PD health plan would cure only some system ills

Yesterday's announcement from the Progressive Democrats of proposals to reduce hospital waiting lists in the short term is the…

Yesterday's announcement from the Progressive Democrats of proposals to reduce hospital waiting lists in the short term is the first overtly political signpost of what might be coming our way in the forthcoming Health Strategy.

Until now the various hints and leaks have come from health organisations and those who have contributed to the review process. What the Progressive Democrats have done is up the ante considerably by offering a most attractive carrot to the long-suffering public health consumer. Their proposal offers the prospect of more equitable access to healthcare.

The proposal to shift 26,000 people - who have been waiting a minimum of three months for in- patient treatment - from the public to the private sector and pay for their care seems breathtakingly simple.

At an average cost of £2,000 per patient the projected bill of £50 million pounds is extremely cheap if it succeeds in dealing with the vexed question of hospital waiting lists.

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Can it work? Will it work? There are a number of hurdles which stand in the proposal's way - assuming, of course, that it receives Cabinet approval and becomes Government policy.

Firstly, can the consultants deliver? For some operations and procedures, they can. Day case facilities are easily expanded if consultants and their private staff are prepared to work evenings and weekends.

For example, the number of endoscopies - the procedure where an optical tube is passed either up or down the intestines - could be considerably increased. Relatively minor operations such as the removal of eye cataracts or orthopaedic key-hole surgery could also be performed in higher numbers without the need for significant infrastructural development.

However, major operations, such as cardiac bypasses or hip replacements, are different matters. The rate-limiting factor in these procedures is not the lack of availability of skilled doctors but rather the need for skilled nurses and dedicated intensive care beds. Both are in extremely short supply in the State in private and public hospitals.

Before this proposal could make a difference for public patients, some major changes would have to take place in both sectors.

The 26,000 patients who would gain from yesterday's offer represent about 15 per cent of the numbers covered by private health insurance.

How will this latter group feel about a possible 10 to 20 per cent increase in waiting times for treatment which, until now, has been available promptly in most specialities? Will hospital consultants deliver?

Sources close to the Irish Hospital Consultants' Association say they will wonder if they are being placed between a rock and a hard place.

If the initiative does work, will they be accused of not having worked hard enough in the past?

If it fails and patients are treated successfully abroad, will they be unfairly criticised when the reasons for failure lie outside their control?

History suggests there are no quick-fix solutions to problems which have been generated over a 20-year period.

For many reasons this interesting proposal is likely, at best, to benefit a minority of those waiting for public hospital treatment.