A week is a long time in health politics…
This time one week ago, no one knew about the 57,000 plus unreported x rays in Tallaght hospital, no one had spoken openly about the 3,000 or 30,000 unread GP referral letters. Six days on from the story being broken by RTE’s Fergal Bowers, no one from the hospital has claimed responsibility, and according to themselves, neither the Minister nor the HSE are responsible. So what on earth is going on?? There are two issues here – at hospital level and at national level. We need to know what happened in Tallaght that allowed this to happen. There have been problems in Tallaght steming from the merging of three hospitals. Initially there was fighting between them and there has been consistent animosity between them and the Dept of Health and subsequently the HSE and Tallaght. Tallaght has always been under funded and also it is a voluntary hospital and according to the HSE it can do as it wants.
But this is simply not good enough. The HSE gave Tallaght a budget of €217 million in 2009 and €209 million is allocated for the year ahead. Each voluntary hospital has a service level agreement with the HSE, surely in this, the HSE can stipulate the most basic quality of care – ie that x rays if required should be read by a radiologists and that GP referral letters for patients are opened and responded to. I simply do not believe that this is outside the control of the HSE. And if it is now, it should be addressed as soon as possible.
There should be a completely independent review of what went on in Tallaght, why were alarm bells not called earlier about the x rays? How come no one paid attention to the unopened GP referral letters (and unopened GP referral letters are much more significant to the unreported x rays although of course the unreported x rays are very important for those whose x rays were wrongly read and got a late diagnosis)? Who in clinical and management failed to carry out their roles? Why did the board not know about this and remedy it? Why did HIQA not tell the HSE sooner? Why did the HSE only find out last Tuesday? Why did the Minister not react more when she heard of radiology problems last December? Are there other bad practices happening in Tallaght? Are there similar failures happening in other hospitals? We need the answers to these questions.
So what do we know about Tallaght hospital? Last year, it had 75,000 Emergency Department admissions and 24,000 inpatients. Tallaght has always had a disproportionate volume of private work – in February 2008 before figures on this were published – 45% of all planned/elective work in Tallaght was private. The most recent HSE health stat figures from November 2009 say its down to 38% but its meant to be 20%. Tallaght is and has always totally ignored the alleged national 80/20 ratio of public/private work in public hospitals. So Tallaght’s proportion of private work is double whats it is meant to be.
Also health stat tells us Tallaght does particularly badly in terms of waiting times:
Waiting times in Emergency Departments
- 16% seen within 6 hour target
- 20% waiting 6-12 hours
- 50% waiting 12-24 hours
- 14% waiting more than 24 hours
Elective waiting times children
- 42% wiating longer than 3 month target
Elective waiting times adults
- 68% seen within 6 months
- 26% waiting more than 6 months
- 6% wiating more than 12 months
Average waiting time for new routine appointment in consultant led clinics are amongst the worst in the country in Tallaght
- Not one out patient clinic is meeting the target of 90 days – three are over 200 days and orthopeadics is 600 days.
- Health stat also tells us that Tallaght has a higher dependence on NCHDs (junior doctors).
We know there is a problem with GP referrals as the practice from local GPs is to refer patients to St James and Blanchardstown, epescially for orthopeadics. We know that there is a disproporationate amount of private work in Tallaght. We know that both radiology and orthopaedics are particularly profitable. Neither the HSE nor the hospital will tell me if the xrays belong to public or private patients.
Lets join the dots here – it is very unlikely that any of the unreported x rays or unopened letters are from public patients. Tallaght does a disproportionate amount of private work. What is going on here is a local and HSE management failure but it is also a direct result of our two tiered health system which privileges private patients over public, which continues to incentivise and reward doctors and hospitals to treat private patients, which punishes hospital consultants who work only with public patients.
The Tallaght debacle is a symptom of our divisive health system, highlighted by Susie Long two years ago, a system propagated and further institutionalised by Mary Harney through the new consultants contract. Lets name it for what it is.