The National Health Strategy fails to address the lengthy delays experienced by patients waiting for their first appointment with a consultant, a report published today says.
The report by the National Economic and Social Forum, which is chaired by Dr Maureen Gaffney, praises the strategy commitment to ensure that no one waits longer than three months for in-patient treatment by the end of 2004.
It notes, however, that "part of the problem facing public patients is lengthy waits for first consultant appointment after referral by a GP, but this issue is not recognised or addressed by the strategy".
And it warns that reductions in waiting times for in-patient treatments should not be achieved by lengthening the time it takes to see a consultant in the first place.
"At the very least those implementing the strategy must be in a position to ensure that the waiting list targets are not met through 'wait shifting' - i.e., reducing waits between outpatient consultation and treatment by increasing waits between GP referral and out-patient consultation."
This will require "systematic measuring and monitoring of waiting at all points on the pathway to treatment," the report, Equity of Access to Hospital Care, says.
But quite apart from that immediate issue, it says, "the inequity between public and private patients in the waiting times they face for initial specialist appointments must itself be addressed".
The report welcomes the commitment in the strategy that additional beds paid for out of taxes will be designated exclusively for public patients. It describes this as "an important and most welcome break with earlier practice".
Government proposals to change the consultant contract so that new consultants will not engage in private practice for a number of years, and to limit private admissions to public hospitals if these prevent waiting list targets being met, are also welcomed in the report.
The report recommends that all patients seeking treatment in public hospitals, should be on the same waiting list. Currently, 20 per cent of beds in public hospitals are designated as private. The report says the length of time it takes to get a hospital bed should not depend on whether a patient is public or private. Instead it should be based on their medical need. For this reason it recommends that there should no longer be separate public and private waiting lists. It expresses concern that the strategy makes no specific commitment in this regard.
Otherwise, while waiting times for public patients may become very much shorter, "public patients might well still have to wait longer for essential treatment than private patients and not necessarily be treated in the same way when in hospital."
The forum also seeks a legal limit to how long public patients should have to wait for treatment. Legislation, it says, should "guarantee rights to treatment within a reasonable period". Such legislation must, however, take into account "the limits of the public resources available for the health services".