We visited the Outpatients' Departments at Queen's Hospital in October 2015. The Department is very large, dealing with over 100,000 patients a year. We were aware from various sources, not least patients themselves, of significant concerns about waiting times for appointments - both initial and follow-up - as well as the time taken within clinics before patients are seen for appointments on the day.
In April 2017, BHRUT confirmed to us that all actions in the action log had been completed by December 2016.
We undertook a further visit to the Outpatients' Departments in May 2018. We visited all four of the "Teams" into which the Departments are divided other than Ophthalmology, which although in Team One is the subject of separate review by Healthwatch.
The groups of volunteers who carried out the visit concluded that, although the four Teams each cover very different specialisms and thus work differently, a common theme is that, while patients regard the clinical service they receive highly and praise individual staff for their effectiveness and helpfulness, there are significant issues around the appointments processes and over-crowded accommodation. In particular, there seems often to be an inordinate time between arrival for an appointment and actually being seen by a clinician. There is a significant risk that the benefits of excellent treatment could well be obscured by the frustrations of getting to be seen, both in terms of waiting time and being in an over-crowded location. It is also unfortunate that patients appear to be penalised for late arrival for appointment whereas there is no balancing compensation to them for being delayed while waiting to be seen.
In Teams 3 and 4 patients who were waiting had the option of going elsewhere within the hospital to wait in more congenial surroundings such as the coffee shop in the hospital atrium. This should be extended to all of the Teams.
Another recurring theme was the apparent reluctance of some staff to enable patients to identify them. BHRUT issues name badges, indicating an individual’s name and role and these should be worn; ID/security passes are insufficient for this purpose. ID/security passes and name badges serve different purposes and neither is adequate substitute for the other.
Finally, it was clear that most clinics operate in a somewhat cramped environment. This is good for neither the patient nor the staff they need to see. Overall, the Queen’s Hospital is, despite its size, a very congested environment and it may be helpful if some at least of the out patients’ clinics could be accommodated elsewhere than in the hospital. There are a number of NHS facilities across the Barking, Havering and Redbridge area where satellite outpatient services could be provided, bringing services nearer to the patient’s home while relieving some of the pressure on accommodation at the hospital. It is acknowledged that this already happens: both King George and Barking Hospitals are used in this way; but there may be opportunities to make use of accommodation in other NHS facilities, not owned by BHRUT, such as the Harold Wood Polyclinic, for outpatients’ consultations.
1 That the appointments process be thoroughly reviewed to bring patients’ arrival times more closely into alignment with consultation times. The seemingly routine expectation that there is inevitability about the delay between arrival at a specified time and being seen is unacceptable.
2 While it is acknowledged that patients’ failure to attend for appointment is a frequent event that causes unnecessary expense and disruption, patients who arrive late for their appointment should not routinely be penalised and, in particular, threatened with the cancellation of treatment.
3 Patients who arrive on time for appointment but have to wait for more than a short time before seeing a clinician should be compensated in some way: at the very least, pager devices (such as those commonly used in restaurants) should be issued to patients to enable them to wait elsewhere if they so wish until they can actually be seen by the clinician(s) with whom their appointment is.
4 Patients should be given detailed guidance about how to get to the place of their appointment and reminders, whether by telephone message, or text, should reiterate that.
5 In addition to formal ID/security passes, staff should be required to use name badges (which are issued in any event). Temporary staff could be issued with re-usable name badges similar in style to those used by permanent staff, in which locally-printed name slips can be inserted.
6 Given that accommodation within the hospital is at a premium, to the extent that the Teams’ accommodation is frequently over-crowded, consideration should be given to operating more clinics from satellite sites.
These reports relate to the visit in 1 October 2015 and May 2018 and are representative only of those patients, carers and staff who participated. They do not seek to be representative of all service users and/or staff.
BHRUT responded formally to our October 2015 report and provided an action plan - these documents are available below. They also responded to the May 2018 report - the response and action plan are included within the report, also available below.
For information about BHRUT, click here
Click here for the CQC's inspection reports on Barking, Havering & Redbridge University Hospitals Trust (proprietors of Queen's Hospital)