An election crisis in waiting
My column from the Medical Independent on 19 February 2015
Extensive overcrowding in emergency departments and in our public hospitals continues to dominate the public and political radar in the early weeks and months of 2015. It is evident that there are continued high numbers on trolleys and in delayed discharges.
Despite the extra €25 million allocated to get people who don’t need to be there out of hospital, the establishment of an Emergency Task Force, and commitment from the highest offices by Tony O’Brien and Leo Varadkar to tackle them, these intractable issues are not going away.
However, the latest figures released on waiting times exemplify another related failure in our health system, and another time-bomb in the making.
One of James Reilly’s highest priorities as Minister was to reduce the numbers of trolleys in EDs and to get rid of the longest waiters for hospital treatment. In order to address these wicked problems, Reilly set up a Special Delivery Unit, originally situated in the Department of Health and now subsumed into the Acute Services Division in the HSE.
The Special Delivery Unit had initial success bringing down the numbers on trolleys and some impact on the longest waiters. James Reilly set targets that no-one was to wait more than 12 months for an outpatient appointment and eight months for hospital treatment in 2014.
By beginning to count and publish outpatient wait times and focus on the longest waiters, James Reilly’s ambition has had some success. Three years ago there were more than 114,000 people waiting over one year for that initial outpatient appointment. Two years ago, that was halved to over 56,000 and in November 2014, it was 55,733.
However, there are more people waiting between three and 12 months. Particularly worrying is the significant increase in those waiting three-to-six months (from 68,356 to 82,795) and six-to-12 months (from 66,886 to 82,975). All these figures are comparing November 2012, 2013 and 2014.
In the absence of any extra capacity in the system, it is unlikely that there can be inroads made on these figures. This means that there are in excess of 150,000 waiting over six months for an initial appointment and of these, over 55,000 are waiting for over a year.
Figures for hospital treatment are even worse. The Special Deliver Unit had some impact in 2011 and 2012, bringing down waiting lists overall and in particular targeting the longest waiters. It got rid of everyone waiting over two years and brought the figures for waiting over one year down to under 214 in November 2012. This was no mean achievement, given the time frame in which it was achieved, when health system cutbacks were at their most severe.
However since November 2013, those figures have gone right back up, from 797 waiting over one year in November 2013, to 4,532 in November 2014. Those waiting between six-to-12 months for inpatient and day case have risen from 6,810 in 2013, to 16,216 in 2014, an extraordinary increase by any accounts. And all of the above figures are unacceptable waiting times for tens of thousands of our citizens.
Similar to the high numbers of trolleys or delayed discharges, there are multiple reasons for the increases in wait time for essential but planned hospital treatment. Top of the list is demand for care exceeding supply, and even though hospital activity has increased year-on-year despite fewer staff and less money, there is less elective activity. And the driver of this is the increases in emergency admissions and beds filled with delayed discharges.
In one year alone between November 2013 and 2014, there was a 5 per cent increase in emergency admissions and a 5 per cent decrease in elective care. Emergency admissions now account for 75 per cent of all inpatient care. And the crisis in emergency departments is only making this worse. Given the weeks of delayed and cancelled surgery in the early months of 2015, these figures are only going to go in the wrong direction.
In his new priorities, Minister Varadkar set a target that nobody would wait over 18 months for an outpatient, inpatient or day case appointment by mid-year 2015, and no greater than 15 months by year-end. Given the figures above, these targets are perhaps realistic and not that surprising. That said, they are completely unacceptable and in many instances inhumane, as people are left to suffer without diagnosis or treatment. These apathetic targets may well come back to haunt the Government in the run-up to election 2015/16 as significant numbers of citizens have to wait too long for treatment.