Waiting lists in public hospitals ‘out of control’

Patients waiting up to nine years for appointment at Waterford hospital, report says

Patients are in some cases are having to wait up to nine years for an outpatient appointment to see a consultant in a public hospital, doctors have claimed.

In a new report to be published on Thursday, the Irish Hospital Consultants' Association (IHCA) said that in Waterford University Hospital at present there were only two consultant urologists to serve a population of 500,000 people.

“Presently there is a nine-year waiting list for an outpatient appointment. At a minimum the service requires an additional three consultants, three registrars, three senior house officers and two interns in the immediate term,” the IHCA report stated.

It said the details of the waiting lists emerged in a recent survey on difficulties arising from staffing problems.

The president of the IHCA, Dr Tom Ryan, said that waiting lists in Ireland's public hospitals were "out of control". He said they would not be brought back to manageable levels unless resources were redirected to increase acute hospital and mental health front-line capacity.

“There are now over 589,000 people on waiting lists in Ireland’s public hospitals and there is no sign that these numbers are going to decrease. Waiting lists are spiralling out of control because there is not enough capacity in the system,” he said.

Front-line staff

“Public hospitals urgently need additional acute beds, intensive care beds, theatre operating time, consultants and other front-line staff. This is essential to reduce the unacceptable waiting lists, the overcrowding of emergency departments and the increasing number of patients being treated on trolleys.

“Currently, our healthcare system appears to be more focused on balancing budgets and rationing care than treating patients.”

Dr Ryan said Ireland’s population had increased by 12 per cent over the last 12 years, with the population aged 65 years and over increasing by more than a third.

“There are more people than ever requiring healthcare and the upcoming budget must reflect this reality. Throughout the past decade the State has severely rationed healthcare, and with an increasing number of patients becoming reliant on private hospitals, in effect acute hospital services are being privatised by stealth.

“Notably the private hospitals understand the increase in existing and future demand for health care services and have expanded their bed capacity, unlike the public hospitals,” said Dr Ryan.

“This situation did not arise overnight. But now the waiting lists are increasing at an alarming rate, as a consequence of decades of healthcare cuts. In addition, lack of acute hospital capacity is impacting adversely on essential surgical appointments, which have declined by over 100,000 (54 per cent) in four years, and on the delivery of timely cancer care to patients. Urgent action is needed to prevent the health system descending into chaos.”

Dr Ryan said health service infrastructure was crumbling in the wake of cumulative cuts of nearly €1.9 billion in the current Health capital plan for 2016 to 2021, compared with 2008. He said acute hospitals were attempting to treat patients with equipment that was increasingly obsolete. The current levels of funding do not even meet the cost of maintaining and replacing existing equipment never mind providing for much needed additional capacity.


“Furthermore, when the new capital investment projects, including the children’s hospital and the plans to relocate maternity hospitals, are funded the existing capital plan of €3 billion will not have sufficient funding to replace obsolete equipment or develop additional capacity to provide care.”

The IHCA has said that Budget 2018 must also provide a significant increase in funding for mental health services which are significantly understaffed and remain funded at 15 per cent below 2008 levels.

In its 2018 prebudget submission, the association pointed to what it described as the failure of the State to address the consultant recruitment and retention crisis. It said this was significantly impacting on patient care.

“The 2008 consultant contract is not being honoured by the State. This, combined with the ongoing discrimination against new entrant consultants, and the failure to reverse the salary cuts (imposed under financial emergency legislation), has created an environment where the health services cannot recruit and retain a sufficient number of high-calibre consultants.

“It is unacceptable that over 400 approved hospital consultant posts are either vacant or filled on a temporary/agency basis. This false economy must be ended as patients are being deprived of care while medical agency costs are exceeding €115 million per year.

“The HSE’s admission that it has appointed 70 non-specialist doctors to specialist consultant posts since 2008 demonstrates the extent of the failure of current health service policies to address the ongoing exodus of highly trained consultants.”

Escalating cost

The submission argued there was a pressing need to address the escalating cost of clinical indemnity. It said this was forcing consultants to cease practice or emigrate.

“The relevant provisions of the Legal Services Regulation Act 2015 must be commenced without further delay, so that the pre-action protocols are implemented to resolve clinical indemnity claims more efficiently and at reduced cost.

“A clear set of measures must be developed to ensure more effective management and utilisation of resources through strengthening governance arrangements, thereby ensuring that they represent best practice and are fit for purpose. This must include the alignment and merger of hospital groups and CHOs [community healthcare organisations]. It is also essential that the current focus of governance is rebalanced to facilitate increased clinical governance input at organisational board levels so as to prioritise the delivery of safe, high-quality, timely care to patients.”