by Professor Siobhan McClelland
Most of us will have to use the NHS at some point in our lives. For most people waiting for something or someone is a common experience of the health service. So, how can you navigate the maze of waiting lists - and how you can get off a hospital trolley and into a bed?
For those who are on a waiting list getting seen as quickly as possible is a priority. But how can you achieve this? A waiting list is simply a queue of patients waiting for treatment or medical advice - either as an outpatient or an in-patient. It's not so much how many people are in the queue but how long they have to wait. The NHS in Wales has a history of people waiting for a long time for treatment although things are now improving.
Most people want to know how they can move from being in the routine category to the urgent one
To get onto a waiting list to see a hospital specialist you will need, first of all, to be referred by your GP. When this referral is received by the hospital you are usually prioritised into one of three categories - urgent, soon and routine. How long you will have to wait will depend not only on which category you are in but where you live, the condition you have been referred for, the consultant and the waiting times targets set by the government. By March 2007, the Welsh Assembly Government is aiming for no one to wait longer than 8 months for in-patient, day case or a first out-patient appointment.
Most people want to know how they can move from being in the routine category to the urgent one. There is only one real reason for this - if your condition deteriorates. If this happens you should see your GP who can contact the hospital who will then consider seeing you earlier. Most of us would agree that those who have the greatest clinical need should be seen first. Although the NHS doesn't always achieve this it is really the only fair way of making the decision about who goes first.
There are some other things you can do though to make sure you are seen as soon as possible:
- Ask your GP if there are other consultants in the same specialty either at your local hospital or at other hospitals with shorter waiting times and ask if you can be referred to one of them.
- Ask if you can be treated as a day case and whether this would mean a shorter time on the waiting list.
- If you can afford it, or if you have private health insurance, you can be referred to see a consultant privately and your GP can arrange this for you.
- Let your GP and the hospital know if you are able to respond to a cancelled appointment and can attend the hospital at short notice. Be as flexible as you can be.
- While you're on the waiting list ask your GP if there is any additional treatment you can receive, such a physiotherapy, which might help you while you wait for your appointment.
And if you are getting worse do go back and tell your GP.
Waiting lists are one way of getting into hospital for what is termed 'elective' or planned treatment. The other way to get into hospital is to be admitted as an emergency, usually through the Accident and Emergency Department.
You can wait a long time in the A&E Department if you come in as what is termed 'walking wounded' rather than an urgent case. So it is always worth thinking about whether you really need to go to A&E in the first place. Consider other options such as your GP, the GP out of hours service or NHS Direct. The Welsh Assembly Government has set a target that 95% of patients should spend no more than four hours in A&E before they are admitted, transferred or discharged and that no one should wait longer than eight hours.
Once you've been seen, if you need to be admitted to the hospital you may find that you end up waiting on a trolley in the A&E Department until a bed becomes available. It is recognised that this is far from ideal and hospitals are working to reduce the number of patients waiting on trolleys and how long they have to wait. However, sometimes there isn't a bed available because there have been a lot of emergencies, planned operations that are taking place and people who are waiting to be discharged.
If you do end up in this situation what can you and your family and friends do to help you?
- If it's possible get a friend of relative to stay with you who will be able to look out for you.
- Don't get overlooked - make sure you are being regularly observed by the nurse in charge of your case and ask to be reviewed by a doctor if you are getting worse.
- You should be receiving any treatment, tests and medication even if you are on a trolley. Ask what the treatment plan is.
- Make sure you don't get hungry, thirsty or cold and remember you are entitled to some privacy.
- Be flexible - any bed anywhere is probably better than a trolley.
- Keep an eye on the time and ask to speak to the nurse or consultant if your wait is becoming too long - but try and do this as reasonably as possible.