HSE keeps patients at arm’s length by playing the waiting game

Waiting lists may be hell for patients, but for politicians and managers they are one of the clearest measures of performance in a health service.

Successive ministers have staked their reputation on reducing the outpatient, inpatient and day care waiting lists, only to find that what goes down comes up again with stubborn ease and regularity.

Fianna Fáil leader Micheál Martin even promised to abolish waiting lists when he was minister for health in 2001 but came nowhere near achieving this objective. He was later mocked by the opposition for his failure to control the numbers.

One favoured way to tackle the problem is to throw money at it. Often this means getting the private sector to do work that should be performed in public hospitals.

The previous minister, James Reilly, brought in experts from abroad to head up a special delivery unit, which aimed to improve the flow of patients through the system. The concentration of effort worked somewhat and numbers fell, but this gloss was partly achieved by comparing figures with those recorded during the extremely cold winters of a few years ago, when demand soared.

In any case, the experts left, having banked their fees, and numbers began rising again.

50,000 knocked off

Last year Reilly ringfenced €17 million for another assault on the lists, which on the face of it succeeded in knocking 50,000 people off the long- wait list at the end of 2013.

Once again, though, the pressures inherent in the health service from a rising, ageing population asserted themselves, and numbers have spiralled upward again. Worse, it is apparent that some of this spending was extremely wasteful, with public patients referred to private consultants and then sent back for another appointment with a public consultant.

As Dr Tony O’Connell, HSE director of acute hospitals, said yesterday, these patients were “double-handled”, with the taxpayer footing the bill for a private consultation and a repeat public consultation.

O’Connell said “only a few hundred” patients were affected in this way, by being taken from the public waiting list, seen by a private consultant and then sent back to the end of the public list. But even that is a few hundred too many.

Faced with their inability to reduce waiting lists, some of those at the helm of the health service have succumbed to “managing” or “massaging” or, as claimed in recent days, “manipulating” the figures. One way is by so-called validation of the lists, for example by striking out the name of anyone who doesn’t reply within a week to a form letter.

Definition of wait

Another way is to change the rules. This is what happened when Reilly came to office on a promise to cut waiting lists. The definition of a long waiter on the inpatient list moved from over three months to over six months, while the outpatient target was shifted from three months to 12.

The abandonment of international standards means Ireland can't be compared to our European neighbours. That avoids negative headlines while also lowering the bar for the ambitions of the service.

And still the problem doesn’t go away, with the waiting list numbers rising as much as 1,000 per cent this year.

The message from all this is clear: waiting lists are a fact of life; they go up and they go down. Better management can make some inroads, and the occasional funding windfall can dress things up better at sensitive times.

A better primary care system might result in fewer people having to go to hospital. But only long-term, structural investment to increase the number of beds and clinical teams will effect a meaningful, long-term solution.