If successful, a new referral system in Northern Ireland could change the way waiting lists are managed in the Republic. Fearghal O'Reilly reports
Radical plans to reduce health service waiting lists could end misery for nearly 190,000 patients in Northern Ireland.
A £35 million (€50.8 million) scheme to come into operation in April aims to ensure that no patient waits more than 13 weeks for a consultant's appointment or treatment. If successful, it could herald change in the management of waiting lists throughout Britain and Ireland.
There are 187,000 (one in nine) people in Northern Ireland waiting for an outpatient appointment and treatment - 40,000 of these have been waiting more than 12 months since first seeing their GP. Stormont health minister Shaun Woodward wants patients to wait no longer than three days for a decision on further treatment after they have seen their family doctor.
In a speech last week, Mr Woodward unveiled his reforms, claiming that the current system had failed both patients and health practitioners. It follows on his warning last summer that health boards in the North could have their funding cut if they fail to provide necessary services.
The money saved would be spent on buying treatment in another health board area or even in the Republic.
From April, the health service in the North will introduce a referral system, the Integrated Clinical Assessment and Treatment Services (Icats), which has British Medical Association (BMA) backing. "This is the term we are using for a range of services for patients which will be provided by integrated multidisciplinary teams of health service professionals, including GPs with a special interest, specialist nurses and allied health professionals," said Mr Woodward.
"Since July [ 2005], the number of patients waiting [for inpatient care] over 12 months has fallen by 70 per cent. Eight months ago more than 4,000 people - some of them in their 80s - were waiting more than 12 months for an inpatient or daycase treatment. Now that figure is just over 1,000."
At present if a GP believes a patient needs specialist care, they must refer them to hospital for an outpatient appointment with a consultant. Mr Woodward believes this "system is not able to respond to the needs of GPs or their patients who may need something other than a traditional hospital appointment".
Icats places everyone who is referred to a specialist on a centrally based electronic referrals management system. "It is a fundamental tenet of the introduction of Icats in any speciality that urgent referrals should not experience unnecessary delay in progressing to attention from a consultant. Where a primary care referral is assessed as not clinically urgent, it will be directed by Icats to the appropriate next step," Mr Woodward said. There are five possible outcomes once patients are referred from Icats:
They are directly placed on operations waiting lists without the need to see a specialist.
They are automatically sent for diagnostic tests without the need for a consultant.
They have face-to-face assessments with a healthcare team.
They are returned to primary healthcare.
They are referred to a consultant.
These new arrangements, said Mr Woodward, "will ensure that the time of hospital consultants be preserved for only those patients who require it". An additional benefit of the Icats system is that patients, once they have seen their GP, will be responded to within three days with a clinical decision as to the next step.
The BMA chairman in Northern Ireland, Dr Brian Patterson, said: "The BMA is supportive of any feasible plan to address this grave situation but we must be certain that these reforms ensure patients see the right person quickly."