Waiting for treatment
With waiting times in hospitals on the rise, eolas reviews the situation.
Despite promises that waiting times for both inpatient and outpatient treatment would be no longer than 15 months by the start of 2016, figures released by the National Treatment Purchase Fund (NTPF) show that waiting times in hospitals are on the rise.
The NTPF is an independent body established by the Minister for Health to collect, collate and validate information on persons waiting for public hospital treatments. The former Minister for Health, Leo Varadkar TD had pledged to eliminate waits of more than 15 months and spent an additional €50 million last year to ensure the target would be met. However, the NTPF’s figures for January 2016 show that, 13,763 outpatients have been waiting for more than 15 months. This figure is an increase on the 9,887 waiting 15 months or more in December 2015.
The increase is thought to be due to the cancellation of outpatient appointments as emergency departments became overcrowded over the winter months and members of the Irish Nurses and Midwives Association in some hospitals threatened to strike. The total number of outpatients on the waiting list had been falling in recent months but January 2016 also saw an increase in this figure.
Overall, there were 383,713 outpatients on the list in January, up by more than 8,000 from 375,440 in December 2015 but less than the 414,000 peak in mid-2015. The problem of long delays in waiting times appears to be concentrated in a handful of hospitals, many of which are also struggling with emergency department overcrowding. Beaumont Hospital in Dublin has the highest number of delays with more than 2,000 outpatients waiting more than 15 months for an appointment. Tullamore, Tallaght and Galway hospitals also have a high number of patients awaiting treatment. Delays are worst in ear, nose and throat departments, orthopaedics and dermatology.
The amount of time a patient has to wait for treatment has resulted in Ireland falling seven places in just two years in the European Health Consumer Index (EHCI). The index has been published by private Swedish firm, Health Consumer Powerhouse since 2005 and covers 48 indicators across 35 countries, including patient rights, information and access to care. The 2015 index ranks Ireland 21st out of 35. In 2013 Ireland was ranked 14th.
The best performing health system is in the Netherlands, which scored 916 points out of a maximum 1,000. Ireland’s health system scored 685, while the worst performing country is Montenegro with 484 points.
Despite recognising the fact that Ireland has detailed official statistics on waiting times across the healthcare sector, the ECHI notes that the country, along with the UK and Sweden has the worst patient organisation feedback on accessibility among the 35 countries ranked. This feedback has led the ECHI to question the validity of the official statistics and as such, the index has scored Ireland on patients’ versions of waiting times, rather than the official statistics.
The report ranks Ireland as the worst country on record with regards to access to health services and states that waiting times are found to be “frequently more than three hours” more often than anywhere else in Europe. The index ranks Ireland the second worst in Europe for direct access to specialists without GP referral, the fourth worst for non-acute operations carried out within 90 days and the eight lowest for the proportion of non-acute CT scans carried out within a week.
The index also notes that 40 per cent of the population purchase duplicate health insurance suggesting this is either due to an extreme case of dissatisfaction with the public system, or simply a technical solution for progressive taxation.
However, it praises Ireland’s efforts to combat MRSA as resistance rates have fallen from 40-45 per cent in 2008 to 20 per cent in 2015.
Speaking about the index’s findings, a spokesperson for the HSE expressed the organisation’s dissatisfaction with the exclusion of its official data from the index, though did acknowledge that the needs of the population and the capacity of Ireland’s health system are, at present, unbalanced.
“The HSE explicitly acknowledges in its 2016 Service Plan that it lacks capacity to provide the type of accessible health services required to meet the current and emerging needs of the population of Ireland,” said the spokesperson.
“Although the overall length of time people spend on waiting lists has improved in recent years, the total numbers waiting, and the numbers waiting in excess of four months for outpatient assessment and inpatient treatment, are unacceptably and unsustainably high. The HSE is working with the Minister for Health to ensure that no one is waiting more than 18 months for an outpatient appointment or inpatient treatment.
“Since 2014, the index has used only patient organisation feedback to score Ireland on accessibility (waiting times) which has resulted in Ireland’s ranking dropping. Now, through the eHealth project we are advancing at pace with a number of important developments including the individual health Identifier (IHI) and eReferral which is currently being rolled out. These initiatives will allow the collection of more reliable data on a patient’s journey through the Irish health system which in turn can factually inform reports such as the EHCI.”
