Minister for Health Simon Harris has outlined five actions to address Ireland’s increasing outpatient and inpatient waiting lists.
These actions include halving the number of patients waiting longer than 18 months for inpatient treatment; a clinical validation of waiting lists to assess their accuracy; appointing “an improvement lead” to examine waiting lists; requesting the special delivery unit to implement a waiting list improvement plan; and asking the HSE to develop specific proposals to tackle the ever-increasing waiting list problem.
None of these actions actually addresses the problem or provides solutions that will have any practical effect.
To cut the waiting lists, one must begin by examining why these lists developed in the first place, followed by actions that will resolve the problems.
In simple terms, there are too many people needing assessment and treatment trying to access a health system that is not large enough or efficient enough to deliver services in a timely fashion.
If the public health service were a business it would not last very long. There must be a streamlining of management within the Department of Health and the HSE. Management systems are complicated, convoluted, disjointed, opaque and difficult to understand.
Disconnection
Many decisions are made and money wasted due to the disconnection between frontline staff and management. Political accountability is lacking. Work practices that were sufficient to deliver a service 40 years ago are still in place, while modern medicine has evolved in its thinking, technology, pharmacology and specialisation.
Our population is increasing and ageing, so requirements for services will continue to place greater demands on our health service until it faces reality and become efficient and effective.
The Minister needs to give the health service some hope that there is a plan in place that will drive reform forward, so the public will have pride in the service. We desperately need to improve the morale of frontline staff and management, and to demonstrate that their dedication and vocational commitment will make a difference.
Retention and recruitment of professional staff is essential. We must make every effort to persuade the best and brightest we train to remain in our health service. It makes no sense to passively haemorrhage those we need to save our health service and then energetically try to attract them home, while trawling the world to recruit foreign staff to fill the gaps. Without adequate trained efficient staff the system is grinding to a halt.
There are not enough beds in our hospital system. If that is not recognised and addressed we are never going to solve the problem of waiting lists for inpatient treatment. Many hospitals are operating at unsafe occupancy rates, with overcrowding, trolley congestion, emergency admissions displacing planned admissions and extreme pressure on all staff who are trying to deliver care in impossible conditions.
Access to diagnostic tests, particularly colonoscopy, ultrasound, CT and MRI scanning are limited and this is a major barriers to speedy assessment and treatment. The diagnostic deficit prevents timely diagnosis and extends hospital stay, as only limited emergency tests are available in the evening and over weekends. It makes no sense to close scanning departments outside the normal working day. Ill-health does not observe office hours.
Restrictive practices
Work practices have to change. This will require unions and professionals to review every aspect of their work. Restrictive practices need to be challenged. Professional empire-building within hospitals and uneven funding of hospitals must be addressed. Those who obstruct change need to be exposed. This is our health service, not their health service. Doing this will not be easy, but it must be done. Lives are at risk and unnecessary inefficiencies must not be tolerated and allowed to continue.
One of the major problems that gives rise to unnecessary admissions and delayed discharges is the lack of community support structures, including home-help hours and homecare packages. Many of our elderly patients end up in residential care, which is vastly more expensive than supported homecare.
Our elder population is growing, paradoxically because of the successes of our health service. Many aspects of our service are world class, including cardiology, cancer care, laboratory services and many specialty services.
It is important that the Minister takes the road less travelled in the Department of Health, and, with courage, makes the correct decisions early in his ministry.
Dr Michael Harty TD for Clare (Independent) is chairman of the Joint Oireachtas Committee on Health and a member of the all-party committee on the future of healthcare