Health service stubbornly resistant to change, cancellation figures underline

Record budgets along with record sums devoted to tackling overcrowding and long waiting times in the health service do not appear to be working, if the latest round of Health Service Executive figures are anything to go by.

Health has been out of the headlines of late, which might lead people to think that its well-publicised troubles are being addressed. Minister for Health Stephen Donnelly, now three years in the job, has finally got his feet under the table and the HSE has a new boss, Bernard Gloster, who seems determined to make much-needed changes.

Alas, the service remains stubbornly resistant to that change. The top remains heavy. The bad bits continue to underperform. And the expedient solutions too often resorted to when a problem arises cause problems elsewhere in the system.

One such expedient reaction is the cancellation of hospital appointments and procedures. Too many sites are too quick to cancel elective work at the first suggestion of overcrowding in their emergency departments. That leaves surgeons twiddling their thumbs as operating theatres close and forces patients to wait even longer for care.

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An astonishing 85,000 cancellations have already been racked up this year. Most are outpatient appointments but the figure includes thousands of inpatient procedures and other tests.

Even stranger, the problem seems to be getting worse. Last winter was a bad one for respiratory viruses, and at one point more than 1,000 patients were on trolleys waiting for admission to a bed. In January, non-urgent work was sacrificed in an effort to contain the crisis.

The crisis passed and overcrowding eased. But the figures obtained by Sinn Féin’s David Cullinane show the number of cancellations has stayed high into the spring and even hit a record for the year in April, at more than 24,000.

It is hard to explain this concerning trend, which bodes ill for next winter. One factor is the rising numbers of patients attending emergency departments, many of them old and frail. Yet we don’t fully understand why this increase in demand has occurred. Another may be staff shortages, due both to positions remaining unfilled and increasing levels of absenteeism.

The Minister could build a throne from the number of action plans published by his department. Last year, the aim was to cut waiting lists by 17 per cent; in the end, the out-turn was about 1 per cent down.

This year, the plan aims to reduce waiting lists by 10 per cent, but already the numbers are running in the wrong direction. Mr Donnelly’s department doesn’t talk any more about the overall size of the waiting list, but of the number of “long waiters” – those waiting longer than the 10- or 12-week targets set in Sláintecare. But even this figure is going awry now, according to the latest figures published last Friday.

Some inroads are being made into the inpatient waiting lists for the most common procedures, as you might expect given €360 million was allocated last year and €443 million this year. But the progress is unimpressive given the outlay. And we have no idea whether value for money is being achieved.

The flaw in the Minister’s thinking is to believe the system can be improved without comprehensive reform or upsetting vested interests. A new consultant contract has been published but without buy-in from the representative bodies. Mr Gloster has rightly talked of the need to implement seven-day working across all areas in hospitals but for now that remains just talk. It remains the case that no one in HSE management has ever been fired for doing a bad job.