Here’s a news item – “a new hospital waiting list initiative has been launched aimed at clearing long waiters. At present, five hospitals account for over 60% of those on inpatient hospital waiting lists for more than a year. Latest figures show that just over 18,500 patients are waiting over three months for hospital treatment, while just over 8,600 are waiting over six months.”
Here’s another new item – “a new hospital waiting list initiative has been launched aimed at clearing long waiters. At present, five hospitals account for 70% of people waiting more than a year for treatment. Latest figures show that just under 24,000 are waiting more than three months for treatment, while just over 11,300 are waiting longer than six months for treatment. The numbers waiting over six months have nearly doubled over the past four months.”
The first news item is from January 2010, during the tenure of that much berated former Health Minister, Mary Harney. The second news item is from this week, during the tenure of the current Health Minister James Reilly, who we are told (frequently) is tackling the waiting list problem.
Well, if frequently launching waiting list initiatives and issuing upbeat statements constitutes tackling the problem, one can suppose that Minister Reilly is tackling the problem.
Unfortunately, statistics tend to be brutally frank, and the latest waiting list figures would beg the question as to whether anything has really changed since Mary Harney departed Hawkins House in early 2011.
Admittedly, the numbers on waiting lists increased substantially during Ms Harney’s tenure after January 2010, and by the time James Reilly came to office in March 2011, three month plus waiters stood at 26,000. After a short period of decline,the numbers are now almost reaching those not so dazzling heights yet again.
The Minister has just announced he has launched yet another initiative aimed at clearing the long waiters from the five hospitals responsible for the longest lists
Ministerial initiatives to tackle waiting list backlogs have been part and parcel of the health planning landscape since before Mary Harney’s time as Minister.
Unfortunately, to date they have been no more than more than sticking plaster solutions that so far have failed to tackle the resourcing and organisational problems that have bedevilled proper access to public hospital care for decades, and which have worsened as a result of the economic collapse of recent years.
To be fair to James Reilly, his establishment of a Special Delivery Unit to cut waiting lists and improve access to hospital care has had some success. During 2012, the SDU’s intervention did lead to some improvements in treatment waiting lists, particularly for long waiters.
By the end of 2012, the total number of three month plus waiters had reduced to 18,773, and among these, only 143 patients were waiting over nine months for treatment. The latter figure is now 3,715. The average waiting time for treatment is now three months, compared to 2.5 months last December.
History is repeating itself. Before they started to get out of control, in late 2009, Mary Harney, through the National Treatment Purchase Fund, had got waiting lists down to roughly the levels James Reilly achieved by late last year, before they inevitably rose again.
This waiting list roller coaster of recent years has a common theme running through it- diminishing healthcare resources and in particular, inadequate hospital and community resources to deal with pressure points in the system.
Can any Minister really keep a permanent lid on waiting lists in a health system that has had more than one fifth of its funding removed since 2008, and with more cuts to come in 2014 and in 2015?
Yes, James Reilly can argue that he has had some success with waiting lists and he will deal with the latest ‘slippage’ through a €18 million funding injection (which will probably get swallowed up pretty quickly).
But to date it appears that his actions have essentially been ‘fire brigade’ exercises that have yet to deal with systemic flaws in the system.
He says the recent waiting list rise was due to a longer ‘clinical winter’ and a higher than normal level of elderly emergency admissions. But if the system is being changed for the better, as we are told, shouldn’t it be able to cope with these surges?
If waiting lists are really being tackled, shouldn’t we be seeing a more or less permanent decline in numbers, and not have to be frequently going back to the waiting list drawing board simply because very ill emergency patients are turning up in hospitals and needing beds?
It is alarming to note that the Minister admitted this week that the recent pressure on beds caused by higher than usual admissions through EDs had to be be dealt with through reducing the number of planned procedures, thereby increasing waiting list numbers, which then have to be dealt with by yet another special initiative.
And the Minister certainly likes his initiatives.
James Reilly’s SDU has launched many of these with varying degrees of success. We have had the patchily successful treatment waiting list initiative referred to above.
We have had an ED trolley wait initiative, which has has reduced trolley numbers, although the figure are still quite high.
Also, figures from the Irish Nurses and Midwives Organisation indicate that recently, the old trolley problem has simply turned into an overcrowded ward problem.
We have had two initiatives under James Reilly to reduce waiting times for colonoscopy and gastroscopy tests. Numbers waiting for these tests, often used to check for cancer, are on the rise again.
We have had a more recent initiative from the SDU to reduce outpatient waiting lists. With nearly 7,000 waiting over four years for a first outpatient appointment and 380,000 in total on these lists at the latest count, this particular initiative clearly has a long way to go.
And then we have the ‘hidden’ waiting lists that don’t normally get officially reported.
A recent Irish College of General Practitioners survey of 300 GPs showed that their private patients only had to wait an average of four days when they were referred to a private hospital for for an ultrasound test, whereas their public patients had to wait on average 14 weeks for this test at a public hospital.
If the GP college didn’t tell us this then we would never have heard about these shocking waiting lists. Up to date figures on average waiting times for GP referrals for hospital diagnostic tests are not published by the HSE or the Department of Health.
Another hidden waiting list is where even if patients get into the hospital system, they still have to wait. Diabetes patients in some hospitals sometimes have to wait two to three years for an outpatient check up, where they are already in the hospital system and have already seen a consultant for the first time.
Again, these statistics are not revealed publicly by the HSE or Department of Health.
James Reilly cannot be faulted for making an effort to improve public patient access to our health system.
Yet, through all the swings and roundabouts of fluctuating waiting list and trolley numbers, and the often reported hardship suffered by sick patients through poor access and poor facilities, and Ministerial promises that things are getting better, the underlying message seems to be that our health system still doesn’t work, despite all the ‘spin’.
The bottom line seems to be that despite some pockets of efficiency and indeed excellence in the service, our broke statelet simply does not have the resources at the moment to provide a uniform standard of quality care.
The hidden truth is that all that can be hoped for is to keep the current system ticking over and hope that not too many people come to too much harm.
Resources are often promised, but seldom delivered, to improve hospital services at crucial pressure points, or to fund community and primary care to a proper level take pressure off hospitals and keep patients out of hospital.
Until this key issue can be resolved, everything else we are told or retold by Minister Reilly and his junior ministers is essentially window dressing.
And as for universal healthcare by 2016 (to be run by insurance companies no less), dream on.
88% rise in treatment waiting lists