No quick cure for reducing waiting lists


Public patients waiting for new hips, triple by-passes, cataract operations or other medical procedures will receive little comfort from the report of the group set up to examine the reasons for hospital waiting lists.

In June 1993, when the then minister for health, Mr Brendan Howlin, initiated the Waiting List Initiative (WLI), allocating £20 million, some 40,000 people were awaiting hospital treatment. Almost £70 million later, that figure is back up to some 34,000.

Mr Cowen has already indicated that he is committed to maintaining this separate stream of funding for addressing waiting lists and waiting times. The initiative operates on the basis of dedicated funding from the Department of Health for a specified number of elective procedures in hospitals. However, clearly simply throwing money at it is not going to solve this problem.

There is some sense of this being a bottomless pit but, as the review group and various other bodies point out, there are far more sensible ways of improving the situation than throwing good money after bad.

The group recommended a series of immediate, medium-term and long-term initiatives if waiting lists and waiting times were to be reduced substantially. It remains to be seen if these will work, but even more importantly whether the Minister will grasp this nettle.

The report pointed out that there were no simple, short-term solutions which on their own would have a significant impact. In its pre-Budget submission, the Irish Medical Organisation (IMO) said the factors which give rise to the waiting lists have not been addressed.

One of the main points it highlights is a lack of hospital consultants. However, it points out that simply increasing numbers would not resolve the problem.

Additional modern, fully equipped theatres are essential, says the organisation, as are the additional support staff to allow for the optimum use of such facilities.

According to the IMO, a planned capital development programme is required over five years. After these and other measures are undertaken, the IMO believes, more than £50 million a year would be required to address all the underlying issues relating to waiting lists.

Fine Gael in its Patients First document published yesterday called for the establishment of a new specialist grade in hospitals to take the pressure of routine work off consultants.

Work which the review group said could be carried out immediately included the assessment of the capacity of the State's hospitals; the improvement of information systems; validation of waiting lists; more communication between GPs and hospitals; the appointment of bed managers and bed utilisation committees; and a number of other short-term initiatives aimed at improving the operation of the system.

The group said waiting lists were a "phenomenon of public rather than private health services" given the role which public hospitals played in providing services for both public and private patients. Having regard to the increase in the number of people with private health insurance, there was an onus on hospital managers to ensure there was equity of access for all patients, both public and private.

It pointed out that some consultants or hospitals may find it attractive to maintain a public waiting list because a proportion of those treated may opt to be treated privately.

It said agreement regarding workloads for consultants treating public patients, as provided for in their contract, should be outlined in all service plans. "The service plan should safeguard equity of access and maintain the agreed proportion of public and private patients treated."

The group said it was vital to direct funds under the WLI specifically to the areas where they would operate to best effect.

The specialities with the highest five waiting lists accounted for some 22,000 of the 32,000 awaiting treatment at the end of last year.

Addressing the issue of hospital capacity, the group said where staffing was an issue these hospitals should receive money to employ temporary staff in certain specialities.

If physical capacity was the problem, the Department should consider additional capacity in hospitals where existing facilities were already appropriately used. It called for the development of geriatric hospitals on the sites of acute hospitals.

The next priority should be the development of rehabilitation facilities and stand-alone day surgery units.

A number of "strong arguments" were heard by the group from "a number of quarters" that it was inconsistent to close beds for periods of the year, usually during the summer, while patients remained on waiting lists for elective treatments.

The group was conscious, it said, of the practical reasons for seasonal bed closures. However, it believed hospital management should take "full account of the scope for elective waiting list activity before making any decisions" in this area.

The report called for hospitals to carry out a postal review of patients on their waiting lists; an improved flow of information between GPs and hospitals concerning the condition of patients; an increase in day case work carried out; the appointment of bed managers; and the discharge of patients to more appropriate facilities for recuperation.

Mr Cowen said in the Dail recently that 418 acute hospital beds were occupied by inappropriately-placed patients. A clear, written policy should be developed by all on planning the discharge of older patients and liaising with the relevant community-based services.