Wednesday 12 December 2007


Again I shamelessly take themes that you, gentle readers, generate yourselves rather than having creativity myself. Again I'm caught by Disillusioned's comments about differences in service provision arising within the same Trust.

So I had a rummage around the stats and, what do you know, Disillusioned is right.

Within our Trust the General Adult services are pretty hit and miss. Some folk get a decent service, many don't. I could wax lyrical about why this is, but it'd be futile and consume me with despair which really isn't in the spirit of the Christmas season!

Within my own corner, Older Adults, my sector is seen to be working well. I've had my annual appraisal last week with a Director from another hospital and he reckoned All Was Good. I've presented at conferences how our team works, since it's seen as A Good Thing. Our Trust likes it and has had me doing teaching and roped in to meetings 'bout it all. In truth, it's all about the team (not me) so it's curious that I get to say my spiel when it's the team as a whole doing the work.

But it got me comparing my team with others. And there is indeed a lack of parity. My team has less qualified and less unqualified staff than any other team. It's the smallest. Other teams, that are larger, have broadly the same amount of work to do (referral rates and sector populations being comparable). In all teams no new patient has to wait more than 10 days to be seen, in our team referrals are all usually seen within the week. Access time aside, from referral with memory problems to receiving your first prescription for a cognitive enhancer, my team gives fastest access, a couple teams are similar but somewhat longer, one team has a delay of almost 2 months longer.

Interesting to see that folk in the same patch with more staff and the same amount of work have a less responsive service.

Now how the heck is this tactfully taken forward?


Disillusioned said...

I think this is something my own Trust is struggling with too. It is, I suspect, a difference in approaches. My supposition is that some teams (and I agree it is a team approach) see the patient as a problem, others see the patient as part of the solution. Sorry - that should probably be "service user" - but I hate that phrase and haven't come up with another I prefer.

Fiona Marcella said...

I hate "service user" too and have just been using it because I thought it was the politically correct thing to do.

Re time between referral and treatment - hmmmm, who gets referred? does it depend on your medical condition? the knowledge and contacts of your GP? the pushiness of your relatives? Is the nature of individuals who get referred to your team in any way different from thatof those who get referred elsewhere? Are your patients (or their relatives) glad and relieved to have been referred or embarrassed and resentful? Just curious

The Shrink said...

Folk in our corner are "patients" not "service users" or "clients."

Partly that's 'cause it sounds daft.

Partly that's 'cause we're not in to politically correct nonsense.

Partly that's 'cause the terms served their purpose 10 years ago but now it's unhelpful to stigmatise mental health and use terminology different to that in physical health medicine/surgery. An obstetrician has obstetric patients who are pregnant mums and aren't even ill. The term patient isn't seen as good or bad in most of medicine/surgery, it's just used to mean a recipient of health care. Why should mental health segregate their recipients of health care off? Worse, they attend their GPs as patients, attend a psychiatric out patient clinic, attend a day hospital or in patient ward, but aren't to be called patients?

Partly that's 'cause the term "out service user clinic" sounds silly, "out patient clinic" is just better.

Mostly it's because we consulted patients and relatives widely, through different informal carer forums, two formal carer groups, informal patient consultation ibn clinicsd and ward and formal directionfrom patient groups. Unanimously we were told that they wanted to be called "patients."

I concede that most were over 65 years old, only 73 we consulted were younger (being in or being the relative of someone in my early onset dementia service) so it's not the same result that many mental health services for working age adults may give. Or maybe it is.

If I'm ever in need of health care I'd like to be called a patient.

And for the record, Marcella, there is no political correctness on this blog. I am not a politician. I long ago learnt I can't always be correct. Thus, political correctness isn't for me. :-)

The Shrink said...


Marcella, patients are referred in consultation with their GP but referalls can be initiated by :
- the patient
- the patient's family
- the GP
- a social worker
- a care assistant
- a neighbour
- a carer or manager (if in a residental care or nurshing home)
- an advocate (often the Alzheimer's Society but occasionally MIND or Age Concern)

Basically anyone can ask to be referred, the GP needs to then agree and fax a referral to us and we then act on this.

As such, there's no need to be pushy.

And no, referral in both absolute numbers and in proportional rates aren't different across the sectors of the district.

Disillusioned said...

Hi Shrink

Sounds like a well-thought-out policy. What's more, you consulted - that rates a "wow!" from where I am standing.

I'd rather be called a patient too... though actually, overall, I'd rather be treated as a person not a problem! fortunately, that is happening with my new CMHT - even if not within the Trust management!

Fiona Marcella said...

Having just assisted my practically gifted but academically insecure 18 year old to write her first essay for her nursing diploma I have discovered one advantage to the term "service user" over "patient" - it increases the word count!