Reports of hospital waiting lists being manipulated are disturbing. The word manipulation suggests a malign process that is not entirely honest. For it to have been used in a confidential memo to staff in one Health Service Executive (HSE) region at a time when hospital waiting times have increased sharply must be a source of worry to patients. Among the methods allegedly used are the prioritisation of patients who are about to be classified as “long-waiters”; sending letters to patients asking them if they still require an appointment; referral to private hospital for earlier assessment; and removing patients from lists if they are also waiting for hospital tests. The Department of Health has said it will be raising the allegations with the HSE, which has said it has “no knowledge” of a confidential internal memo outlining the practice.
Referring a patient to hospital should be a simple, linear process. A general practitioner makes a professional decision to refer a patient for a consultant opinion to confirm a diagnosis. Once the letter of referral is received by the hospital it is date stamped; this date becomes day zero for the purposes of determining how long a person subsequently waits to be seen. Letters are then assessed by individual consultants to determine the degree of urgency attached to the referral which allows the patient to be seen within a clinically appropriate time.
It is accepted practice internationally for waiting lists to be validated. This is a transparent exercise by which patients who have been waiting some 6 months or longer are contacted to see if they have moved address or have decided to pursue private treatment. The methods used must take account of the person’s ability to respond to the communication.
What is not acceptable, and is denied by the HSE, is any attempt to change an individual’s position on a waiting list so as to prevent them falling into a longer wait category. Nor is it acceptable to remove someone from a waiting list simply because they also require an investigation.Waiting times for hospital treatment must be transparent and based on clinical need. No other method of prioritisation is acceptable.