List of broken promises grow
Here is my column from Medical Independent, 23 May 2013
Dr James Reilly ran for election and secured the health ministry by making promises to reduce waiting times for hospital care, deliver free GP care for all within the first term of government and universal health insurance if elected for a second term. These are three very different, but related promises. The Programme for Government “committed to developing a universal, single-tiered health service which guarantees access to medical care based on need, not income”.
They planned to achieve this by driving down the cost of care, providing more care in the community and reforming how we pay for care. Central to Minister Reilly’s plans was ‘fixing’ the long waits for hospital care – in emergency departments (EDs), for out-patient appointments with specialists and planned hospital treatment. He set up the Special Delivery Unit (SDU) – his swat team – to reduce the time citizens wait for care.
In 2013, the SDU spent over €36 million trying to achieve this. Speeding up the time people wait in EDs and for planned elective care is directly related to having beds in hospitals to treat both emergency and elective patients. The Irish health system has had chronic waiting lists and large numbers of patients who should not be in hospital beds for decades now.
Brendan Drumm, HSE chief from 2005 to 2010, made reducing ‘delayed discharges’ (the term given to those unlucky enough to be left in hospital beds unnecessarily who should be at home in the community or in a nursing home bed) one of his top priorities in his long forgotten “transformation” programme.
In March 2011, when Reilly took up the mantle as health minister, there were 636 delayed discharged patients in hospital. This was down from figures in the 700s in 2009 and 800s in 2010. On 18 March 2013, there were 784 delayed discharges in hospital beds.
This increase has the knock on effect of even longer waits in EDs, cancelled surgery resulting in longer wait times for elective treatment and inappropriate care for those stuck in hospital.
Seven hundred of the 784 delayed discharges were over 65-year-olds. More than half were in Dublin teaching hospitals, while 78 were left to languishin appropriately in hospital beds for more than six months.
This high delayed discharge figure, combined with higher numbers in EDs, resulted in the HSE freeing up 400 additional nursing home support scheme (NHSS) beds in March and suspending NHSS admissions from the community for a three-week period in April. The suspension and the extra NHSS beds were direct efforts to make space for people in overcrowded EDs and more desperate attempts to achieve the SDU’s targets.
By 15 April, the 784 figure had been brought down to 687. Meanwhile, after much noise from our political leaders about ED improvements between 2011 and 2012, the first four months of 2013 saw the numbers of people waiting and the length of their waits creep up again. There was a reduction of 2,500 in 2012 compared to 2011 (a 22 per cent reduction year-on-year), but the 2013 figures are the same as 2012 and when extra beds on wards are counted they are above the 2011 peak.
There have been improvements in reducing the longest waiters for elective treatment. Most people are waiting for less time, but a majority are still waiting far too long. Much media hype has been given to people in the West waiting more than four years for an out-patient appointment. Of course no one should wait a year, let alone four years, for an appointment, but at least the HSE is now publishing out-patient waiting times and has set a target to reduce them.
There is no doubt that it is very hard to achieve a reduction in hospital wait times in the context of cutbacks of more than €1.5 billion and 10,000 staff in the public health system.
However, it is proving impossible to do so without transferring care from hospital to the community, without reducing the cost of care and changing the way we pay for care.
Perpetual budget overruns and delays in the introduction of free GP care, fewer home help hours in first two months of 2013 compared to previous years, and continued long waits for hospital care are all evidence of the perfect storm for an overly burdened, contracting, yet costly, health system in crisis and a government that is failing spectacularly to deliver on its promise of a reformed health system.