Complex health service problems must not be overlooked

Analysis: Overcrowding and waiting lists are difficult to fix, but best practice can help

“The chaos has far-reaching consequences. Patients are getting sicker, and some are dying, because they can’t get the treatment they need, when they need it.”

“The chaos has far-reaching consequences. Patients are getting sicker, and some are dying, because they can’t get the treatment they need, when they need it.”

 

Last month finally saw street protests about the state of our health service.

Yet the reason hundreds spontaneously gathered outside Department of Health headquarters in Dublin on a weekday afternoon had nothing to do with the long waiting lists and delays in treatment which are the single biggest failing of the system.

What motivated ordinary people to demonstrate was a concern over possible religious interference in the running of the new national maternity hospital, not the months and years family or friends spend waiting to access a hospital bed.

The contrast between the spontaneous protest over the maternity hospital, and the lack of public outcry over waiting lists, could not be more stark. People clearly feel they can do more to influence decisions on future services than they can about current logjams.

But ignoring the problem, simply because it is so hard to resolve, doesn’t mean it will go away. In fact, as the latest figures show, waiting lists are getting longer.

Meanwhile, overcrowding in hospital emergency departments is also worse than ever. Despite all the initiatives and taskforces of the past year, trolley numbers were up in the first four months of this year over 2016.

Consequences

This chaos has far-reaching consequences. Patients are getting sicker, and some are dying, because they can’t get the treatment they need, when they need it. Highly paid surgeons are left to twiddle their thumbs because operating theatres are closed due to staff shortages. The chaos and unpredictability of an overburdened system drives talented staff abroad – leading to more gaps in services. The system is grinding to a halt.

Anyone who saw RTÉ’s Living on the List documentary in January knows this; they probably knew it already, as a patient, or the carer of a family member waiting for treatment. And yet the problem worsens.

We now have “pre-waiting lists” and “hidden waiting lists” in addition to the usual queues, and all of them continue to lengthen.

This is in spite of the fact that, for the first time in a decade, serious amounts of extra money are now available for the health service.

Budget 2017 provided for €20 million to be provided to the National Treatment Purchase Fund (NTPF) this year for the treatment of long-waiting patients, rising to €55 million in 2018.

Some €5 million of this funding is already on stream to pay for more than 2,000 day-case procedures, which were due to start in March.

Period of change

The NTPF’s role in treating patients on waiting lists was scrapped in 2011, only to be restored last year. Its new responsibilities coincide with a period of change within the organisation, with the departure of key senior staff and the arrival this week of a new chief executive, Liam Sloyan.

It seems likely the extra money will lead to some improvement in the figures later in the year, but experience tells us this impact will be cosmetic. Outsourcing waiting lists to the private sector doesn’t work in the long-term; once funding dries up, the lists soar again.

Minister for Health Simon Harris has been, to use Micheál Martin’s mis-phrase in the Dáil this week, “a rabbit caught in the headlines”. Initially, he ploughed resources into cutting the number of patients whose discharge from hospital was being delayed by a lack of step-down beds. The delayed discharge figure fell alright, but trolley numbers went in the wrong direction. That caused massive overcrowding in many emergency departments and forced the cancellation of elective surgery.

When the misery of people on the waiting list hit our television screens, Mr Harris pointed the finger at the HSE – “they are in charge of operations” – much to the annoyance of its senior managers.

The Minister has repeatedly demanded accountability from health managers but has yet to use the big stick he threatens to wave around. This is in spite of the fact that both the waiting list and trolley problems are concentrated in a small number of under-performing hospitals.

Trolley numbers, for example, have plummeted in Dublin while soaring in places like Limerick, Clonmel and Cork. Some hospital groups are redirecting long waiting patients to other facilities for treatment, with positive results, while in other parts of the country lists grow like topsy. We wouldn’t have half the problems we do if best practice was extended nationwide.

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