwood was speaking following the release of the Medical Specialist Group's annual report for 2019.

The practice has targets for seeing patients within a specified amount of time as part of its near £18m. contract with Health & Social Care. It is meeting many of those, but in cases such as orthopaedics, it is yet to reach those targets. 

"We had 12,500 [orthopaedic outpatients] in 2018 and 2019, compared to just over 20,000 in the previous four years, so it is a really significant increase," he said. 

The island's health care system is starting to see the effects of an ageing demographic. 

"But there have to be more complicated reasons than that," Dr Yarwood said of the increase in orthopaedic operations.

Pictured: 71% of inpatients were seen within the contractual waiting time, which was an improvement on the years before but still well below the 95% target. 

One suggestion he put forward was that more people might be using the MSG now, because of its enhanced team of surgeons, compared to relying on off-island providers through their health insurance. 

"We have expanded to a fourth surgeon which has improved our sub-specialism in different areas of orthopaedics."

Some of the most complex operations will always go off island, while some patients are being to the UK or their operations in order to ease waiting lists, which state that, as a target, 95% of MSG patients should be seen within a contracted waiting time. 

"As a clinician I am proud of the clinical matters that are going to affect many patients," said Dr Yarwood. "I would like to have a low day patient conversion rate, a low Hospital Acquired Infection rate, I would like to know that I am not going to be readmitted because of unplanned bleeding.

"These are the areas at the sharp end of medical care, and we achieve these things with our really good team of staff. 

"I would sooner wait 12 weeks for a really good operation than wait seven weeks for one that doesn’t go very well."

Pictured: The MSG's Mill House site. 

The target of admitting and discharging at least 95% of Emergency Department patients within four hours is currently 4% below that, however HSC Medical Director Dr Peter Rabey said their performance compares favourably with UK hospitals, even those with greater resources on hand. 

"The targets are the same as the UK, but at 91% we are doing much better than the UK, which is only managing around 80%," he said. "I think our target is ambitious, as we don’t have the things which would allow us to game the system, such as junior doctors who can see patients - we work only with consultants."

With 12 full-time equivalent consultants and a team of nurses, there is always going to be limitations to what can be staffed and how often. For example, the CT Scanner cannot be staffed all night long because of the staff resources of doing so, and there are limited beds in some units, while there are "single points of failure" if a consultant is unavailable. 

Pictured: Readmission rates at the Emergency Department are better than target, but waiting times have only been met 91% of the time, compared to a 95% target. 

However, Dr Rabey said the planned investment in the PEH will expand services that are currently physical landlocked and improve efficiency by moving the maternity ward closer to the operating theatres and increasing the size of the ICU, among a number of changes. 

"Designing these services also takes a huge amount of clinical time because they need to sit down with the planners," he said. 

"The current hospital is just about coping with current demand and is not going to cope with future demand."

Pictured top: Dr Gary Yarwood and Dr Peter Rabey.