Statement by Minister Responsible for Health, Osbourne Bodden, on Access to Obstetric Care

On 27th February, North Side MLA Ezzard Miller, speaking in the Legislative Assembly, voiced concerns with regards to the ability of the public to access to obstetricians and other specialist medical services.

In response the Ministry of Health has worked closely with the Health Services Authority (HSA) to review current access policies for specialist care, and the wait times that patients experience for these services.

At present the HSA (obstetrics clinic) receptionist makes the appointment at the desk. If no appointment is available, if the appointment is being made for a new antenatal patient, or if the patient requests an earlier appointment, then the receptionist will refer the patient to the midwife for review.  If the midwife is with a patient in a clinic room or out on home visits, the receptionist will take the number and have the midwife return the call.

The waiting period for obstetric and gynaecological services is approximately two weeks. If a particular physician is requested the waiting time may be six to eight weeks, although most physicians will see extra patients in clinic, if the need is confirmed by the midwife.

The HSA acknowledges that the waiting periods for specialist services are generally longer than it would Iike. Measures that have been taken to reduce wait time include extra clinics and staff. Yet the volume of persons seeking care still drives long waits.

Staffing Levels and Scheduled Clinics

The HSA currently employs three consultant obstetricians/gynecologists and two registrars with

ob/gyn experience, one of whom covers Faith Hospital. It also offers all women’s health services, including: gynaecology and obstetrics, family planning, antenatal and postnatal clinics, as well as cancer screening.

The physician service is complemented by midwifery services in a shared-care model, offered by two midwives and other support staff. The midwives offer antenatal care, family planning, and postnatal care, including home visits, and pap smears. There is no waiting time for midwives’ clinics.

Physician clinics are scheduled every day except Monday and Thursday, which are surgery days. Additional sessions are added where the surgery lists allow.

Each week there are fifteen clinic sessions. Each session is scheduled for four hours but generally runs for five to six hours. Each day there is an ob/gyn on call. This person has no scheduled clinic and is responsible for obstetric and gynecological emergencies.

Emergency Care

ln the case of the person with a miscarriage being directed to the emergency room, this was the correct procedure in what was indeed an emergency situation. In most instances, these persons require blood work, ultrasound, and preparation for the operating room. The emergency room, with the ob/gyn on call, is the department best suited to handle this level of acute care, as the clinic is not prepared to deliver the rapid intervention required.

The HSA acknowledges the value of the suggestion for patients to see the physician of their choice. Gynaecology appointments are made for the physicians requested. In obstetrics this has been considered, but, in an environment of shared-care, is not very practical as deliveries are done by the midwives supported by the physician on call.

Other Jurisdictions

We believe it is important to note that the Cayman lslands is not alone in the length of wait times that people may face to access obstetricians and gynaecologists.

Canada

The median wait time in Canada to see a specialist physician is a little over four weeks according to the study “Healthy Canadians: Canadian government report on comparable health care indicators”.

USA

In the USA, the Merritt Hawkins survey on wait times in 2009 concluded that the average wait time to see an obstetrician/gynecologist is twenty-seven days, or, four weeks. (This survey includes numbers from both privately covered and Medicaid patients).

UK

In England, wait times to see a specialist range widely, depending upon the county, from eight days to several weeks, and the NHS website notes that patients have the legal right to start the NHS consultant-led treatment within a maximum of l8 weeks from referral.

Dental Clinic

Mr Miller also mentioned that the Dental Clinic faced a similar situation with regards to wait times for patients. The clinic supplernents its appointment system with emergency sessions held 8.00am – 3.30pm weekdays and 8.00am – 10.30am on Saturdays. No patient in pain is sent away, as there is a dentist on call every day. After hours services are available through Accident and Emergency.

The waiting times for dental appointments do vary. As an example an appointment booked on 28 February, would be slotted into the next available appointment time in March 17 (which is approxirnately three weeks). At the same time if a particular dentist is required, the wait time can be as much as 12 weeks.

On behalf of the HSA, I apologise for any inconvenience experienced by its patients. The Authority strives daily to improve customer care and service, and will do whatever is necessary to achieve continued improvements. (GIS)