Something is rotten in Hawkins House
See here my column from the Medical Independent from 21 June on the failure to make progress on waiting times in Emergency Departments and elective hospital treatment and the role of James Reilly’s Special Delivery Unit Two years ago this month, the Minister for Health James Reilly announced the appointment of Dr Martin Connor to the Special Delivery Unit (SDU).
There was much pomp and hype at the rushed press conference. Reilly introduced Dr Connor, citing his “considerable international experience and reputation”. At the time Minister Reilly specified how Dr Connor “will concentrate on reducing trolley waits in emergency departments and cutting waiting lists in health services”.
Six months later, it was confirmed that Dr Connor would stay for a three-year period until December 2014. He was, according to responses from the Department of Health at the time, “on a contract for services basis on an all in fixed price of €480,000 (including expenses)”, in other words he was being paid €160,000 per year. He was, when first hired for the SDU, Harkness Fellow in Healthcare Policy and Practice in Stanford University and commuting between Dublin and California. Dr Connor is now leaving the SDU, 15 months earlier than contracted.
A few weeks ago, in this column, figures were cited which showed increased pressure on hospitals, evident in high numbers of patients still in hospital beds unnecessarily (delayed discharges) and those waiting in emergency departments. ED figures dropped in 2012, but for the first four months of 2013, they were back up to pre-SDU 2011 levels. If extra beds on wards are counted, they are higher than 2011, when trolley numbers hit their peak.
Internationally the normal waiting time for planned treatment is three to four months. Minister Reilly, and his team in the SDU, decided to concentrate on the longest waiters, with some effect. In April 2011, there were 2,182 people waiting more than a year for treatment. By December 2012, this had been reduced to 36 and no one was waiting more than two years. Encouraged by this progress, the Minister set a target that no patients should wait more than nine months for treatment.
Recent NTPF figures tell a similar story to the ED situation. There were improvements in 2012, when the SDU spent €36 million in hospitals with the longest waiting patients (also covered in this column previously, alongside the perverse incentives of rewarding poor performing hospitals). The NTPF figures also show an increase numbers waiting overall, and most worryingly for patients, a doubling of patients waiting more than six months for treatment between December 2012 and April 2013 (from 6,039 to 11,348) and an 18-fold increase in numbers waiting more than 12 months (from 36 up to 563).
These most recent figures are really problematic. Even the rarely updated SDU website acknowledges the reversed trends. For EDs it says, “waiting times for admission have been unacceptably high in a number of hospitals, often breaching the current six-hour maximum waiting time target”. Figures for the first three months of 2013 show 63 per cent of ED attendees were discharged or admitted within six hours compared to 67.5 per cent in December 2012. On in-patient waiting times, the SDU says, “the trend has been upwards recently, despite the work of the NTPF”, while for “out-patient waiting times – the time from GP referral to an appointment with a consultant is unacceptably long in many specialties”.
In June 2011, Minister Reilly was asked about the experience in England and Northern Ireland where targets improved dramatically for a short time period and then trends reversed. Dr Connor had done a three-year stint in Northern Ireland’s Department of Health, Social Services and Public Safety. The Minister stated specifically that the underlying reasons causing the long waits were not addressed and they would not make the same mistake here.
At that same event, the Minister talked about the importance of “focused integrated leadership at the top” and “renewed energy and enthusiasm”. Reilly was confident that real improvements in EDs and wait times would be evident in 18 months (two years maximum).
Two years on, there are new chiefs in the HSE and the Department of Health. Dr Martin Connor and Dr Alan Smith, the SDU’s Head of Scheduled Care (charged with bringing down waiting lists) are both leaving the SDU. As of January 2013, the SDU is apparently in the HSE and will soon report to the new National Director of Acute Hospitals, Mr Ian Carter.
The SDU has done some service in gathering good data on waiting times and putting out-patient data in the spotlight. However, it has failed in its main remit, evident in the dire situation in EDs and in the wait times, which are worse now than when Minister Reilly took up his post, with the exception of the longest waiters. Minister Reilly’s SDU is not working and given the exodus of key people, it would seem that something is rotten in Hawkins House.