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WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY DEPUTY G.P. SOUTHERN OF ST. HELIER
ANSWER TO BE TABLED ON TUESDAY 5th JULY 2011
Question
The response to my question (6394) on 20th June 2011 on waiting times for physiotherapy following the loss of 3.5 staff under CSR stated –
"waiting times for clients referred directly by GPs have increased from 1 to 5 weeks in the first 4 months of 2011. This is a result of a significant increase in referrals (up 29%) creating delays not as a result of CSR cuts. Similar patterns of delay are created whenever there is an increase in referrals.
All fluctuations are negligible"
Given the 5-fold increase in the waiting time in response to a 29% increase in referrals what steps is the Minister taking to enable the physiotherapy service to cope with such fluctuations in demand?
Will she apologise to patients who have been kept waiting for appropriate treatment?
What steps if any will she take to improve waiting times in this service, and if not why not?
Answer
The increase in waiting times in the physiotherapy service is not the result of CSR cuts, it is the result of significant increases in referrals. Fluctuations and increases in waiting times occurs in any service operating at full capacity that has to manage either a sudden increase in demand or a reduction in capacity (for example through staff illness).
For illustrative purposes Table 1, which is based on an imaginary scenario, shows how an increase in referrals over a relatively short period of time creates a significant backlog, hence extending waiting times into the future.
The physiotherapy department provides direct GP access which can result in referral volumes varying from month to month with no obvious seasonal pattern. When backlogs occur they are balanced out by a catching up process that occurs when referral rate drops. This has been the trend over the past three years. The physiotherapy department works to minimise the impact on patients by prioritising all urgent referrals based on clinical needs.
Fluctuations in demand present a challenge due to lack of spare capacity across all HSSD services, not just physiotherapy. HSSD regrets the impact this has on patients and where possible manages it through short term increases in capacity, the use of locums etc. HSSD recognises however that these pressures will only increase as a result of demographic changes and hence proposes the major service redesign outlined in the Green Paper.
Figure 1: Illustration of impact of increase in referrals (based on an imaginary scenario)
Week | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Number of patients that can be seen each week in Clinic A | 50 | 50 | 50 | 50 | 50 | 50 | 50 | 50 | 50 | 50 |
Standard number of weekly referrals to Clinic A | 51 | 51 | 51 | 51 | 51 | 51 | 51 | 51 | 51 | 51 |
20% increase in standard number of referral over 4 weeks = 10 additional patients over 4 weeks) | 0 | 3 | 3 | 4 | 0 | 0 | 0 | 0 | 0 | 0 |
Number of patients now having to wait | 1 | 5 | 9 | 14 | 15 | 16 | 17 | 18 | 19 | 20 |
% of patients now waiting | 2 | 10 | 18 | 28 | 30 | 32 | 34 | 36 | 38 | 40 |