Medical test waiting periods one more potentially fatal level of delay

Much has improved in the way we deal with cancer in the decade since the tragic death of Susie Long shone a harsh light on a system that was clearly failing patients.

Long died in October 2007 after waiting seven months for a colonoscopy in a public hospital to diagnose her bowel cancer, having met private patients who were seen in three days.

Since then, cancer services have been consolidated in eight centres rather than fragmented in 30 different hospitals of varying quality. Survival rates have improved, partly due to better treatment and partly due to more powerful drugs, though they still lag behind the rates in other European countries.

Today, a majority of patients will survive what used to be known as “the big C”. For some cancers, especially childhood cancers, we can talk confidently about a “cure”.

Long’s case raised questions about access to tests for cancer that haven’t gone away. It also called into question the fairness of Ireland’s unique public-private health system, one that remains with us to this day.

Efforts were made to reduce the waiting time for tests. The then minister for health, Mary Harney, promised no patient would have to wait more than a month for a colonoscopy. An official target of 13 weeks was set for patients waiting for the test and this was met for a time.

Stalled diagnostics

In recent years, though, the waiting times for diagnostics such as MRIs, CT scans and colonoscopies have started to climb again. The HSE refuses to release figures, saying the data it receives is “unvalidated” but staff working in the area have been remarking on the trend for some time.

The only data to emerge up to now shows more than 4,000 people are currently waiting longer than the 13-week limit for a colonoscopy. The potential for missed diagnosis of cancers and other conditions is obvious.

The study published by the Irish Cancer Society today fills in much of the gap in our knowledge about these delays, as well as quantifying the extent of inequality. Most private patients will be tested within a week, or two weeks for endoscopies, but public patients will wait months, even years. As one doctor put it: "If the patient is public, you always wait."

While based on information provided by family doctors to the Irish College of GPs, it provides the clearest picture yet of a system of diagnostic tests that is every bit as clogged up and dysfunctional as hospital emergency departments and the wider inpatient and outpatient waiting lists.

GPs are the first port of call for most of us when we start to feel ill. They are well-placed to diagnose patients and to direct them for further tests when required. The very sick will get seen by the system quickly, it is clear, but the problem lies with the broader group of patients where illness is only suspected or who are presenting with non-specific symptoms.

Here, GPs report major problems with access to, and information from, hospitals. Many report routing patients to emergency departments in the hope of an early test. All take to badgering hospitals for appointments, though some fear they lose out here through a lack of personal contacts.

In effect, the enforced wait for tests amounts to an additional layer of delay for public patients before they are forced to languish on the main waiting lists for hospital treatment or appointments. For a small minority whose conditions remain undiagnosed, this wait will prove fatal.