‘Cautious optimism’? New unambitious targets for hospital wait times

On Wednesday 25 January, Minister James Reilly held a news conference to announce new targets on reducing the numbers of trolleys and wait times for hospital treatment. It was good news all-round… ‘Cautious optimism’ was the prevailing sentiment of the day.After a national forum of hospital managers, HSE and Department of Health people, new targets were announced for shorter wait times in Emergency Departments and for planned  hospital treatment. These are two of minister’s priority areas since he came in to government less than a year ago.

Just weeks in office, Minister Reilly said that never again would there be 567 people on a trolley. He set up Special Delivery Unit [SDU] (his swat team or ‘nerve centre’) in the Department of Health to sort out these long waits for public patients for hospital treatment. At the press briefing after the forum on 25 January, Minister Reilly was talking it up, saying that ‘reform does work, and delivers for patients’ that they were ‘improving quality with decreasing resources’, there was a ’cause for cautious optimism’, that ‘this year is a year of reform’ that will ‘deliver Irish people a service they can feel safe in’.

The first target announced is about trolleys – that no one should wait more than nine hours AND significantly 95% should be seen in six hours. That is from time of arrival in an Emergency Department to either leaving the department or getting in to an actual bed.

Given the €750 million cut in budget and decreased staff numbers is this target hour emergency care target realistic? Well the minister and his SDU team think so. They went to great effort showing chart after chart of improvements in numbers of trolleys, comparing recent weeks to this time last year.

Although trolleys are a very crude measurement, there is a considerable improvement since December – there are 1,800 fewer people on trolleys in 16 work days in January 2012 compared to two years ago and 1,300 compared fewer when compared to last year – so that’s progress. There are still 5,000 + people waiting on trolleys. Obviously each one is too many. But fewer than before.

Can the improvement in numbers be explained by the weather or fewer people presenting or is the system getting better?

The numbers presenting are up not down, and the numbers being admitted to hospital beds is slightly up so there is a real improvement although given high numbers still on trolleys there is room for much more.

Can the six hour target be achieved by December 2012? They think so through better systems in Emergency Departments, by monitoring numbers three times a day, the use of newly opened Medical Assessment Units, the better use of hospital beds, more primary care etc…

But there was a difference with the briefing when compared to a previous SDU off-the-record briefing in October – Minsters Reilly was accompanied by Ministers of state Lynch and Shortall,  while HSE head of clinical programmes Barry White was there giving a more coherent, unified, system wide approach.

The other target announced is that ‘no one should wait more than nine months for elective treatment’, given €750 million coming out of health system, 3,000 fewer staff, is it really possible?

Well again, the minister and his swat team seem confident that by December 2012 no one will wait more than nine months for hospital treatment. The minister already set a target of no one waiting more than a year by December just gone. I put it to him these were very unambitious targets, that previous government set targets of maximum wait time of six and three months. Minister Reilly pointed out that difference is previous government never achieved them, this government more or less achieved the 12 month one within 9 months.

I also put it that it might result in increased numbers waiting between three and nine months which with the publicly available material is what we has happened up to October last year but Martin Connor, the SDU special advisor said it was ‘achievable, although ambitious and a stretch to achieve’.

These targets, although unambitious, if achieved are good news for people. Yet we know the longest waits for people is often the wait to see a specialist in the first place (referral from GP to initial appointment with a hospital consultant, which is know as the outpatient waiting list – but despite the promise there was no target set for this.

There are problems with accurate outpatient waiting numbers and times. The SDU are working on this and committed that by the  end of March we will get information on numbers waiting and how long and then they will set a target. Because this is the real bottle neck in the Irish health system, this target will be most important.

Here’s hoping the minister/SDU’s targets are reached… Reason for ‘cautious optimism’ perhaps?

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