Public-private debate at core of controversy

MEDICAL MATTERS:Patient safety must be given utmost priority

LIKE MANY media storms, the controversy over unreported X-ray backlogs and unopened referral letters at Dublin’s Tallaght hospital has blown over. But important issues for patient safety remain to be addressed, something highlighted by the Ombudsman Emily O’Reilly in a conference speech last week.

Referring to a recent case she had examined and her assumption the problem wasn’t unique to Tallaght, she said she would be surprised if further inquiries “didn’t show that the private patients were more likely to have had their referrals attended to and their X-rays reported on”.

O’Reilly said her office had recently investigated a case concerning a woman who was suffering from a chronic condition which had possible respiratory and cardiac implications. It emerged that test results containing significant abnormalities, and sent by post to her consultant, remained unopened in the hospital’s public patients’ office. Some days later, the woman died suddenly.

“In the case of a public patient, I was told by the hospital that test results were sent to the public patients’ office and that the onus was on the consultant to collect them. Occasionally, when letters were stacking up, a member of the secretarial staff might alert a consultant to this fact; but there was no system in place to ensure that this happened,” the Ombudsman noted.

“In contrast, it was clear that private patients had their test results opened by the particular consultant’s private secretary on a daily basis. In this way, the private secretary was in a position immediately to draw the attention of the consultant to any results that might be of concern.”

Is this why a significant proportion of people entitled to medical cards and free medical care in the public system also carry private health insurance? Probably not, at least until now. But it certainly adds another powerful reason for those who can afford it to continue to pay their premiums to the VHI, Quinn and Aviva.

Whatever about the additional “hotel” facilities offered by private hospitals and enjoyed by private patients, can it be right that such a fundamental process as transferring a person from primary to secondary care should differ markedly between public and private patients? If two people have exactly the same symptoms suggestive of bowel cancer, are we happy to live in a Republic which treats their urgent referrals differently depending on who is paying for their care?

More so than the X-ray controversy, the lack of governance over the referrals process unfortunately means we cannot trust our public health system. Which is why the national survey of referrals announced by the Health Information and Quality Authority (Hiqa), in conjunction with the Irish College of General Practitioners, is so important. It is essential that no matter where in the State a person lives, or whether they are a public or a private patient, the process should be consistent. Hiqa has indicated it will closely examine “the performance and integrity of the referral process . . . and that there is an efficient and consistent process for patients regardless of what hospital they are attending”.

In this age of well-developed information technology there is no reason why a unified e-mail referral system cannot be introduced for all hospitals here. By confirming receipt of the electronic letter and by subsequently sending a copy of the patient’s appointment details to the referring GP, future “Tallaghtgates” can be avoided. In fact, such a system already exists.

Healthcarebookings.com is the brainchild of Michael Sheehan and is up and running in the Blackrock and Galway clinics. It enables outpatient and X-ray appointments to be made by GPs; and their patients can track and record these appointments in a safe and secure manner.

Indeed, Hiqa may well recommend such a system in its forthcoming report. But whatever it concludes, the referral pathway must be equitable and available to everyone, as well as being rapid, reliable and consistent.

mhouston@irishtimes.com