There is no disputing the need to make the health service more efficient and increase productivity but the carrot and stick approach being adopted by Minister for Health Stephen Donnelly in respect of consultant posts is something of a new departure.
The Minister has announced that from next year hospitals will only receive funding for new consultant posts if their existing consultants are seeing as many outpatients as their peers elsewhere. The measure is intended to incentivise hospitals to speed up implementing reforms and efficiency measures to cut outpatient waiting lists.
It is set against a background of stubbornly high outpatient waiting lists and spiralling costs across the whole system. More than 400,000 people are currently waiting longer than the 10-week target for an outpatient appointment while the Government has had to provide an additional €1.5 billion in health funding this year on top of the €22.5 billion allowed in the budget. An additional €1.2 billion has also been built into next year’s budget just to maintain existing service levels.
This situation is not sustainable and fresh approaches are needed. The idea of linking further investment to current performance is superficially attractive. Donnelly argues that that the number of outpatients seen in hospitals per consultant has fallen by almost 30 per cent since 2016. He believes that had outpatient activity per consultant in acute hospitals last year been at the same level as in 2016, more than 1.4 million additional appointments could have taken place.
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The Irish Medical Organisation, which represents hospital doctors, has been quick to identify the main flaw in this data driven approach which is the difficulty of comparing one hospital with another. They highlighted numerous factors that could affect consultants’ productivity such as access to clinics, the complexity of treatment required, and access to diagnostics, beds and theatres. The IMO could be expected to make such arguments but there is a clear issue around the use of crude measure to decide where investment should go.
There are also ethical and clinical issues, namely the allocation of funding to hospitals that produce the best numbers rather that those with the greatest need. The danger of fostering a culture in which hospitals focus more on numbers of patients seen than quality of care is also obvious.
Devising a way of measuring consultant productivity that allows for all these variables would be no easy task, but it may have to be tried. Donnelly’s proposed narrow focus has the attraction of simplicity but may not produce the desired outcome. It is part of a wider story of fast-rising spending in health delivering sporadic results, but seemingly failing to address key issues. Some of this is due to the fast rise in the population and the increased expense of medical procedures, but ensuring better value for money remains a crunch issue.