Report questions value of £70m investment


Sustained investment by successive governments has not had a significant impact on hospital waiting lists, according to a report of a group advising the Minister.

The report, presented to the Minister for Health, Mr Cowen, over three months ago, calls for an urgent review of hospital capacity. It says it believed some hospitals have reached capacity and the latest data revealed that bed occupancy rates in Irish hospitals were the highest in the EU.

The group was set up by Mr Cowen in April to examine the effectiveness of the Waiting List Initiative (WLI) and how best to reduce the numbers awaiting hospital treatment. It is due to be presented to the Cabinet within weeks.

Over five years, £70 million has been invested to tackle the problem. However, the report concludes that a series of initiatives must be taken if waiting lists and waiting times are to be substantially reduced. "There are no simple, short-term solutions which, on their own, will have a significant impact."

Some £58 million has been spent on the WLI between 1993 and 1997 and a further £12 million has been set aside for this year. However, the report says it is "difficult to point with absolute certainty to a direct link" between the funding and a reduction in waiting lists.

Meanwhile, Fine Gael announced a plan yesterday to tackle the "endemic and persistent" problem of waiting lists. The party's health spokesman, Mr Alan Shatter, said the Government should admit the extent of the waiting list crisis.

There were, he said, two waiting lists. "The visible list is made up of 34,331 public patients throughout the country who are waiting to be admitted to a hospital for surgery or treatment. The second, hidden list is made up of those tens of thousands of people who have been referred by their GP to a consultant. It cannot be easily estimated since the Department of Health does not keep records of it. Many of those on the hidden list will be waiting for months, some for years."

This problem was also identified by the review group. It said in the worst situation there could be an incentive to keep in-patient waiting lists short by "failing to refer patients as soon as possible from the out-patients' setting".

It also said the present system of allocating funding to hospitals may be acting as a disincentive to hospitals to improve their waiting lists. The group considered whether the basis on which this funding was currently allocated "might send inappropriate signals in this regard to hospitals, who might fear that an improvement in their waiting list performance would lead to a reduction in WLI funding".

Changes were suggested so that hospitals or particular departments could be financially rewarded for good performance.

However, the report says the "available evidence" suggested there was a strong correlation between the amount of funding given to a hospital and the reduction in the number of people waiting for treatment by the end of each year.

Total lists fell by the end of years in which substantial WLI funding was provided. In contrast, total lists rose by the end of 1995 and 1997, years when the funding was reduced considerably from the previous year.

The group said the WLI had been an important element of hospital activity since its inception in 1993. "Inevitably, questions can be raised about validation (and hence the true extent) of waiting lists, the net effect of WLI on waiting lists and waiting times, and the management of waiting lists at hospital level."

Nonetheless, says the report, it was clear the WLI had funded a large number of elective procedures and had enabled thousands of patients to receive treatment more quickly than would have been possible under normal hospital services.

It says the aim of the WLI was to reduce waiting times for in-patient procedures in public hospitals to no longer than 12 months for adults and six months for children. However, about 75 per cent of adults awaiting cardiac surgery and 66 per cent of those awaiting vascular surgery and plastic surgery appear on waiting lists for longer than 12 months. A similar situation exists for children, particularly in cardiac surgery.