With some 530,000 people now on public hospital waiting lists and higher numbers of patients waiting long periods for a hospital appointment, waiting times for secondary care continue their inexorable rise. A record 430,000 patients were waiting for an outpatient appointment at the end of last month, according to the latest data from the National Treatment Purchase Fund (NTPF). More than 70,000 of them have been waiting for an appointment for more than a year, while 39,000 have been waiting longer than the 15-month supposed "maximum" set by the Government.
Minister for Health Simon Harris has responded with a plan aimed at reducing the number of patients on waiting lists. He says it will reduce by 50 per cent the numbers waiting over 18 months by year end.
However the details do not engender confidence. The rhetoric is one of management speak rather than innovation– illustrated by the jaded obfuscation of a “clinical validation of all inpatient/daycase waiting lists where patients are waiting longer than 15 months”.
These once-off pruning exercises have not worked in the past and do not tackle the core problem which is a lack of capacity in an inefficient hospital system. The Minister has previously outlined an €1 million initiative to outsource procedures such as colonoscopy – frequently used to check for bowel cancer – for those patients who are currently waiting more than 12 months for tests. But how far has this initiative progressed? How many patients have already been tested or received firm appointments? We need to see completion figures and timescales of implementation for ministerial initiatives to be credible. Rehashing announcements is not acceptable.
What is required is a commitment to invest in additional beds and more staff to address the obvious capacity issue. But there is no point in investing resources into sclerotic Health Service Executive structures. To do so would be to encourage the continuation of inefficiency and to reward the system's dysfunctional culture.
Newly commissioned beds and future staff recruitment must be structured in a way that benchmarks efficiency seen in the private hospital sector. Inpatients do not wait days for tests to be completed in private hospitals.
Even those with complex multiple morbidities are investigated and treated at a quicker pace in private hospitals than occurs in the often more densely-staffed public system.
A comparative audit of the speed of investigation of those long wait patients who will now undergo endoscopy under the NTPF in the private system could be instructive.
It is likely to show just how sclerotic the public system has become. In the meantime, the Minister’s stated intention to bring greater political leadership to the public hospital crisis, however welcome in terms of ambition, is unlikely to stand the test of time.