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
Laughing all the way to the bank
TWENTY-SIX former politicians who are earning pensions of more than €100,000 a year are escaping a super tax because of a legal loophole.
Former Fianna Fail ministers Charlie McCreevy, Dermot Ahern, Noel Dempsey, John O’Donoghue, Joe Walsh, Michael Woods and Martin Cullen — and former Progressive Democrats leader Mary Harney — are among those not having to pay the 20pc tax.
Another is former Fianna Fail minister Ray Burke, who was convicted of tax evasion.
The loophole arises because the higher rate applies only if a single pension is worth more than €100,000 but not if the politician is getting a number of pensions with a combined value above that level.
“It’s obviously unfair otherwise on the people who are paying it. The impression was given last year that it would be all office holders,” she said.
Ms Tuffy said she was in favour of a higher income tax on people earning over €100,000 in the forthcoming Budget rather than singling out former ministers again for heavier taxes.
Public Expenditure Minister Brendan Howlin has introduced an amendment to close the loophole by the end of the year.
It will allow the pension levy to be applied to all the combined pensions of a former office holder. A department spokeswoman said that all public bodies would be requested to supply the PPS numbers and pension payments of those with multiple pensions.
She said the department would then calculate the new higher pension levy and apply it.
Mr Howlin has said that the estimated savings for the new rate already was €400,000 per year — when the impact on retired judges, former semi-state chief executives and former secretaries-general is taken into account.
Mr Ahern and Mr Cowen are paying a total pension levy of around €11,000 each on their TDs‘ and ministerial pensions, leaving them with pensions of €111,235 each. But if their TDs’ pensions and ministers pensions were combined together, their pension levy bill would rise by up to €7,000 extra.
This is because they will only be able to claim one exemption from the public sector pension levy — rather than the present arrangement of one for each pension.
It means just six senior politicians are paying the super levy this year — which is in stark contrast to what was expected when it was announced by the Government last November.
At the time, Public Expenditure Minister Brendan Howlin said that “everyone had to burden-share” at a time of financial emergency.
Those paying the extra levy are former Taoisigh Bertie Ahern, Brian Cowen, Albert Reynolds and John Bruton, who all have ministerial pensions worth more than €100,000 even before their TD pensions are counted.
Former presidents Mary McAleese and Mary Robinson are also paying the new super levy on their presidential pensions. But former health minister Mary Harney is escaping the super levy because she has a TD’s pension of around €50,000 and a ministerial pension of €79,000.
Another in this category is former finance minister Charlie McCreevy, who has a TD’s pension of around €50,000 and a ministerial pension of €69,000.
Others who are not being hit include former Fianna Fail Junior Minister Frank Fahey, former PD Junior Minister Bobby Molloy and former Labour leader Dick Spring.
These ministers do have to pay the public service pension levy, but not at the higher 20pc rate, which kicks in at €100,000.
The information on those being hit by the levy was supplied by the Department of Public Expenditure to Labour Dublin-Mid West TD Joanna Tuffy. She called for the closure of the loophole.
Dr James Reilly the Health Minister has once again spectacularly changed his story on the site selected for a primary care site in his constituency.
Dr. Reilly claimed the decision on the site was made during Mary Harney tenure in office. Ruairí Quinn the Minister for Education backed up this claim.
Reilly now admits that this information is totally incorrect.
Enda the Time has come to sack Minister Reilly and at the same time a slap on the wrist for Master Quinn