THERE HAS been no significant improvement in outpatient waiting times in the health service, with some patients having to wait up to eight years for an appointment, a report by the Government's spending watchdog has revealed. PAUL CULLEN, Consumer Affairs Correspondent, reports
Almost 35,000 patients have been waiting for more than two years for an outpatient appointment, compared with a target waiting time of 90 days, the study by the Comptroller and Auditor General found. This figure is probably an under-estimate as not all the State’s hospitals provided figures for the study.
The revelations on long waiting times is just one of a number of health-related findings in the latest C&AG’s annual review of value for money in the public service. The 2008 report, published earlier this month, devotes five of its 42 chapters to health issues.
According to the report, the national average waiting time across all medical specialities fell slightly from 194 days in October 2008 to 186 days last January. Orthopaedics, which reports the longest waiting times, saw the average wait for patients go from 473 days to 461 days over this period.
The report was unable to establish the longest waiting time for an individual clinic because waiting times are calculated as an average across a speciality. However, in one hospital, the longest waiting time for an individual clinic was 2,920 days (eight years).
This would appear to indicate there has been no improvement in the very longest waiting times in the health service; in December 2007, The Irish Timesreported that 48 patients who were waiting to be seen in the outpatient department of Mayo General Hospital earlier this year had been on the waiting list since 1999, while patients are also waiting to be seen in the outpatients department of Galway's University College Hospital/Merlin Park Regional Hospital since the year 2000.
In his report, Comptroller and Auditor General John Buckley criticises some “dysfunctional” practices in the management of waiting lists, and says the practice in one hospital of closing the outpatient appointments book in order to bring waiting times under control should be banned.
As well as the 175,000 patients waiting for outpatient appointments, the report also found that 37,200 people were waiting for procedures. More than half had been waiting for more than three months, and 2,400 were waiting for more than a year.
The ability of hospitals to carry out common procedures as day cases – without the need for a costly overnight stay – varied hugely, from 22 per cent for the hospital with the lowest day-case rate to 82 per cent for the one with the highest rate.
The split between public and private activity in hospitals also varied greatly, from 45 per cent in the hospital with the lowest level of public activity, to 94 per cent in the highest.
The report also found little change in waiting times for the National Treatment Purchase Fund (NTPF), which organises inpatient treatment for public patients who have been waiting the longest for surgical procedures. The exception was for patients waiting for surgery for longer than 12 months, whose numbers dropped 75 per cent.
However, the C&AG’s staff found that more than 90 per cent of the longest waiting hospital patients were removed from the lists after their cases were reviewed by NTPF staff, leading Mr Buckley to say it was difficult to see how the scheme could discharge its functions for the patients it was targeting.
The report also found that half of all inpatients who were treated privately in public hospitals were not charged for their accommodation, mostly because they were in a public bed.
More than 180,000 private patients were accommodated last year in public wards and could not be charged. Effectively, this is a gain for the private insurers, as their customers have already paid their premiums.
At the end of last year, private health insurers owed the HSE €87 million and the voluntary hospitals €77 million in maintenance charges. Tallaght hospital was owed €15.5 million, St James’s €13.6 million and Waterford Regional €12.2 million. Many of these charges have been outstanding for a long time, Mr Buckley found.
“The low rate of income recovery from patients who were treated privately in the hospitals reviewed would suggest that the State is facilitating private medicine without getting the related income for the service it provides,” he concluded.
The report blames the delays in payment on “outmoded” paper-based administration systems and delays in sign-offs by consultants. It points out that although charging rates have increased, they still do not represent the full economic cost borne by the public system when it houses private patients.
For example, private care patients are charged up to €758 a day for maintenance when the actual cost of their accommodation is estimated by the HSE at up to €1,018. In addition, hospitals cannot charge for private patients in private beds who are treated by the new category A consultants, who don’t have any private practice.
According to Mr Buckley, 1,688 of the State’s 1,888 hospital consultants have opted into the new contracts agreed with the HSE in 2008. Some 629 have category A contracts, while the rest have category B contracts allowing private practice.
He says the HSE needs to push ahead with arrangements to verify that the new arrangements are delivering the gains that were promised, such as longer working hours.
In a review of the Dublin ambulance service, the report says the limited integration of the service in the city and the State raises concern about the quality of service delivered, as measured by the response times to emergency calls. “The duplication of communication and overhead costs militates against achieving value for money.”
A review of the service carried out in 2007 found that one- quarter of emergency calls were dealt with in eight minutes but this compared poorly with an eight-minute response time for 75 per cent of calls in England.