Lies, damned lies, and statistics…
Here is the bones of my Drivetime health slot on 17 September 2009
In the last week alone, four reports detailing the performance of the health service have been published. Yet they hardly hit the public radar. How happy must the spin doctors in the HSE and the Department of Health be in this NAMA land we are living in. These reports just published provided a myriad of facts and figures – the June and July HSE PR reports, the ESRI HIPE report for 2007, the Annual Report of the Controller and Auditor General which has over 50 pages on different aspects of the health service – So what do these reports really tell us?
If we look at breast cancer referrals. There is a target of a maximum 2 week wait for urgent referrals and 82% of cases are meeting this but 18% were not, ie the majority of women were seen within 2 weeks – this is v good but 1,114 women in July had to wait longer for two weeks even when they were urgent cases. There is also a target of all women with potential breast cancer being seen within 12 weeks and just 80% met that target so 20% or 2,387 did not.
€€; In relation to money, the HSE are much closer than ever before in living within their budget but they are still over budget by about €123 million – not bad – and the majority of this is in two areas; hospitals in the North and West are particularly over budget; and €47 million over their pension budget. Some interesting facts, budget for foreign travel was €105,000 in first three months of 2008, where as in second quarter of 09 it was €7,000 – that’s a significant drop.
Emergency: In relation to emergency services, a year ago, 86% of ambulance calls were met with in 26 minutes – (26 minutes is the target). In July 09 it was 83% so that’s a drop of 3%. Also the number of people showing up to Emergency department is down by nearly 3% when comparing first six months of 08 with 09. What’s interesting about this is the October budget introduced a charge of €100 for people showing up in EDs without letter of referral to EDs. So this figure may indicate this increased charge is hitting. But also interesting is the number of admissions is not down, so it may be acting as a deterrent for people who don’t need to be there.
Public private mix: Interestingly, all the reports deal with the public private mix in hospitals. But in particular the Controller and Auditor General had some key findings here. Since 1991, we have what is officially called a 80/20 public private designation in public hospitals. This was put in place to control private care and provide extra money from private patients to the benefit of public care. The most recent HSE figures for July 09 show 75% of inpatient work is public – it is meant to be 80%. This is 7 months in to new VERY expensive consultants contract which is meant to ensure the 80/20 mix. There are some startling findings in C&AG report:
- 50% of private care in public hospitals not charged for their maintenance
- this is an estimated loss of €356 million for all hospitals in a year
- Rates charged despite significant increase – do not represent economic cost
The C&AG found that current system is “facilitating private medicine without getting the related income for the service it provides”. He concludes that “ensuring equitable access and optimising the recovery of the cost maintenance of all privately treated patients are difficult to achieve simultaneously within the present system”.
The C&AG is unsure whether the new consultants contract will address this, plus further complicating factors that new public only consultants may result in loss of revenue to public hospitals – all making it very clear that the current system ensures private patients privileged over public patients and subsidised heavily by public money – heard that somewhere before?
The Controller and Auditor General also looked at the HSE’s new performance measurement system Healthstat – and overall he was v positive about healthstat. But he had a particularly interesting findings in relation to waiting times which was new to me. In January 09, there were 37,000 people waiting for procedures. The government target is no one should be waiting over 3 months, yet 18,500 were waiting over three months. The HSE target is 6 months – yet there are still 6,300 waiting over six months
The C&AG is critical of this measurement, as he believes it may not reflect the actual numbers waiting, because in many hospitals, people are taking off waiting list once they have been given an appointment for the treatment not when they have had it.
He points out that at the moment there are large numbers of cancellation of elective treatment due to tight budgets, over crowding and bed shortages, pressures from A&E (70& of admissions) and bed blockers 899s and therefore the 18,500 figure is not a true reflection.
In one hospital they looked at the total number of patients waiting for treatment was 1,741 but actually there were 766 others who had an appointment for treatment. Other really interesting findings on out patient and day cases – the C&Ag is doing really interesting digging – v useful.