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Waiting lists in Wales are going up, whilst staff recruitment isn’t keeping up with the demand. Quite simply, this means that consultants are working overtime to manage the demand. We know this isn’t just a problem for consultants but endemic across the NHS. We urgently need to see a long-term strategy for the NHS that addresses the fundamental workforce, workload and funding challenges, in Wales.
Figures from Welsh Government show that there are 41% more consultants that there were ten years ago. Unfortunately, the vast majority of that growth was up until 2010, 31% in fact. From 2010 to 2015, growth has been just over 9%. Growth has slowed down whereas demand certainly hasn’t.
Most consultants work overtime in the standard sense of the word. I work one extra session per week. That’s not my routine job. Many people have to work even more on top of this, just to keep waiting lists down, and this is where the problem lays.
Waiting list initiative payments were negotiated to enable health boards to enlist consultants to provide additional services on an occasional basis, to reduce waiting lists. This work is only ever undertaken at the specific request of the employer, and the enhanced pay rate reflects the ad-hoc nature of the work, and the inconvenience and disruption to family life.
Doctors in my department work overtime regularly. There is immense pressure on the system and waiting lists are too long. Waiting list initiatives are a quick fix. Hospitals could reduce the reliance on overtime, and ease the load on consultants, by recruiting extra staff. Another option is to give admin tasks and duties such as routine follow-ups, to other staff, to further ease the load and allow consultants to get on with the job in hand.
The £8m figure for the cost of covering overtime payment for consultants in Wales is only 3% of the total consultants’ pay bill. It’s not a large proportion. Lets not forget, in the four years leading to 2014, NHS Wales spent £21m on management consultants. Would it be better to spend this money to recruit more consultants? Absolutely. Money also has to go to support front line staff – that includes nurses, radiographers and theatre staff, who are supporting extra lists on evenings and on the weekends.
In my specialty, neurology, we regularly have ‘breaching patients’, who are reaching the 36 week target. Extra lists have to be put on to keep a cap on that target.
It remains vital, in these times of serious pressure on the health service, that health boards focus their resources on the most clinically urgent patients, and that they recruit adequate staff to provide all necessary services in a way that is both timely and sustainable. This is the root of this issue and one that cannot be put on the waiting list.
Dr Trevor Pickersgill is chair of BMA Cymru Wales consultants committee
My left knee has problems. It collapses, suffers extreme pain and blood flow is partly compromised. It was examined at the pain clinic where the examination made the pain level rise from intense to extreme. I complained. At the complaints meeting I was informed, "do not mention the pain in my back or I will never get a new knee". So I kept quiet while my knee was thoroughly examined. After 18 months of tests, X-rays, MRI scans and seeing 3 consultants I was eventually told there was nothing mechanically wrong with my knee. During that 18 month period I have fallen a number of times and grit my teeth at the ever increasing pain in my lower back. The last consultant I saw took one look at an MRI scan of my lower back taken in 2012 and said, 'Why hasn't anyone done something about this?' He was pointing to the extreme level of damage to the discs L1 to S3.
In mid 2004 I had an operation to repair a hernia in my lower left stomach and a mesh was fitted. All was fine until January 2005. I stepped out of the bath with my full weight on my left leg. It collapsed instantly tearing all the muscles in my upper leg. I lost all feeling in my left knee which was now uncontrollable. I could walk short distances by throwing my leg forward to lock my knee, but any distraction caused my leg to collapse. In 2011 I stepped back off a small step and my leg collapsed once again. I used my walking stick to push myself onto my back to prevent my weight crushing my ankle and remained on the floor until I recovered my breath. Then the feeling returned to my upper leg and knee. 6 years of pain came flooding back in one moment. After the pain stabilised the only thing not working was my knee. I felt like a thousand tens machines were triggering independently from just behind my knee to my toes.
I now know the reason my left knee collapsed. There are 2 femoral nerves branches running under the mesh fitted during hernia operation. Bowel movement under these nerves affect how those nerves function, which is not good or reliable for walking. I have been told scar tissue prevents any operation to relieve pressure on the femoral nerves, so I'm stuck with the problem.
When my leg collapsed it also damaged my sciatic nerve behind my knee, though this could be caused by the poor state of my lower back. I now await a neurological examination to see what or if anything can be done.
I was given Duloxetine for the nerve pain but had a nasty reaction to the drug. Suffered heart problems, high blood pressure & a small stroke due to the deep purple patches the drug caused. I'm now on high levels of Oxycodone which take the edge off the pain for a few hours., but leave me drowsy. I lay flat for an hour or two to take pressure off my lower back & sit with all pressure on my right buttock.
I have seen so many consultants in the last 2 years and still more to come. If only my GP did more when the incident first occurred I could have been in a better state of health. I don't blame my GP, he had a stroke and it took a number of years before someone noticed there was something wrong.
He offered 2 options for all ailments. Antibiotics or pain clinic.