BY THE end of this year almost 1 per cent of the Republic's population are likely to have their names on public in patient hospital waiting lists.
The numbers on the lists keep rising, and the summer months have been marked by hospital bed closures and the suspension of operating lists, further clogging the system.
If the figure keeps rising and hits the predicted 30,000 by the end of the year, waiting lists will probably feature prominently in another general election, just as they did in 1989, when Fianna Fail suffered at the polls for cutbacks while in government.
The latest figures for this year are not yet available from the Department of Health. This, said the Fianna Fail spokeswoman on health, Mrs Maire Geoghegan Quinn, might indicate just how bad the situation has become.
"I smell a rat. I asked Minister Noonan for the figures in April. He said they were being collated and he would write to me about them as soon as they were available. I'm still waiting," she said.
In response to inquiries by The Irish Times, the Department said that seasonal bed closures have been a characteristic of the "provision and organisation" of hospital services throughout the State for many years. They are also planned to coincide with annual leave for staff at a time when the level of hospital activity is at a low point. They are also used as an opportunity to refurbish wards.
"As it is an annual feature of the management of the hospital service, it is, therefore, not expected that it will unduly affect the number of people on waiting lists," said a Department spokeswoman.
According to Mr Finbarr Fitzpatrick, of the Irish Hospital Consultants' Association (IHCA), an average of 10 per cent of the beds in St Vincent's Hospital, Dublin, are closed during July, August, September and October.
An internal memo, circulated to senior staff at the hospital in July, revealed that in areas where expenditure has over run budget, the departments involved have been instructed to implement measures to bring their activity "back in line with the budget levels approved at the beginning of the year".
To stay within budget, the hospital management has to make savings of £1 million by the end of 1996. It is already running £600,000 over budget this year. The memo stated that seasonal ward closures would be introduced immediately and reviewed during the coming months.
It said that no elective work could be carried out in departments that have overspent until the over runs are brought under control and all in patient and outpatient work relating to patients outside the hospital's catchment area was to cease immediately.
It also said that, if a patient from outside St Vincent's area is referred to a consultant, then the consultant should visit the patient in the hospital where he or she is a patient.
All new sources of referral that were not in place in 1994-1995 should stop, and all in patient and out patient work relating to patients not in the catchment area should cease immediately except in "exceptional" circumstances. One theatre each week would be closed until further notice.
The number of people on in patient waiting lists rose from 23,835 in December 1994 to 27,752 in December 1995, an increase of some 16 per cent. Mr Fitzpatrick, secretary general of the IHCA, predicted that the figure will be over 30,000 by the end of this year.
However, the Department is spending only £7 million on its special waiting list initiative in 1996 (additional funds allocated to health boards to clear the waiting lists), £1 million less than in 1995.
The funding was to cater for additional ear, nose and throat procedures, general surgery and hip or knee replacements, and £1 million of it was for cardiac surgery.
By the end of this year, £45 million will have been spent on waiting list initiatives since 1993. The first began in June 1993 when the in patient waiting list for all specialities totalled 40,130. The aim of the initiative, according to the Department of Health, is to limit waiting list delays to 12 months for adults and six months for children.
More money is needed for this year, said Mrs Geoghegan Quinn. "The Minister for Health needs to get the money from the Budget and he needs to get it now. There will be huge pressure in the winter. The numbers on the waiting lists need to be brought down toga manageable level, as they were in 1993."
The figures will inevitably rise once winter sets in and the situation will have been exacerbated by the summer bed closures and what the IHCA has described as the "near total closedown of elective admissions".
The IHCA said the number of bed closures this summer doubled compared to last year. Consultants, according to Mr Fitzpatrick, "feel medical control of the hospitals is slipping away from them in a big way". They feel decisions are taken by "paper pushers and not by people with any medical qualification".
"All this means that there will be an even bigger backlog over the next few months. Nobody denies that administrative staff are important, but an essential part of hospital life is being forgotten. People come to hospital to be looked after by doctors and nurses and everything else is secondary to that," he added.
Since 70 per cent of a hospital's budget was paid in wages and salaries, closing beds was not the way to save money.
He denied that consultants were rattling the Minister's cage now because of anger over the non publication of the Buckley Review of their pay and conditions.
Keeping people on waiting lists was often a false economy, Mr Fitzpatrick argued.
"If you need a hip replacement and your operation is deferred, then the expense is simply deferred to next year, when it is by definition going to cost more," he said.
The waiting list problem can also be improved by other measures, according to Dr Derek Mowbray, a healthcare management consultant and director of MAS, a company advising Irish health boards and hospital managers.
He told The Irish Times that inpatient waiting lists do require short term additional resources when the numbers get out of hand. It is also necessary, he said, to look at the "overall picture" and work out exactly how long it would take to get through the people on the waiting lists.
There should be fewer return visits by out patients and consultants should have a higher throughput of patients to get through the numbers. "Sometimes consultants will repeatedly see the same person in out patients without seeing new patients," he said.
There must be a balance, Dr Mowbray said, between the number of people treated on out patient and in patient lists. He also said there should be more opportunities for general practitioners to practise more specialist medicine so that they can treat more patients themselves and not refer them all to hospital.