Huge waiting lists for serious immune deficiencies and urgent allergy problems

Royal Victoria Hospital

Royal Victoria Hospital

HUGE backlogs and long waiting times for people with serious immune deficiencies and urgent allergy problems have come to light in documents obtained by The Detail.

The Immunology Day centre is based at the Royal Victoria Hospital site in Belfast. It hit the headlines late last year after 59 patients with conditions affecting their immune system were recalled.

The latest evidence uncovered by The Detail, suggests that recent attempts by the Belfast Health and Social Care Trust to cap the numbers on the waiting list by using locum doctors on an ad hoc basis seem to be failing, while the costs continue to rise.

Figures requested under Freedom of Information legislation show that the Belfast Health Trust has spent over £80,000 on providing independent expert opinion and clinic attendances for the Immunology/Allergy service. Despite this, there are still waits of up to 60 weeks within the clinic and in some cases a waiting list of over 900 patients.

DEPARTMENTAL PROBLEMS

In January The Detail highlighted serious hygiene failings with the immunology clinic’s sinks and taps after the source of an infection that killed three babies was traced to the taps at the Royal Victoria’s neonatal unit.

The Detail has also obtained minutes from RVH’s Immunology department’s management meetings which show that serious internal problems were being flagged up as far back as 2010.

In April 2010 concerns regarding data protections were raised when it was noted that recycled paper containing patient’s details had been used and subsequently taken outside the department in error. This raised concerns regarding data protection and raised questions why paper with patient’s details on it were being recycled.

In a statement the Belfast Trust said: "To reduce costs it had been the practice to recycle as much stationery as possible. On this occasion recycled paper containing a patient’s details had been re-used. A member of the medical staff had taken the paperwork outside of the department. The paperwork never left the possession of the doctor and when it was noticed that there was patient information on the reverse side it was returned to the department immediately for confidential disposal.

“The doctor immediately raised a concern. While there was no loss of patient information nor an actual data protection issue, the potential for data loss and data protection issues was recognised and the practice of recycling paper in this manner was stopped immediately. This situation has not occurred again.”

Other issues highlighted at a meeting in June 2010 show that there were problems around finding medical records and often clerical staff had to act as porter in retrieving notes for other departments.

In a statement to The Detail, the trust acknowledged that there can be occasions when a medical record may be in another part of the hospital, especially if a patient is attending more than one clinic and these need to be accessed.

They say it is not uncommon practice for clerical staff to go to another department to get access to the medical record if this is required

LOCUM COVER

In November last year it was revealed that the General Medical Council (GMC) had imposed a range of conditions on the license of one of the Royal’s consultant senior immunologists. Since December 2011 this position has been filled by a locum doctor from England who has continued to cover the Immunology/Allergy Clinics at the Royal Victoria Hospital.

Despite the increasing cost, waiting lists have continued to grow.

The Belfast Trust say it is required to fill gaps in their total number of clinicians to ensure that patients receive timely and appropriate treatment.

Earlier this month the Health Committee discussed the growing problem of cancelled hospital appointments and waiting lists.

Figures supplied by the department outlined that from the 31st March 2011 to the quarter ending 31st December 2011, show there were almost 190,000 appointments cancelled by hospitals across all of Northern Ireland’s health and social care trusts.

Number of appointment cancelled by hospitals by HSC trusts 31st March - 31st December 2011

Number of appointment cancelled by hospitals by HSC trusts 31st March - 31st December 2011

The Immunology Service was a single handed service until 2007/8 when approval was given for the appointment of a second consultant. The trust claim that it proved difficult to recruit for this post.

In a statement it said: “The Immunology clinical workforce is relatively small on a UK-wide basis and attracting eligible Registrars to a NI consultant post proved difficult. At the time a locum consultant was employed, greatly increasing the capacity within the service with a consequent reduction in the waiting list. This locum left post after a year and it was not possible to recruit the substantive consultant post until February 2011.”

In December 2011 the trust entered into a contract with an Independent sector provider from Leicestershire to provide consultant medical cover and also additional independent expert opinion to the clinic.

By January of this year 15 clinics had been held at a total cost of £40,000. This cost has now doubled, spiralling to over £80,000. The cost to the trust works out at £2,815 per day with a total of 30 clinics culminating at £84,450. This includes flights and accommodation and the expertise of a special nurse supporting the consultant immunologist.

WAITING LISTS

The trust has said that since employing the independent company in December 2011 it has resulted in over 400 additional attendances up until the 31st March 2012. They say it is envisaged that a further 600 clinic slots will be provided in the first six months of 2012/13, with an anticipated maximum wait of 36 weeks at that point. The waiting list “standard” is to see patients within nine weeks of receipt of referral.

However, the latest figures received by The Detail show that, as of April 2012, the longest wait for an adult patient classified as an “urgent patient” was 52 weeks, while the wait for a “routine adult patient” could be up to 60 weeks.

Paediatric patients are seen at the Royal Belfast’s Hospital for Sick Children on the same site. The wait for urgent paediatric patients stands at 18 weeks, while routine paediatric patients may have to wait up to 47 weeks.

Waiting times for urgent, routine and review appointments for Immunology and Allergy at Royal Victoria

Waiting times for urgent, routine and review appointments for Immunology and Allergy at Royal Victoria

Figures for the number of adult patients backlogged on the waiting list and classified as urgent in February 2009 amounted to only one patient. By February 2012 this figure had dramatically risen to 183 patients. Similarly the number of adult routine patients on the waiting list in February 2009 totalled at 13, by February 2012 there were 919 patients on the waiting list. Routine paediatric patients stood at six in February 2009 and by 2012 this number had risen to 140 patients.

Waiting list figures (backlog) for clinics end of February 2009, 2010, 2011 and 2012

Waiting list figures (backlog) for clinics end of February 2009, 2010, 2011 and 2012

These figures only include the backlog patients and not those seen within the nine weeks “standard” referral.

A further breakdown of the data shows that while there were no ad hoc immunology and allergy clinics held by the trust to address the backlog of patients in February 2009, by February 2012 this number had escalated to 15 clinics with 228 attendances. An additional 342 patients (24 clinics) were seen under the independent contractor in the year ending February 2012.

The Belfast Trust told The Detail that even with the appointment of the second consultant, the Health & Social Care Board (HSCB) recognised that a capacity gap still existed and asked the trust to submit a business case for a third consultant with a special interest in allergy. This case is currently with the HSCB for consideration and the trust claim once the business case is approved they will immediately commence the recruitment process.

In Northern Ireland, allergies affect around 180,000 children (40%) and over 400,000 adults (30%). Of this, approximately 22,000 children and 24,000 adults have a food allergy and many will have more than one allergy.

Maureen Paul from Allergy NI believes that the lack of specialist allergy services in Northern Ireland has put those that do exist under enormous strain.

She said: "Serious reactions can be traumatic and it is vital that patients, whether adult or children, are seen as soon as possible after this frightening experience. We are greatly concerned at the backlog of children and adult patients waiting for urgent and routine appointments.

“The Department of Health document Priorities for Action 2010/2011 stated that by March 2011 it is expected that all outpatients would be seen within nine weeks following GP referral and even this can be a long time when you aren’t sure which food is safe for your child or you to eat.”